In this, the third and final installment in this series, Paul discusses his system of prioritizing your approach to rehabilitation and revitalization of body/mind systems.
Movement that Matters
Today, there are many philosophical and mechanical approaches to treating injuries and developing exercise programs for health or performance. Unfortunately for the public, the majority of these approaches still operate on the illusion that the musculoskeletal system is an isolated system that runs all by itself. Since we know for absolute sure that this is far from the truth, prior to assessing a client or patient’s ability to move and perform general motor tasks, practitioners should have:
* Completed an investigation of diet, lifestyle factors, hormonal and visceral health within the framework of the six major classifications of stressors (see Figure 1 in Part 1).
* Looked for reptilian stressors that correlate with the patients symptom profile and behavior patterns (see Figure 2 in Part 1).
* Completed the survival totem pole assessment (Figure 4 in Part 2) to identify potential problems in any of the body’s major control centers, understanding that the hierarchical structure of neurological control allows for the sacrifice of subordinate structures on the totem pole. Included in the survival totem pole assessment is a very comprehensive assessment of length/tension relationships, joint motion, core stabilizer system function assessments and special testing for potential impingement of the CNS.
After gathering key systems information, the next step is to complete the Primal Pattern (PP) assessment. The PP assessment is based on research into human development. A study of the general evolution of species and the evolution of man suggests that we are what we are today because of the selective pressures of Nature. Through extensive clinical observation and empirical research, I have concluded that to survive in the wild (which was our home for greater than 99.9 percent of human evolution), humans would have had to have been proficient at the following movements while unsupported on our own feet:
* Squatting
* Lunging
* Bending
* Pushing
* Pulling
* Twisting (such as throwing)
* Gait:
o Walk
o Jog
o Sprint
It became evident early in my career that athletes, laborers and people in general were commonly injured when forced by their environment to perform movement patterns they couldn’t perform well. I also noted that anyone who couldn’t perform a PP movement with good form was at greater risk of injury because PPs serve as a working foundation from which a plethora of other movements are built (i.e., throwing a ball, which is a lunge coupled with a twist and a push).
A typical example is the laborer who hurts his back while squatting down to pick up a heavy object (heavy being relative to the individual's level of conditioning). Upon consulting a physician or typical rehabilitation professional, he is told he shouldn’t squat because it is dangerous for the back, and he is told he should hereafter avoid squatting! This scenario presents a common problem in that squatting is a Primal Pattern. As an PP, it is almost impossible to escape the environmental demand to execute the movement. You squat to sit in a chair, get into a car, get on and off the toilet (which used to be on the ground), dress small children, pick up a five gallon bottle of water for the dispenser... we squat all the time!
With extensive knowledge of how to perform PP assessments and how to modify the assessment techniques to better suit each person’s specific work, sport or recreational environment, you will then gather relevant data. After completing the PP assessment, the next task is prioritizing the combined findings of the entire evaluation process.
Determine Your Physiological Load and Prioritize
Having completed a very thorough assessment of your client’s physical-emotional-mental and spiritual stressors in the format described previously, we will have gathered a significant amount of relevant data. While this information is critical for developing a coaching and treatment strategy, there is commonly much that needs to be corrected, and the client can become overwhelmed. It is also my experience that less experienced health care professionals can also become overwhelmed by the volume and diversity of challenges presented by most clients! It is for this reason that I developed the Physiological Load Assessment (PLA) form (see Figure 5 below). The PLA allows the practitioner the opportunity to empower a client/patient by letting him see what are usually obvious changes that need to be made to achieve function and vitality.
Figure 5
The process begins by listing all key stressors in their relevant columns. For example, any musculoskeletal complaints would be listed above the “Physical – Musculoskeletal” column, while any relevant visceral findings or hormonal findings would go above their columns respectively.
You then need to explain to the client that the body shares it’s stressors to protect it's self from accumulating too much energy in any given system or tissue, the result of which would be dis-ease! With this understanding, we can look at the number of stress inputs above each of the columns (represented by one of the sinks that are plumbed together) and collectively agree as to which system is potentially the greatest source of stress or aberrant energy.
After the client understands that body systems all share their stress, creating a total stress picture (see Figure 1 in Part 1 to appreciate how the body totals stressors), and they understand which system is under the greatest load, the practitioner must decide which self help options will most effectively alleviate the stressors loading the body systems. As the practitioner decides what self help methods will be most advantageous for the client’s specific needs, they are listed below each of the systems (sinks named after systems). Through this process, the patient usually begins to see a pattern emerge. For example, diet is commonly listed under each system sink as an important means of alleviating stress. Common options to alleviate stress include:
* Diet
* Circadian rhythm management
* Hydration
* Stretching
* Self help courses for improved mental/emotional/spiritual understanding
* Exercise programs or exercise program modifications
* Specific therapies or specialists such as:
o Detoxification procedures
o Hormonal testing and balancing (Biohealth Diagnostics!)
o Tai Chi, Chi Gong or Yoga lessons
o Feldenkrais or Alexander lessons
o Body work options such as sports massage, Rolfing or trigger point therapy
o Breathing lessons from an expert (I often use voice coaches)
o Psychologist
o Marriage or relationship counseling
o Financial planning
o Seeking council to overcome addiction
Don't Treat the Disease, Treat the Person!
While the current medical model is heavily slanted toward what I call "this for that" treatment, or the “Band-Aid Effect,” I think the current statistics on disease show that the model is failing drastically! As I often tell my patients, we evolved in the wild without drugs and doctors and we did so without near the prevalence of disease. Therefore, the greatest healer of all must be within us! The goal is always to coach the person with the disease, not treat the disease that has the person. Simply stated, disease is a symptom. It is not a cause.
When the clinician or therapist identifies which of the foundation principles are not being lived by, a structured plan should be built and agreed upon by the client to bring him into a resource state, balance or harmony. Foundation treatment principles include:
* Good diet
o Eating correctly for your metabolic type
o Eat organic foods
o Rotate foods on a four day cycle for food variety and decreased immune stress
* Adequate daily water intake
* Adequate exercise
o Work hard and rest hard!
o Working-out vs. working in
* Adequate rest and living in accordance with a natural sleep/wake cycle
* Live with a purpose! Have goals to improve:
o Physical health
o Emotional health
o Mental health
o Spiritual health
In conclusion, this system of assessment uses a holistic approach. This approach can help your clients achieve the ease and the life they’ve always wanted! All practitioners should carefully assess a client’s overall physiological load and identify any red flags that may require specific medical attention or tests. Implementing a personalized treatment plan to address stress, diet, exercise and related lifestyle factors flows out of the comprehensive assessment. Further, each client should be respected as a unique human being with unique challenges. There are no cookie-cutter approaches where you can try to fit the client into a standard mold. We use a careful system of assessment tools and questionnaires based upon interrelated physical, emotional, mental and spiritual systems of the human. This approach maximizes each client’s probability of achieving actual recovery leading to a state of vitality and well being.
It is the dream of all fitness professionals that their clients reach independence, becoming truly functional individuals as soon as possible. Using the principles described in this article series will help you to realize this dream!
References:
1. Connolly, Ceci. March 29, 2002. Pharmaceutical Spending Continues Steady Increase. Washington Post, p. A09.
2. http://www.mercola.com
3. MacLean, Paul. (2002). The Evolutionary Neuroethology of Paul MacLean: Convergences and Frontiers. Ed: Gerald A Cory, Jr., and Russell Gardner, Jr. Praeger, Westport, Connecticut.
4. Pearce, Joseph Chilton. (2002). The Biology of Transcendence: A Blueprint of the Human Spirit. Park Street Press.
5. Paul Check
Forwarded By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Call your Total Whole Health, Fitness, and Nutrition Fitness Elements Express Specialist Today!
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Saturday, November 8, 2008
Friday, November 7, 2008
"How To Incorporate A Holistic Approach to Injury - Part 2"
Part 2 picks up where Part 1 left off, as Paul introduces the survival totem pole and describes how it should be used to during your comprehensive screening assessment of all clients.
Follow the Survival Totem Pole
Once we have determined how stressed the client is and how much stress the ANS and hormonal system is under, we then know which tests must be used to objectify the client’s situation. We make the decisions as to which clinical or lab tests we need to run based on practical screening tests and a review of the reptilian stressors described above. Having gathered this valuable information, we then proceed to physical testing to determine the state of the key body systems that regulate and control the musculoskeletal system. To complete this comprehensive screening assessment, one must follow what I call the survival totem pole (see Figure 4).
Figure 4
I developed the survival totem pole after many years of clinical experience with challenge patients. I found that most challenge patients had multiple ailments and that if my therapeutic protocols did not address the primary stressor, my therapeutic interventions were both short term in effect and palliative. Having spent many years studying human anatomy and human development, I built a system of analysis that identified stressors in the order of importance to survival so that I could prioritize both my therapeutic and coaching efforts. This dramatically improved my clinical results, and the system has allowed me to get results with many challenge patients that were unsuccessful with other approaches. To better understand the survival totem pole, I will briefly explain each symbol and it’s significance. As you review the survival totem pole, keep in mind that each symbol reigns superior to the symbols (systems) below it when viewed from a survival perspective.
Respiration
Oxygen is the most vital nutrient of the human body. If you don’t take it in with each breath, you have about three minutes before your brain begins to die, and in five minutes, you are dead! With that in mind, it is pretty safe to say that breathing is so vital to life that the body will do almost anything to accommodate respiration. Anything altering respiration must become high priority in any treatment protocol seeking long-term resolution!
Mastication
Second only to breathing, which provides oxygen, we must consider mastication. Mastication is a fancy word that embodies the chewing of your food and how your teeth fit together. When we chew our food, the teeth must fit together in a smooth, well coordinated manner, much like the gears in the transmission of your car. If you miss-shift, you grind the gears. If you do that too often, your transmission will fail, and you must get it repaired. Your teeth are no different. If your teeth don’t fit together properly, you develop what is called a hit and slide bite. This means that your teeth mesh incorrectly. and the little guiding facets of your teeth have to usher the teeth into the correct position. When you consider that the average person opens and closes his mouth some 4,000 times a day, it becomes apparent that if the teeth don’t fit together correctly, they will quickly wear out. Imagine miss-shifting in your car 4,000 times a day, and think how quickly that would wear out the steel gears in your transmission!
The masticatory apparatus consists not only of the teeth and jaw but the head, neck, shoulder and arm complex, which are all one working system. This system is technically referred to as the stomatognathic (sto-mat-o-nathic) system. Since the stomatognathic system is co-dependent upon all systems inferior to it on the survival totem pole, you will see the logic behind assessing the overall functionality of each individual client, regardless of where his pain may be!
The Eyes
Quite simply, as a developmental being, if you couldn’t see, you wouldn’t know what was going to try and eat you, and you wouldn’t be able to see what you were going to eat. The result of this is obvious! When the eyes are imbalanced for any reason, the eye muscles can fatigue, and their length/tension relationships are often altered. This results in a visual field dysfunction. Because the body is so dependent upon both focal vision (target recognition) and ambient vision (proprioception), anything that disrupts binocular vision will cause the body to compensate below in attempt to correct eye position. It is not uncommon to see a patient with an eye muscle imbalance or one weak eye stand with his head or body twisted to one side in attempt to correct eye alignment. As you can well imagine, this could cause a lot of musculoskeletal stress, such as back pain! No matter how hard you try to poke, prod, stretch, exercise or mobilize the back, until the eyes are working correctly, you will never alleviate the stress in the back because it is sacrificial to the eyes, which are superior on the survival totem pole.
Auditory – Vestibular
You can well imagine how essential hearing was to our survival in the wild. Our nervous systems are structured such that any loss of hearing automatically results in a compensatory change in the orientation of our posture to bring the good ear closer to any sound. If you work as a bank teller, for example, you will end up talking to and listening to people with your head slightly turned to favor the good ear. It won’t take long before your musculoskeletal system becomes strained and imbalanced due to the task of accommodating faulty hearing. This is yet another example of how the body is structured in a hierarchical manner for the purpose of survival.
The vestibular system works intimately with your eyes and upper cervical spine to maintain your balance. The vestibular system monitors head position relative to the body and serves to activate the extensor muscles to right the body. For example, if you begin to fall to the left when riding a bicycle, your vestibular system will sense you are falling left and reflexively activate the left knee extensors and hip extensors so that you can push against the ground or foot pedal to right yourself. When someone has a vestibular dysfunction, his balance is impaired and his chances of injury are much greater. Therefore, before going out of the way to do a bunch of work on the body to treat an injury, we need to make sure the individual has the ability to maintain his balance.
The Upper Cervical Spine
The top three cervical vertebra are classically referred to as the upper cervical spine. This region of the spine is loaded with specialized proprioceptive nerve endings to inform the body of where the head is relative to the body and where the body is relative to the head. The combination of information coming to the brain from the eyes, vestibular system and upper cervical spine is primarily what is used to keep upright while performing activities of daily living. The atlas, the top cervical vertebra, is the most easily subluxated (malpositioned) vertebra of all spinal vertebra. An important and intimate communication link to the spinal cord via specialized ligaments called denticulate ligaments is created at this level of the spine. Because of this link, if for any reason the atlas is malpositioned, compression, torsion and/or sheer can result in the spinal cord at this level. Since every nerve root in the body passes through the atlas, if there is a problem at this level, literally any body system or body segment can be negatively affected. Clearly, assessing optimal function of the upper cervical spine is a must!
Visceral Systems
Next, we must make sure that the hormonal glands and organs of digestion and elimination are working correctly. Using a comprehensive questionnaire system and hands on assessment techniques I developed through my clinical practice, I can identify any gland or organ that may be causing reflex dysfunction in the musculoskeletal system. We can make this assessment two ways:
1. The questionnaire system looks for key indicators of glandular and organ stress, directing the clinician to look more closely at those systems.
2. Each organ borrows it’s sensory fibers from the sympathetic nervous system, which is intimate with the sensory and motor nerves of the musculoskeletal system at each level of the spinal cord (see Figure 5). Due to this anatomical relationship, when pain fibers are activated in any organ or gland, there is a corresponding response in the skin and muscles innervated by the spinal segments that also have nerve roots feeding the organ in distress.
The Emotions
As you can see by the symbol showing the broken heart, the lightening bolt in the stomach and in the tail end of the colon, our emotions can greatly influence any organ or system in our body. It is my philosophy that energy precedes structure. Stated another way, this means that thoughts create words and words create deeds. Your body is a physical expression of that transfer of energy. I listen to my clients carefully and use careful assessment techniques to determine where there is an emotional imbalance because the emotions are so powerful and influential over the body that this symbol of the survival totem pole is what I refer to as a floating symbol: it has the power to override any other symbol and can be the source of any and all problems in the body and mind.
The body in pain also produces high levels of stress that must be managed, or it may cause permeant damage. Generally, when there is an inflammatory process in the body, there is an abundance of energy. In time, if this inflammatory process is not properly managed, it will shift from being an inflammatory condition to a degenerative condition. For example, a tendonitis may eventually become a tendinosis. The degenerative condition marks the point at which the body runs out of restorative energy.
By tracking which zone of the body (chakra association) each client has musculoskeletal, hormonal or visceral problems, we can use the Eastern system of yoga to correlate emotional issues commonly related to a given body region, gland or organ (see Figure 6.). When the client can be shown the correlation between his emotional status and his physiology, he generally becomes more willing to receive coaching for emotional self management. Failure to address emotional imbalances and the associated energy dysregulation is a common stumbling block to conventional approaches to pain and dysfunction of all types.
The Sacrum
The sacrum is derived from the Latin sacer, meaning sacred or strong bone. This sacred bone is also intimate with the tail end of the nervous system, which attaches at the coccyx. It is important to realize that anything that disrupts the position of the upper cervical vertebra, particularly the top vertebra (C1 or Atlas) and the second vertebra (C2 or Axis) at the top, or the sacrum at the bottom, can cause torque in the spinal cord. The axons of the spinal cord are extremely sensitive to tension and compression, and the brain will do its best to alter your body position to minimize aberrant mechanical tension in the central nervous system. This means that any faulty biomechanics of the upper cervical spine and cranium or of the sacrum can result in shifted and twisted postures. The common result of these compensations is low back pain, pain in one of your legs and concomitant dysfunction of any physiological system being fed by the distorted nerve fibers.
Because the head contains the eyes, ears and vestibular system and the teeth, which must be maintained level with the horizon as their functional working position, the body will sacrifice anything below the head/neck interface to accommodate maintenance of the sensory organs of the cranium. For this reason, I always clear and correct dysfunction in the order of the survival totem pole. Frequently therapists and doctors try to correct the position of the pelvis and sacrum without paying attention to the fact that many systems use the pelvis and sacrum as a buffer system to maintain optimal function of key survival systems.
Slave Joints
The two halves of the pelvis, each called a “hemipelvis”, the spinal joints from C3-L5 and the joints of the upper and lower extremity are called slave joints. This is because they will be sacrificed by the CNS in attempt to maintain optimal head position, as stated above. By assessing and correcting dysfunction in any and all systems above the slave joints on the survival totem pole, I have successfully resolved cases of seemingly intractable musculoskeletal pain.
As you can see after going through the survival totem pole, there is a very logical structure to our body plan. Mother Nature has done an excellent job over time to assure our survival. Now we just need to survive ourselves! As you can well imagine, following this plan to assess the body results in the accumulation of a lot of information.
The next real secret of my success as a therapist and coach lies in my system of prioritizing our approach to rehabilitation and revitalization of body/mind systems. For more on this, stay tuned for Part 3!
References: Paul Check
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Follow the Survival Totem Pole
Once we have determined how stressed the client is and how much stress the ANS and hormonal system is under, we then know which tests must be used to objectify the client’s situation. We make the decisions as to which clinical or lab tests we need to run based on practical screening tests and a review of the reptilian stressors described above. Having gathered this valuable information, we then proceed to physical testing to determine the state of the key body systems that regulate and control the musculoskeletal system. To complete this comprehensive screening assessment, one must follow what I call the survival totem pole (see Figure 4).
Figure 4
I developed the survival totem pole after many years of clinical experience with challenge patients. I found that most challenge patients had multiple ailments and that if my therapeutic protocols did not address the primary stressor, my therapeutic interventions were both short term in effect and palliative. Having spent many years studying human anatomy and human development, I built a system of analysis that identified stressors in the order of importance to survival so that I could prioritize both my therapeutic and coaching efforts. This dramatically improved my clinical results, and the system has allowed me to get results with many challenge patients that were unsuccessful with other approaches. To better understand the survival totem pole, I will briefly explain each symbol and it’s significance. As you review the survival totem pole, keep in mind that each symbol reigns superior to the symbols (systems) below it when viewed from a survival perspective.
Respiration
Oxygen is the most vital nutrient of the human body. If you don’t take it in with each breath, you have about three minutes before your brain begins to die, and in five minutes, you are dead! With that in mind, it is pretty safe to say that breathing is so vital to life that the body will do almost anything to accommodate respiration. Anything altering respiration must become high priority in any treatment protocol seeking long-term resolution!
Mastication
Second only to breathing, which provides oxygen, we must consider mastication. Mastication is a fancy word that embodies the chewing of your food and how your teeth fit together. When we chew our food, the teeth must fit together in a smooth, well coordinated manner, much like the gears in the transmission of your car. If you miss-shift, you grind the gears. If you do that too often, your transmission will fail, and you must get it repaired. Your teeth are no different. If your teeth don’t fit together properly, you develop what is called a hit and slide bite. This means that your teeth mesh incorrectly. and the little guiding facets of your teeth have to usher the teeth into the correct position. When you consider that the average person opens and closes his mouth some 4,000 times a day, it becomes apparent that if the teeth don’t fit together correctly, they will quickly wear out. Imagine miss-shifting in your car 4,000 times a day, and think how quickly that would wear out the steel gears in your transmission!
The masticatory apparatus consists not only of the teeth and jaw but the head, neck, shoulder and arm complex, which are all one working system. This system is technically referred to as the stomatognathic (sto-mat-o-nathic) system. Since the stomatognathic system is co-dependent upon all systems inferior to it on the survival totem pole, you will see the logic behind assessing the overall functionality of each individual client, regardless of where his pain may be!
The Eyes
Quite simply, as a developmental being, if you couldn’t see, you wouldn’t know what was going to try and eat you, and you wouldn’t be able to see what you were going to eat. The result of this is obvious! When the eyes are imbalanced for any reason, the eye muscles can fatigue, and their length/tension relationships are often altered. This results in a visual field dysfunction. Because the body is so dependent upon both focal vision (target recognition) and ambient vision (proprioception), anything that disrupts binocular vision will cause the body to compensate below in attempt to correct eye position. It is not uncommon to see a patient with an eye muscle imbalance or one weak eye stand with his head or body twisted to one side in attempt to correct eye alignment. As you can well imagine, this could cause a lot of musculoskeletal stress, such as back pain! No matter how hard you try to poke, prod, stretch, exercise or mobilize the back, until the eyes are working correctly, you will never alleviate the stress in the back because it is sacrificial to the eyes, which are superior on the survival totem pole.
Auditory – Vestibular
You can well imagine how essential hearing was to our survival in the wild. Our nervous systems are structured such that any loss of hearing automatically results in a compensatory change in the orientation of our posture to bring the good ear closer to any sound. If you work as a bank teller, for example, you will end up talking to and listening to people with your head slightly turned to favor the good ear. It won’t take long before your musculoskeletal system becomes strained and imbalanced due to the task of accommodating faulty hearing. This is yet another example of how the body is structured in a hierarchical manner for the purpose of survival.
The vestibular system works intimately with your eyes and upper cervical spine to maintain your balance. The vestibular system monitors head position relative to the body and serves to activate the extensor muscles to right the body. For example, if you begin to fall to the left when riding a bicycle, your vestibular system will sense you are falling left and reflexively activate the left knee extensors and hip extensors so that you can push against the ground or foot pedal to right yourself. When someone has a vestibular dysfunction, his balance is impaired and his chances of injury are much greater. Therefore, before going out of the way to do a bunch of work on the body to treat an injury, we need to make sure the individual has the ability to maintain his balance.
The Upper Cervical Spine
The top three cervical vertebra are classically referred to as the upper cervical spine. This region of the spine is loaded with specialized proprioceptive nerve endings to inform the body of where the head is relative to the body and where the body is relative to the head. The combination of information coming to the brain from the eyes, vestibular system and upper cervical spine is primarily what is used to keep upright while performing activities of daily living. The atlas, the top cervical vertebra, is the most easily subluxated (malpositioned) vertebra of all spinal vertebra. An important and intimate communication link to the spinal cord via specialized ligaments called denticulate ligaments is created at this level of the spine. Because of this link, if for any reason the atlas is malpositioned, compression, torsion and/or sheer can result in the spinal cord at this level. Since every nerve root in the body passes through the atlas, if there is a problem at this level, literally any body system or body segment can be negatively affected. Clearly, assessing optimal function of the upper cervical spine is a must!
Visceral Systems
Next, we must make sure that the hormonal glands and organs of digestion and elimination are working correctly. Using a comprehensive questionnaire system and hands on assessment techniques I developed through my clinical practice, I can identify any gland or organ that may be causing reflex dysfunction in the musculoskeletal system. We can make this assessment two ways:
1. The questionnaire system looks for key indicators of glandular and organ stress, directing the clinician to look more closely at those systems.
2. Each organ borrows it’s sensory fibers from the sympathetic nervous system, which is intimate with the sensory and motor nerves of the musculoskeletal system at each level of the spinal cord (see Figure 5). Due to this anatomical relationship, when pain fibers are activated in any organ or gland, there is a corresponding response in the skin and muscles innervated by the spinal segments that also have nerve roots feeding the organ in distress.
The Emotions
As you can see by the symbol showing the broken heart, the lightening bolt in the stomach and in the tail end of the colon, our emotions can greatly influence any organ or system in our body. It is my philosophy that energy precedes structure. Stated another way, this means that thoughts create words and words create deeds. Your body is a physical expression of that transfer of energy. I listen to my clients carefully and use careful assessment techniques to determine where there is an emotional imbalance because the emotions are so powerful and influential over the body that this symbol of the survival totem pole is what I refer to as a floating symbol: it has the power to override any other symbol and can be the source of any and all problems in the body and mind.
The body in pain also produces high levels of stress that must be managed, or it may cause permeant damage. Generally, when there is an inflammatory process in the body, there is an abundance of energy. In time, if this inflammatory process is not properly managed, it will shift from being an inflammatory condition to a degenerative condition. For example, a tendonitis may eventually become a tendinosis. The degenerative condition marks the point at which the body runs out of restorative energy.
By tracking which zone of the body (chakra association) each client has musculoskeletal, hormonal or visceral problems, we can use the Eastern system of yoga to correlate emotional issues commonly related to a given body region, gland or organ (see Figure 6.). When the client can be shown the correlation between his emotional status and his physiology, he generally becomes more willing to receive coaching for emotional self management. Failure to address emotional imbalances and the associated energy dysregulation is a common stumbling block to conventional approaches to pain and dysfunction of all types.
The Sacrum
The sacrum is derived from the Latin sacer, meaning sacred or strong bone. This sacred bone is also intimate with the tail end of the nervous system, which attaches at the coccyx. It is important to realize that anything that disrupts the position of the upper cervical vertebra, particularly the top vertebra (C1 or Atlas) and the second vertebra (C2 or Axis) at the top, or the sacrum at the bottom, can cause torque in the spinal cord. The axons of the spinal cord are extremely sensitive to tension and compression, and the brain will do its best to alter your body position to minimize aberrant mechanical tension in the central nervous system. This means that any faulty biomechanics of the upper cervical spine and cranium or of the sacrum can result in shifted and twisted postures. The common result of these compensations is low back pain, pain in one of your legs and concomitant dysfunction of any physiological system being fed by the distorted nerve fibers.
Because the head contains the eyes, ears and vestibular system and the teeth, which must be maintained level with the horizon as their functional working position, the body will sacrifice anything below the head/neck interface to accommodate maintenance of the sensory organs of the cranium. For this reason, I always clear and correct dysfunction in the order of the survival totem pole. Frequently therapists and doctors try to correct the position of the pelvis and sacrum without paying attention to the fact that many systems use the pelvis and sacrum as a buffer system to maintain optimal function of key survival systems.
Slave Joints
The two halves of the pelvis, each called a “hemipelvis”, the spinal joints from C3-L5 and the joints of the upper and lower extremity are called slave joints. This is because they will be sacrificed by the CNS in attempt to maintain optimal head position, as stated above. By assessing and correcting dysfunction in any and all systems above the slave joints on the survival totem pole, I have successfully resolved cases of seemingly intractable musculoskeletal pain.
As you can see after going through the survival totem pole, there is a very logical structure to our body plan. Mother Nature has done an excellent job over time to assure our survival. Now we just need to survive ourselves! As you can well imagine, following this plan to assess the body results in the accumulation of a lot of information.
The next real secret of my success as a therapist and coach lies in my system of prioritizing our approach to rehabilitation and revitalization of body/mind systems. For more on this, stay tuned for Part 3!
References: Paul Check
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Thursday, November 6, 2008
"How To Incorporate A Holistic Approach to Injury - Part 1"
Certainly you must be aware of the unique situation humanity finds itself in today. There are more doctors, scientists, therapists and advanced technology than ever in history, and yet we are more unhealthy, unfit and more sick than ever before!
How can it be that we put men on the moon at will, make laser guided missiles, have the ability to image your insides with incredible reproducibility and perform major surgery through a key hole, and yet last year alone, American pharmacies filled three billion prescriptions? On average, that is one prescription for every man, woman and child in the US every single month.
So what can you do? The key to getting satisfying results when assessing and treating all clients is to utilize a holistic approach. Simple, yet effective assessment methods can be used to evaluate the things that are important indicators of stress on the individual’s systems, not only the physical but also the mental, emotional and energy systems. Once you identify the systems of the body and areas of a client’s life where he needs coaching, you can begin with foundation principles, regardless of an individual’s challenges.
While clients learn how to better manage themselves using foundation principles, they can also be encouraged to work with other experts in any given area necessary to balance their physical, emotional, mental and spiritual bodies. As a result, their energy and their activities improve. Regardless of the challenges, the following system can be used to determine what each client needs to do in order to achieve health and vitality by a series of steps.
Identify the Primary Stressor
The body is a complex living organism. It may be considered a cybernetic organism, or a system of systems. All body systems are inter-linked and inseparable. Not only are our body systems inter-linked and inseparable, and as such, we are inter-linked and inseparable from our external environment: the ecosystem.
Stress is pretty much always thought of as bad. Yet to become and remain vital, we require manageable doses of a variety of stressors (see Figure 1 below). The necessary stressors entering our bodies and lives can be broken down into six major categories:
1. Physical: Correct exercise methods in an optimal dose of volume and intensity for each person aids in keeping the body resilient.
2. Chemical: Our bodies have developed both the need for chemicals and the systems to protect us against harmful chemicals. While there are a myriad of possible examples of good chemical stressors, consider that the small doses of harmful chemicals used by plants to protect themselves are beneficial to our bodies in the correct doses. Parasitic organisms produce harmful chemicals, yet research shows that in absence of stimulus from parasitic organisms and their chemicals, our immune systems wouldn’t develop adequately to protect us in most environments.
3. Electromagnetic: The sun is a very valuable form of electromagnetic (ELM) stress, yet you all know what happens if you get too much! But ELM stress is increased through exposure when using any of the modern electrical conveniences we all enjoy, such as our cell phones, computers and iPods.
4. Psychic: While few enjoy the stress of an argument or being put into psychologically challenging situations, anyone overly protected from such situations would be psychologically underdeveloped, incapable of handling the world. The tipping point becomes unbalanced easily if we are not emotionally intelligent managing our selves and our relationships.
5. Nutrition: Eating unadulterated foodstuffs that are ideal in macronutrient proportion for your racial, ethnic and genetic roots affords an optimal nutritional stressor, the stress here being the work of eating, digesting, assimilating, metabolizing and eliminating the foodstuffs and the nutrients contained therein.
6. Thermal: Our bodies are very sensitive to temperature, like any living organism’s body. By being exposed to variances in temperature, it helps our body become more dynamic, better able to adapt to a variety or seasons and environments. Internal environments where air conditioning coolers are used can magnify the degree of stress we experience daily.
Figure 1
As you can see in Figure 1, the chart shows the physiological or good stressors indicated by green arrows, while red arrows indicate the non-physiological, excessive or bad stressors. If you look at it another way, the green arrows indicate forms of beneficial stress that result in the collection of "chi," or life force energy. The red arrows indicate that a given stress is absorbing or over utilizing chi or life force energy faster than it can be built it up.
When we are predominantly exposed to physiological or beneficial stressors, we maintain homeostasis (i.e., balance). The healthy body will also have a high capacity for allostasis, which is the ability to bounce back to balance after exposure to an excess dose of any given stressor. For example, if you go to the gym and work out, you will be breaking down tissue, creating inflammation, placing heavy demands on the thermo-regulatory system, cardiovascular system, endocrine system, nervous system, etc. The stress of the workout temporarily throws your body out of balance. If your body is healthy, you will bounce back (allostasis) to balance (homeostasis) in short order.
The healthier your body, the faster you can bounce back from any given stressor. Looked at another way, the healthier the body (here meaning your physical-emotional-mental-spiritual being), the greater the stressor or number of stressors it takes to push you out of balance. As you can see in Figure 1, all stressors accumulate (funnel) in the body to create a total stress picture (green-yellow-red continuum). The more stress you accumulate, the more symptomatic you become, and the closer to death due to being out of chi you become. Needless to say, your tolerance for exercise, yet another form of stress, in most cases is reduced in proportion to the level of overall stress you are experiencing at any given time. This is why so many people have bad reactions to exercise, such as feeling worse, perpetual soreness or simply not seeing results.
Understanding Stress Perception
The human brain, a product of billions of years of evolutionary development, is imprinted with functional remnants from key developmental periods. Scientists that study phylogeny (development of species) also study encephalization, which is the study of brain development. Perhaps the most accomplished scientist in the study of encephalization of the human brain is Paul MacLean. MacLean has shown through years of research that the brain can be broken into three distinctly identifiable yet fully integrated brains that have the characteristics of our developmental predecessors. Referring to our brain as the triune brain (three in one), MacLean shows us that what makes up our brain stem and much of our autonomic centers is what the typical reptile has as it's entire brain, called the reptilian brain (see Figure 2).
Figure 2
The reptilian brain, although clearly identifiable by researchers, is not modular. Dr. MacLean makes it clear that the reptilian brain acts like operating software, such as your typical Microsoft Windows 2000. The reptilian brain, like Windows 2000, serves as a platform from which higher brain functions are dependent. The developmental outgrowths of the reptilian brain are the paleo-mammalian (old mammal) and neocortical (new) brain, as seen in Figure 2. More recent research now identifies a fourth component to our brain, which is referred to as the forebrain. It is the creative decision making aspect of the neocortical brain and is often diminished in size and function in those exposed to excessive stress during the developmental periods of childhood and adolescence.
This area of the brain is typically “reactive” to stress. By better understanding our innate developmental survival drives and behaviors, we can better understand what our ancestral software actually determines to be a useful or threatening stressor to the system. Our reptile ancestors have three primary survival drives that dictate their behaviors in any given situation. They are:
1. Safety: Since the reptilian brain developed as an outgrowth of our developmentally older autonomic nervous system (ANS) or vegetative nervous system, it controls our internal organs and hormonal glands. The concern for territory and the protection of self are high priorities, and any perceived threat to the reptile’s safety, results in what is classically called the fight/flight response. Any survival threat immediately results in the production of stress hormones, as mediated by activation of the sympathetic nervous system (SNS), often called the fight or flight nervous system. Any of the six classes of stressors in excess can threaten our safety and evoke a reptilian stress response, or what I call a survival response.
2. Sustenance: Once the reptile is sure it is safe, then and only then does sustenance (eating) come into the picture. By the same token, anything threatening the reptile’s ability to feed itself will activate a fight/flight or stress response. In the human being, our reptilian software also sees any threat to sustenance as a threat to survival. Therefore, under eating, skipping meals or eating foods void of nutrition can activate the SNS, producing a stress response. As shown below in Figure 3, chronic activation of the SNS secondary to what is perceived by our reptilian brain as a threat to our survival comes at a cost to our hormonal and immune systems.
3. Sex/Procreation: The genes of our reptilian ancestors and all our ancestors before them, all the way back to the single celled amebas, wanted to survive! Anything that threatens our ability to have sex or procreate ultimately causes a reptilian stress response, just like a threat to our safety or sustenance. Due to the complexity of our mammalian and neocortical developments, we often behave in accordance with a stress response because our higher brain functions (which are more creative) override our reptilian survival software.
Figure 3
This brief overview of the reptilian brain has been given to show that an excess of any one or combination of the six classes of stressors (Figure 1) can result in a direct or perceived stressor to the reptilian brain. Because the reptilian brain is inclusive of the ANS and because any stressor perceived as a threat to the organism produces elevated SNS tone (activity), there is an associated hormonal response. In a nutshell, any excess stressor (six major categories) entering the body/mind may itself activate the release of stress hormones (glucocorticoids), or it may be perceived as a threat by our reptilian software, which means a threat to our safety, sustenance or sex/procreation.
The Hormonal Sea-Saw
When our SNS tone is repeatedly elevated due to our life situation or our perception of life, our ability to recover from injury or achieve our physical goals with an exercise program are limited (see Figure 3). This is because chronic exposure to stressors of any type, particularly reptilian stressors, elevates glucocorticoid levels. Eventually, this leads to adrenal fatigue and often progressive breakdown of body systems. Which ones malfunction first is influenced by lifestyle factors and genetics.
As you can imagine at this point, there is no sense rubbing, poking and mobilizing tissues and joints if we are just treating the end product of a runaway stress response: a body that can’t heal itself no matter how good the doctor or therapist! As health and wellness professionals, it is important to investigate diet and lifestyle as well as the history of each client’s relevant physical, emotional, mental and spiritual stressors so you can assist each in calming the reptile and balancing the ANS for optimal hormonal function. Growth and repair are not possible otherwise! You will find that these individual’s merely bounce from doctor to doctor and therapist to therapist.
In Part 2 of this series, Chek introduces the Survival Totem Pole, a system of analysis that identifies stressors in the order of importance to survival so that you can prioritize your therapeutic and coaching efforts with clients.
References: Paul Check
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
How can it be that we put men on the moon at will, make laser guided missiles, have the ability to image your insides with incredible reproducibility and perform major surgery through a key hole, and yet last year alone, American pharmacies filled three billion prescriptions? On average, that is one prescription for every man, woman and child in the US every single month.
So what can you do? The key to getting satisfying results when assessing and treating all clients is to utilize a holistic approach. Simple, yet effective assessment methods can be used to evaluate the things that are important indicators of stress on the individual’s systems, not only the physical but also the mental, emotional and energy systems. Once you identify the systems of the body and areas of a client’s life where he needs coaching, you can begin with foundation principles, regardless of an individual’s challenges.
While clients learn how to better manage themselves using foundation principles, they can also be encouraged to work with other experts in any given area necessary to balance their physical, emotional, mental and spiritual bodies. As a result, their energy and their activities improve. Regardless of the challenges, the following system can be used to determine what each client needs to do in order to achieve health and vitality by a series of steps.
Identify the Primary Stressor
The body is a complex living organism. It may be considered a cybernetic organism, or a system of systems. All body systems are inter-linked and inseparable. Not only are our body systems inter-linked and inseparable, and as such, we are inter-linked and inseparable from our external environment: the ecosystem.
Stress is pretty much always thought of as bad. Yet to become and remain vital, we require manageable doses of a variety of stressors (see Figure 1 below). The necessary stressors entering our bodies and lives can be broken down into six major categories:
1. Physical: Correct exercise methods in an optimal dose of volume and intensity for each person aids in keeping the body resilient.
2. Chemical: Our bodies have developed both the need for chemicals and the systems to protect us against harmful chemicals. While there are a myriad of possible examples of good chemical stressors, consider that the small doses of harmful chemicals used by plants to protect themselves are beneficial to our bodies in the correct doses. Parasitic organisms produce harmful chemicals, yet research shows that in absence of stimulus from parasitic organisms and their chemicals, our immune systems wouldn’t develop adequately to protect us in most environments.
3. Electromagnetic: The sun is a very valuable form of electromagnetic (ELM) stress, yet you all know what happens if you get too much! But ELM stress is increased through exposure when using any of the modern electrical conveniences we all enjoy, such as our cell phones, computers and iPods.
4. Psychic: While few enjoy the stress of an argument or being put into psychologically challenging situations, anyone overly protected from such situations would be psychologically underdeveloped, incapable of handling the world. The tipping point becomes unbalanced easily if we are not emotionally intelligent managing our selves and our relationships.
5. Nutrition: Eating unadulterated foodstuffs that are ideal in macronutrient proportion for your racial, ethnic and genetic roots affords an optimal nutritional stressor, the stress here being the work of eating, digesting, assimilating, metabolizing and eliminating the foodstuffs and the nutrients contained therein.
6. Thermal: Our bodies are very sensitive to temperature, like any living organism’s body. By being exposed to variances in temperature, it helps our body become more dynamic, better able to adapt to a variety or seasons and environments. Internal environments where air conditioning coolers are used can magnify the degree of stress we experience daily.
Figure 1
As you can see in Figure 1, the chart shows the physiological or good stressors indicated by green arrows, while red arrows indicate the non-physiological, excessive or bad stressors. If you look at it another way, the green arrows indicate forms of beneficial stress that result in the collection of "chi," or life force energy. The red arrows indicate that a given stress is absorbing or over utilizing chi or life force energy faster than it can be built it up.
When we are predominantly exposed to physiological or beneficial stressors, we maintain homeostasis (i.e., balance). The healthy body will also have a high capacity for allostasis, which is the ability to bounce back to balance after exposure to an excess dose of any given stressor. For example, if you go to the gym and work out, you will be breaking down tissue, creating inflammation, placing heavy demands on the thermo-regulatory system, cardiovascular system, endocrine system, nervous system, etc. The stress of the workout temporarily throws your body out of balance. If your body is healthy, you will bounce back (allostasis) to balance (homeostasis) in short order.
The healthier your body, the faster you can bounce back from any given stressor. Looked at another way, the healthier the body (here meaning your physical-emotional-mental-spiritual being), the greater the stressor or number of stressors it takes to push you out of balance. As you can see in Figure 1, all stressors accumulate (funnel) in the body to create a total stress picture (green-yellow-red continuum). The more stress you accumulate, the more symptomatic you become, and the closer to death due to being out of chi you become. Needless to say, your tolerance for exercise, yet another form of stress, in most cases is reduced in proportion to the level of overall stress you are experiencing at any given time. This is why so many people have bad reactions to exercise, such as feeling worse, perpetual soreness or simply not seeing results.
Understanding Stress Perception
The human brain, a product of billions of years of evolutionary development, is imprinted with functional remnants from key developmental periods. Scientists that study phylogeny (development of species) also study encephalization, which is the study of brain development. Perhaps the most accomplished scientist in the study of encephalization of the human brain is Paul MacLean. MacLean has shown through years of research that the brain can be broken into three distinctly identifiable yet fully integrated brains that have the characteristics of our developmental predecessors. Referring to our brain as the triune brain (three in one), MacLean shows us that what makes up our brain stem and much of our autonomic centers is what the typical reptile has as it's entire brain, called the reptilian brain (see Figure 2).
Figure 2
The reptilian brain, although clearly identifiable by researchers, is not modular. Dr. MacLean makes it clear that the reptilian brain acts like operating software, such as your typical Microsoft Windows 2000. The reptilian brain, like Windows 2000, serves as a platform from which higher brain functions are dependent. The developmental outgrowths of the reptilian brain are the paleo-mammalian (old mammal) and neocortical (new) brain, as seen in Figure 2. More recent research now identifies a fourth component to our brain, which is referred to as the forebrain. It is the creative decision making aspect of the neocortical brain and is often diminished in size and function in those exposed to excessive stress during the developmental periods of childhood and adolescence.
This area of the brain is typically “reactive” to stress. By better understanding our innate developmental survival drives and behaviors, we can better understand what our ancestral software actually determines to be a useful or threatening stressor to the system. Our reptile ancestors have three primary survival drives that dictate their behaviors in any given situation. They are:
1. Safety: Since the reptilian brain developed as an outgrowth of our developmentally older autonomic nervous system (ANS) or vegetative nervous system, it controls our internal organs and hormonal glands. The concern for territory and the protection of self are high priorities, and any perceived threat to the reptile’s safety, results in what is classically called the fight/flight response. Any survival threat immediately results in the production of stress hormones, as mediated by activation of the sympathetic nervous system (SNS), often called the fight or flight nervous system. Any of the six classes of stressors in excess can threaten our safety and evoke a reptilian stress response, or what I call a survival response.
2. Sustenance: Once the reptile is sure it is safe, then and only then does sustenance (eating) come into the picture. By the same token, anything threatening the reptile’s ability to feed itself will activate a fight/flight or stress response. In the human being, our reptilian software also sees any threat to sustenance as a threat to survival. Therefore, under eating, skipping meals or eating foods void of nutrition can activate the SNS, producing a stress response. As shown below in Figure 3, chronic activation of the SNS secondary to what is perceived by our reptilian brain as a threat to our survival comes at a cost to our hormonal and immune systems.
3. Sex/Procreation: The genes of our reptilian ancestors and all our ancestors before them, all the way back to the single celled amebas, wanted to survive! Anything that threatens our ability to have sex or procreate ultimately causes a reptilian stress response, just like a threat to our safety or sustenance. Due to the complexity of our mammalian and neocortical developments, we often behave in accordance with a stress response because our higher brain functions (which are more creative) override our reptilian survival software.
Figure 3
This brief overview of the reptilian brain has been given to show that an excess of any one or combination of the six classes of stressors (Figure 1) can result in a direct or perceived stressor to the reptilian brain. Because the reptilian brain is inclusive of the ANS and because any stressor perceived as a threat to the organism produces elevated SNS tone (activity), there is an associated hormonal response. In a nutshell, any excess stressor (six major categories) entering the body/mind may itself activate the release of stress hormones (glucocorticoids), or it may be perceived as a threat by our reptilian software, which means a threat to our safety, sustenance or sex/procreation.
The Hormonal Sea-Saw
When our SNS tone is repeatedly elevated due to our life situation or our perception of life, our ability to recover from injury or achieve our physical goals with an exercise program are limited (see Figure 3). This is because chronic exposure to stressors of any type, particularly reptilian stressors, elevates glucocorticoid levels. Eventually, this leads to adrenal fatigue and often progressive breakdown of body systems. Which ones malfunction first is influenced by lifestyle factors and genetics.
As you can imagine at this point, there is no sense rubbing, poking and mobilizing tissues and joints if we are just treating the end product of a runaway stress response: a body that can’t heal itself no matter how good the doctor or therapist! As health and wellness professionals, it is important to investigate diet and lifestyle as well as the history of each client’s relevant physical, emotional, mental and spiritual stressors so you can assist each in calming the reptile and balancing the ANS for optimal hormonal function. Growth and repair are not possible otherwise! You will find that these individual’s merely bounce from doctor to doctor and therapist to therapist.
In Part 2 of this series, Chek introduces the Survival Totem Pole, a system of analysis that identifies stressors in the order of importance to survival so that you can prioritize your therapeutic and coaching efforts with clients.
References: Paul Check
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Tuesday, November 4, 2008
"New Updated Physical Activity Guidelines for Older Adults - Part 2"
"New Updated Physical Activity Guidelines for Older Adults - Part 2"
In Part 1 of this series, Tammy explained the recently updated physical activity guidelines for older adults, specifically as they relate to flexibility and stretching. In this article, she continues her review of the guidelines, as they relate to endurance and strength training.
Endurance Guidelines
Maximal oxygen consumption (VO2max), an index of maximal cardiovascular (CV) function, decreases five to 15 percent per decade after the age of 25. Decreases in maximal cardiac output, due to maximal heart rate decreases of six to 10 bpm per decade, contribute to the age-associated reduction in VO2max. But older adults elicit the same 10 to 30 percent increases in VO2max with prolonged endurance exercise training as young adults. As with young adults, the magnitude of the increase in VO2max in older adults is also a function of training intensity, with light intensity training eliciting minimal or no changes.
Some evidence indicates that maintaining high levels of exercise training results in a diminished rate of loss of VO2max with age in older adults. These studies generally report a reduced rate of loss expressed as a percentage of the initial VO2max value, which could be due to the athletes' initially higher VO2max. On the other hand, the rate of VO2max decline for endurance trained athletes over age 70 appears to be similar to that for sedentary adults, probably as a result of their inability to maintain the same training stimulus as when they were younger.
Because CV disease is the major cause of death in older men and women, the effect of endurance exercise training on CV disease risk factors is of vital importance. Cross sectional and intervention studies in older adults consistently indicate that endurance exercise training is associated with lower fasting and glucose-stimulated plasma insulin levels, as well as improved glucose tolerance (if initially impaired) and insulin sensitivity. Improvements in glucose and insulin metabolism are evident in older adults before changes in body weight or body composition occur.
Endurance exercise training appears to lower blood pressure to the same degree in young and older hypertensive adults. One study in older hypertensive adults reported that training at 50 percent VO2max reduced blood pressure the same or more than training at 70 percent VO2max. In a second study in older hypertensive adults, training at 40 to 50 percent VO2max decreased blood pressure, although subsequent training at 50 to 60 percent VO2max reduced blood pressure somewhat further. Thus, it appears that light to moderate intensity training is effective in lowering blood pressure in older hypertensive adults.
The minimal data available generally support the conclusion that older adults improve their plasma lipoprotein lipid profiles with exercise training. However, these changes may be secondary to training-induced reductions in body fat stores. The improvements are generally similar to those evident in young adults and include increases in HDL (the good cholesterol) levels and reductions in triglyceride levels and LDL.
Body composition is also improved with endurance exercise training in a similar fashion in older and young adults. The most consistent change is a one to four percent reduction in the overall percent of body fat with exercise training in older adults, even if body weight is maintained, and one study reported that intra-abdominal fat decreased by 25 percent in older men who lost only 2.5 kg (about 5 pounds) of body weight with exercise training. This finding is especially important for older men because intra-abdominal fat is the body fat depot that increases the most with age and is associated with other CV disease risk factors.
Maximizing both the quality and quantity of life in older adults is best accomplished by adding activities like walking, swimming and cycling into an individual's daily lifestyle.
The initiation of a regular physical activity program can produce numerous changes in the CV system and in certain CV disease risk factors that run counter to the deteriorations that manifest with aging. While the CDC/ACSM guidelines recommend light to moderate intensity lifestyle physical activities to optimize health, moderate or high intensity exercise may be required to elicit adaptations in the CV system and in CV disease risk factors. The only consistent beneficial CV response to light to moderate intensity exercise training in older adults is a reduction in blood pressure in older hypertensive adults. However, the initiation and maintenance of long term light to moderate intensity physical activity programs in older adults may reduce the rate of age-associated deterioration in numerous physiological functions, even if they do not result in absolute increases in these measures that, in the long run, should benefit both quantity and quality of life.
Aerobic exercises do not require excessive speed or strength, but they do place demands on the cardiovascular and respiratory systems. Previously, this was considered the only type of exercise that truly improved health and fitness. We now know that strength training also improves the various systems in the body and has the added benefit of preserving strength so that people can continue to perform ADLs and other activities. Remember that frailer adults might need to improve their strength before they can seriously begin to work on endurance.
The number of healthy older individuals who are active in sports has increased significantly. These individuals continue to perform at a high level, although there appears to be a loss in functional capacity that cannot be overcome by training. No accepted theory of aging exists, but older athletes may be limited primarily by the inability to maintain the same volume and intensity of training. Also, older athletes appear to respond more slowly to the same training load than do younger athletes. The principles of training in older athletes are similar to those in young athletes. However, additional days of recovery and cross training may be necessary to prevent orthopedic injuries. Older adults need to train smarter, not harder. They can't expect to continue with the same intensity of training as when they were younger, and they have to be a little more creative.
To establish and maintain a training intensity that is both safe and capable of producing physiological improvements, the intensity level of the exercise needs to be regularly monitored by rating of perceived exertion (RPE-Borg Scale) and/or by heart rate count. As a personal trainer, you should be familiar with both of these. An intensity level of 40 to 75 percent VO2 max, which translates to roughly a 12-14 on the Borg six-to-20 scale, sustained for 20 to 60 minutes is recommended for older adults.
How much work is done depends on how hard and for how long someone exercises. Older adults with chronic disease should work out at a lower intensity for a longer period of time, rather than at a high intensity for a shorter period of time. A frequency of three to five days per week is the general recommendation with the goal of an overall energy expenditure of 1000 calories per week.
Strength Training Guidelines
Once adults pass the physical prime of their teens and 20s, they annually lose an average of 10 ounces of lean body mass, which is mostly in the form of muscle tissue. Unchecked, this gradual loss of muscle strength is the main reason elderly Americans have difficulty performing the tasks of daily living, which ultimately leads to their loss of independence. This phenomenon, called sarcopenia, is derived from Greek words meaning, “vanishing flesh.” It is NOT an inevitable consequence of aging. Instead, it is an inevitable consequence of disuse.
Another important reason for older people to strength train is evidence suggests that exercise might decrease the rate of bone loss associated with osteoporosis and reduce the likelihood of falls that result in hip fractures. A frightening statistic is that almost 24 percent of people over age 50 who have hip fractures die within a year. Falling is a serious public health concern among elderly people because of its frequency, the morbidity associated with falls and the cost of the necessary healthcare. Unintentional injury, which most often results from a fall, ranks as the sixth leading cause of death among people over 65 years of age. Muscle weakness has been identified as one of the biggest potentially modifiable risk factors for falling. In the late 80s to early 90s, studies began indicating that despite a decrease in the number of muscle fibers and muscle strength, muscle function can be maintained and/or improved with training, even in the very old.
A slight increase in muscle strength at any age can improve quality of life and stave off the frailty that used to be considered a normal part of getting old. While strength training is not the only type of exercise that is important for older adults, it should be obvious that the frailer a person becomes, the greater the importance of strength training. Sometimes, strength training and flexibility are the only types of exercise in which the elderly can engage until they gain enough muscle strength to allow them to work on their endurance and balance. In his book, Specialized Strength Training: Winning Workouts for Specific Populations, Wayne Westcott, PhD, and Susan Ramsden list 13 health and fitness benefits that result from strength training by older adults. They are as follows: avoidance of muscle loss and metabolic rate reduction; increased muscle mass and metabolic rate; reduced body fat and resting blood pressure; increased bone mineral density, glucose metabolism, and gastrointestinal transit; improved blood lipid levels; and reduced low back pain, arthritic pain, and depression.
Two equally important factors facilitate the strength building process. The first is progressive resistance exercise to stress the muscles and stimulate physiological adaptation. The second is sufficient recovery time to permit tissue repair, building and protein overcompensation, leading to larger and stronger muscles. If muscles are not given enough time to rest, clients may develop overuse injuries and/or muscles may break down rather than build up. Westcott recommends that older adults allow 72 to 96 hours for recovery before exercising the same muscle group again. This is considerably different than the 48 hour guideline that is typically quoted as the industry standard.
Dr. Westcott suggests the following guidelines:
Exercises: Strength training guidelines for seniors call for one exercise for each of the main muscle groups.
Frequency: These exercises should be performed two to three times per week. Recent studies have shown two times per week to be at least as productive as three times per week.
Sets: Single and multiple set training protocols have proven effective for increasing muscle strength and mass in senior men and women, but studies comparing one and three sets of exercise have found no significant developmental differences during the first few months of training. It is suggested then that seniors begin strength training with one set of each exercise, moving onto three sets as they progress.
Resistence: The training resistance or weight load should be between 60 and 90 percent of 1RM to increase muscle size and strength.
Repetitions: The generally recommended number of repetitions per set is eight to 15. Most people can perform about eight repetitions with 80 percent of their maximum resistance and about 12 repetitions at 70 percent of their maximum. For those with limiting chronic conditions, it is advisable to begin with lighter weight loads that allow about 15 reps per set. This higher repetition protocol adds a margin of safety while providing about the same strength training stimulus. Research has shown that the number of repetitions is not important as long as muscle fatigue for each exercise set occurs within a 30 to 90 second (anaerobic) time period. When the muscle reaches fatigue within this time period, strength gains are statistically equal when using higher repetitions with lighter weight/resistance (15 reps at 60% 1RM) compared to lower repetitions with heavier weight/resistance (6 reps at 90% 1RM). This is sometimes a difficult concept for someone to accept as true if they are used to lifting heavy, but there are numerous research studies stretching from 1991 to the present that confirm this.
Progression: The key to muscle development is progressive increases in resistance. Whenever the repetition goal can be performed with proper form to muscle fatigue, raise the weight by five percent.
Speed: The general consensus is that older adults should use controlled movement speeds when performing strength exercises. Because six second repetitions have a long, successful history, this speed is recommended for older exercisers. The cadence is two seconds up (concentric phase) and four seconds down (eccentric phase).
Range: It is important for seniors to develop strength throughout their full range of motion. Full range exercise is necessary for building full range muscle strength. So seniors should perform each exercise through the complete range of joint movement, taking their muscles from their fully extended position to their fully contracted position and back. But if any part of the exercise causes pain, then the range of motion needs to be adjusted appropriately. Training range should only be through PAIN FREE range of motion.
Technique: In addition to controlled movement speed and full movement range, exercise technique is critical when training older adults. Always practice proper posture when performing strength exercises with particular emphasis on body stability and back support. To avoid unnecessary blood pressure elevation, older adults should breathe continuously throughout every repetition. They should exhale on the lift and inhale on lowering. They should never hold their breath or hold the weight in a static position since this can raise blood pressure unduly.
American Heart Associations' Views on Strength Training
In a statement issued July 17, 2007 (shortly before the new ACSM/AHA physical activity recommendations), the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity and Metabolism stressed that weight or resistance training is a complement to, not a replacement for, aerobic exercise such as walking, running, cycling or swimming. According to the Council, weight training increases the ability of people to go about their daily lives (i.e., lifting objects, taking care of themselves and their loved ones). It increases muscle mass and helps people keep their weight down. Weight training, when prescribed appropriately, can help patients after a heart attack or heart surgery.
Why it’s important: Exercise is an important part of health. However, doctors worry about the value and even safety of weight training, particularly in people who have had heart attacks or undergone heart surgery. This statement not only buttresses the value of weight training in healthy people but gives credence to the idea that, with certain precautions, weight training can be helpful to people who have had heart surgery or are recovering from a heart attack.
What’s already known: Resistance or strength training, when prescribed and supervised, can increase strength and endurance - both factors that enable people to live better, whether they have heart disease or not. Endurance training is more effective in improving stamina and the ability of the heart to pump oxygenated blood. On the other hand, resistance training, when conducted over months or years, can affect the composition and amount of muscle. Increasing muscle mass through weight training can increase your metabolism and make it easier to maintain or lose weight.
How this study was done: This review represents a consensus among experts who have reviewed published studies on weight training. While no studies were carried out by the authors, they reviewed and evaluated the most current literature and came to a consensus on the recommendations. This updated review is a revision to a review published in 2000.
What was found: Weight or resistance training, in addition to aerobic exercise, benefits people with and without prior heart disease, lowering the risk of heart ailments. Weight training should be used as a complement to aerobic exercise, not a substitute for it.
“Resistance training not only enhances the benefits of aerobic fitness, but it appears to provide the added benefit of increased functional capacity and independence. It helps people better perform tasks of daily living, like lifting sacks of groceries,” said Mark Williams, Ph.D., professor of medicine in the Division of Cardiology at Creighton University School of Medicine in Omaha, Nebraska in a released statement. The benefits of weight training include increased strength, muscle coordination, more muscle mass and higher bone density in both men and women.
The statement recommends training such as performing lifts rhythmically, doing both upper and lower body exercises and learning how to breathe effectively during exercise.
“The emphasis at the early stage of training is to allow time for the muscles to adapt and to practice good technique, thus reducing the potential for excessive muscle soreness and injury,” Williams said.
The statement suggests setting the weight limits low for such training during recovery from a heart attack, procedure or surgery. However, Williams said, “When prescribed appropriately, patients can often do more to train safely and benefit significantly.” He said early in training, repetitions should be limited to eight to 12 for healthy, inactive adults or 10 to 15 repetitions at a low level of resistance (e.g., less than 40 percent of 1 repetition maximum) for older adults more than 50 to 60 years of age, more frail persons or cardiac patients.
The bottom line is, weight training, monitored and designed specifically for you, can increase your fitness and your muscle mass, helping you attain a greater level of fitness and a healthy weight.
References:
1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991,1998.
2. Circulation. 2007; 116: 000-000, published online July 16, 2007
3. Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.
4. Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
5. Tammy Peterson
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
WWW.MyFitnessElements.com
In Part 1 of this series, Tammy explained the recently updated physical activity guidelines for older adults, specifically as they relate to flexibility and stretching. In this article, she continues her review of the guidelines, as they relate to endurance and strength training.
Endurance Guidelines
Maximal oxygen consumption (VO2max), an index of maximal cardiovascular (CV) function, decreases five to 15 percent per decade after the age of 25. Decreases in maximal cardiac output, due to maximal heart rate decreases of six to 10 bpm per decade, contribute to the age-associated reduction in VO2max. But older adults elicit the same 10 to 30 percent increases in VO2max with prolonged endurance exercise training as young adults. As with young adults, the magnitude of the increase in VO2max in older adults is also a function of training intensity, with light intensity training eliciting minimal or no changes.
Some evidence indicates that maintaining high levels of exercise training results in a diminished rate of loss of VO2max with age in older adults. These studies generally report a reduced rate of loss expressed as a percentage of the initial VO2max value, which could be due to the athletes' initially higher VO2max. On the other hand, the rate of VO2max decline for endurance trained athletes over age 70 appears to be similar to that for sedentary adults, probably as a result of their inability to maintain the same training stimulus as when they were younger.
Because CV disease is the major cause of death in older men and women, the effect of endurance exercise training on CV disease risk factors is of vital importance. Cross sectional and intervention studies in older adults consistently indicate that endurance exercise training is associated with lower fasting and glucose-stimulated plasma insulin levels, as well as improved glucose tolerance (if initially impaired) and insulin sensitivity. Improvements in glucose and insulin metabolism are evident in older adults before changes in body weight or body composition occur.
Endurance exercise training appears to lower blood pressure to the same degree in young and older hypertensive adults. One study in older hypertensive adults reported that training at 50 percent VO2max reduced blood pressure the same or more than training at 70 percent VO2max. In a second study in older hypertensive adults, training at 40 to 50 percent VO2max decreased blood pressure, although subsequent training at 50 to 60 percent VO2max reduced blood pressure somewhat further. Thus, it appears that light to moderate intensity training is effective in lowering blood pressure in older hypertensive adults.
The minimal data available generally support the conclusion that older adults improve their plasma lipoprotein lipid profiles with exercise training. However, these changes may be secondary to training-induced reductions in body fat stores. The improvements are generally similar to those evident in young adults and include increases in HDL (the good cholesterol) levels and reductions in triglyceride levels and LDL.
Body composition is also improved with endurance exercise training in a similar fashion in older and young adults. The most consistent change is a one to four percent reduction in the overall percent of body fat with exercise training in older adults, even if body weight is maintained, and one study reported that intra-abdominal fat decreased by 25 percent in older men who lost only 2.5 kg (about 5 pounds) of body weight with exercise training. This finding is especially important for older men because intra-abdominal fat is the body fat depot that increases the most with age and is associated with other CV disease risk factors.
Maximizing both the quality and quantity of life in older adults is best accomplished by adding activities like walking, swimming and cycling into an individual's daily lifestyle.
The initiation of a regular physical activity program can produce numerous changes in the CV system and in certain CV disease risk factors that run counter to the deteriorations that manifest with aging. While the CDC/ACSM guidelines recommend light to moderate intensity lifestyle physical activities to optimize health, moderate or high intensity exercise may be required to elicit adaptations in the CV system and in CV disease risk factors. The only consistent beneficial CV response to light to moderate intensity exercise training in older adults is a reduction in blood pressure in older hypertensive adults. However, the initiation and maintenance of long term light to moderate intensity physical activity programs in older adults may reduce the rate of age-associated deterioration in numerous physiological functions, even if they do not result in absolute increases in these measures that, in the long run, should benefit both quantity and quality of life.
Aerobic exercises do not require excessive speed or strength, but they do place demands on the cardiovascular and respiratory systems. Previously, this was considered the only type of exercise that truly improved health and fitness. We now know that strength training also improves the various systems in the body and has the added benefit of preserving strength so that people can continue to perform ADLs and other activities. Remember that frailer adults might need to improve their strength before they can seriously begin to work on endurance.
The number of healthy older individuals who are active in sports has increased significantly. These individuals continue to perform at a high level, although there appears to be a loss in functional capacity that cannot be overcome by training. No accepted theory of aging exists, but older athletes may be limited primarily by the inability to maintain the same volume and intensity of training. Also, older athletes appear to respond more slowly to the same training load than do younger athletes. The principles of training in older athletes are similar to those in young athletes. However, additional days of recovery and cross training may be necessary to prevent orthopedic injuries. Older adults need to train smarter, not harder. They can't expect to continue with the same intensity of training as when they were younger, and they have to be a little more creative.
To establish and maintain a training intensity that is both safe and capable of producing physiological improvements, the intensity level of the exercise needs to be regularly monitored by rating of perceived exertion (RPE-Borg Scale) and/or by heart rate count. As a personal trainer, you should be familiar with both of these. An intensity level of 40 to 75 percent VO2 max, which translates to roughly a 12-14 on the Borg six-to-20 scale, sustained for 20 to 60 minutes is recommended for older adults.
How much work is done depends on how hard and for how long someone exercises. Older adults with chronic disease should work out at a lower intensity for a longer period of time, rather than at a high intensity for a shorter period of time. A frequency of three to five days per week is the general recommendation with the goal of an overall energy expenditure of 1000 calories per week.
Strength Training Guidelines
Once adults pass the physical prime of their teens and 20s, they annually lose an average of 10 ounces of lean body mass, which is mostly in the form of muscle tissue. Unchecked, this gradual loss of muscle strength is the main reason elderly Americans have difficulty performing the tasks of daily living, which ultimately leads to their loss of independence. This phenomenon, called sarcopenia, is derived from Greek words meaning, “vanishing flesh.” It is NOT an inevitable consequence of aging. Instead, it is an inevitable consequence of disuse.
Another important reason for older people to strength train is evidence suggests that exercise might decrease the rate of bone loss associated with osteoporosis and reduce the likelihood of falls that result in hip fractures. A frightening statistic is that almost 24 percent of people over age 50 who have hip fractures die within a year. Falling is a serious public health concern among elderly people because of its frequency, the morbidity associated with falls and the cost of the necessary healthcare. Unintentional injury, which most often results from a fall, ranks as the sixth leading cause of death among people over 65 years of age. Muscle weakness has been identified as one of the biggest potentially modifiable risk factors for falling. In the late 80s to early 90s, studies began indicating that despite a decrease in the number of muscle fibers and muscle strength, muscle function can be maintained and/or improved with training, even in the very old.
A slight increase in muscle strength at any age can improve quality of life and stave off the frailty that used to be considered a normal part of getting old. While strength training is not the only type of exercise that is important for older adults, it should be obvious that the frailer a person becomes, the greater the importance of strength training. Sometimes, strength training and flexibility are the only types of exercise in which the elderly can engage until they gain enough muscle strength to allow them to work on their endurance and balance. In his book, Specialized Strength Training: Winning Workouts for Specific Populations, Wayne Westcott, PhD, and Susan Ramsden list 13 health and fitness benefits that result from strength training by older adults. They are as follows: avoidance of muscle loss and metabolic rate reduction; increased muscle mass and metabolic rate; reduced body fat and resting blood pressure; increased bone mineral density, glucose metabolism, and gastrointestinal transit; improved blood lipid levels; and reduced low back pain, arthritic pain, and depression.
Two equally important factors facilitate the strength building process. The first is progressive resistance exercise to stress the muscles and stimulate physiological adaptation. The second is sufficient recovery time to permit tissue repair, building and protein overcompensation, leading to larger and stronger muscles. If muscles are not given enough time to rest, clients may develop overuse injuries and/or muscles may break down rather than build up. Westcott recommends that older adults allow 72 to 96 hours for recovery before exercising the same muscle group again. This is considerably different than the 48 hour guideline that is typically quoted as the industry standard.
Dr. Westcott suggests the following guidelines:
Exercises: Strength training guidelines for seniors call for one exercise for each of the main muscle groups.
Frequency: These exercises should be performed two to three times per week. Recent studies have shown two times per week to be at least as productive as three times per week.
Sets: Single and multiple set training protocols have proven effective for increasing muscle strength and mass in senior men and women, but studies comparing one and three sets of exercise have found no significant developmental differences during the first few months of training. It is suggested then that seniors begin strength training with one set of each exercise, moving onto three sets as they progress.
Resistence: The training resistance or weight load should be between 60 and 90 percent of 1RM to increase muscle size and strength.
Repetitions: The generally recommended number of repetitions per set is eight to 15. Most people can perform about eight repetitions with 80 percent of their maximum resistance and about 12 repetitions at 70 percent of their maximum. For those with limiting chronic conditions, it is advisable to begin with lighter weight loads that allow about 15 reps per set. This higher repetition protocol adds a margin of safety while providing about the same strength training stimulus. Research has shown that the number of repetitions is not important as long as muscle fatigue for each exercise set occurs within a 30 to 90 second (anaerobic) time period. When the muscle reaches fatigue within this time period, strength gains are statistically equal when using higher repetitions with lighter weight/resistance (15 reps at 60% 1RM) compared to lower repetitions with heavier weight/resistance (6 reps at 90% 1RM). This is sometimes a difficult concept for someone to accept as true if they are used to lifting heavy, but there are numerous research studies stretching from 1991 to the present that confirm this.
Progression: The key to muscle development is progressive increases in resistance. Whenever the repetition goal can be performed with proper form to muscle fatigue, raise the weight by five percent.
Speed: The general consensus is that older adults should use controlled movement speeds when performing strength exercises. Because six second repetitions have a long, successful history, this speed is recommended for older exercisers. The cadence is two seconds up (concentric phase) and four seconds down (eccentric phase).
Range: It is important for seniors to develop strength throughout their full range of motion. Full range exercise is necessary for building full range muscle strength. So seniors should perform each exercise through the complete range of joint movement, taking their muscles from their fully extended position to their fully contracted position and back. But if any part of the exercise causes pain, then the range of motion needs to be adjusted appropriately. Training range should only be through PAIN FREE range of motion.
Technique: In addition to controlled movement speed and full movement range, exercise technique is critical when training older adults. Always practice proper posture when performing strength exercises with particular emphasis on body stability and back support. To avoid unnecessary blood pressure elevation, older adults should breathe continuously throughout every repetition. They should exhale on the lift and inhale on lowering. They should never hold their breath or hold the weight in a static position since this can raise blood pressure unduly.
American Heart Associations' Views on Strength Training
In a statement issued July 17, 2007 (shortly before the new ACSM/AHA physical activity recommendations), the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity and Metabolism stressed that weight or resistance training is a complement to, not a replacement for, aerobic exercise such as walking, running, cycling or swimming. According to the Council, weight training increases the ability of people to go about their daily lives (i.e., lifting objects, taking care of themselves and their loved ones). It increases muscle mass and helps people keep their weight down. Weight training, when prescribed appropriately, can help patients after a heart attack or heart surgery.
Why it’s important: Exercise is an important part of health. However, doctors worry about the value and even safety of weight training, particularly in people who have had heart attacks or undergone heart surgery. This statement not only buttresses the value of weight training in healthy people but gives credence to the idea that, with certain precautions, weight training can be helpful to people who have had heart surgery or are recovering from a heart attack.
What’s already known: Resistance or strength training, when prescribed and supervised, can increase strength and endurance - both factors that enable people to live better, whether they have heart disease or not. Endurance training is more effective in improving stamina and the ability of the heart to pump oxygenated blood. On the other hand, resistance training, when conducted over months or years, can affect the composition and amount of muscle. Increasing muscle mass through weight training can increase your metabolism and make it easier to maintain or lose weight.
How this study was done: This review represents a consensus among experts who have reviewed published studies on weight training. While no studies were carried out by the authors, they reviewed and evaluated the most current literature and came to a consensus on the recommendations. This updated review is a revision to a review published in 2000.
What was found: Weight or resistance training, in addition to aerobic exercise, benefits people with and without prior heart disease, lowering the risk of heart ailments. Weight training should be used as a complement to aerobic exercise, not a substitute for it.
“Resistance training not only enhances the benefits of aerobic fitness, but it appears to provide the added benefit of increased functional capacity and independence. It helps people better perform tasks of daily living, like lifting sacks of groceries,” said Mark Williams, Ph.D., professor of medicine in the Division of Cardiology at Creighton University School of Medicine in Omaha, Nebraska in a released statement. The benefits of weight training include increased strength, muscle coordination, more muscle mass and higher bone density in both men and women.
The statement recommends training such as performing lifts rhythmically, doing both upper and lower body exercises and learning how to breathe effectively during exercise.
“The emphasis at the early stage of training is to allow time for the muscles to adapt and to practice good technique, thus reducing the potential for excessive muscle soreness and injury,” Williams said.
The statement suggests setting the weight limits low for such training during recovery from a heart attack, procedure or surgery. However, Williams said, “When prescribed appropriately, patients can often do more to train safely and benefit significantly.” He said early in training, repetitions should be limited to eight to 12 for healthy, inactive adults or 10 to 15 repetitions at a low level of resistance (e.g., less than 40 percent of 1 repetition maximum) for older adults more than 50 to 60 years of age, more frail persons or cardiac patients.
The bottom line is, weight training, monitored and designed specifically for you, can increase your fitness and your muscle mass, helping you attain a greater level of fitness and a healthy weight.
References:
1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991,1998.
2. Circulation. 2007; 116: 000-000, published online July 16, 2007
3. Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.
4. Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
5. Tammy Peterson
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
WWW.MyFitnessElements.com
Monday, November 3, 2008
"New Updated Physical Activity Guidelines for Older Adults - Part 1"
On August 1, 2007 the American College of Sports Medicine (ACSM) and American Heart Association (AHA) unveiled updated physical activity recommendations for healthy adults ages 18 to 64 years and companion recommendations for those ages 65 and older. The companion recommendations extend to adults ages 50 to 64 years who have chronic health conditions or functional limitations that impact their fitness, physical activity or ability to move.
These guidelines state that all healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week.
Further, adults will benefit from performing activities that maintain or increase muscular strength and endurance for at least two days each week. It is recommended that eight to 10 exercises using the major muscle groups be performed on two non-consecutive days. To maximize strength development, a resistance (weight) should be used for eight to 12 repetitions of each exercise resulting in willful fatigue.
The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce risk of chronic disease and premature death.
The companion recommendations similar to the updated ACSM/AHA recommendations for adults is specifically applied to adults aged 65 and older and adults aged 50 to 64 with chronic conditions or physical functional limitations (e.g., arthritis) that affect movement ability or physical fitness.
The recommendations are an update and clarification of the 1995 recommendations from the Centers for Disease Control and Prevention (CDC) and ACSM on the types and amounts of physical activity needed by healthy adults to improve and maintain health. The intent is to provide more comprehensive and explicit public health recommendations for adults based upon available evidence of the health benefits of physical activity.
The core recommendations remain fundamentally unchanged, despite more than 10 years passing since they were issued. New science has been evaluated to understand the biological mechanisms by which physical activity provides health benefits and the physical activity profile (type, intensity and amount) that is associated with enhanced health and quality of life. This publication reflects a review of that evidence and considers key issues not fully clarified in the original recommendations.
The updated recommendations for adults are improved in several ways.
1. Moderate intensity physical activity has been clarified. The 1995 document specified “most, preferably all days per week” as the recommended frequency while the new recommendation identifies five days per week as the recommended minimum.
2. Vigorous intensity physical activity has been explicitly incorporated into the recommendations. To acknowledge both the preferences of some adults for vigorous intensity physical activity and the substantial science base related to participation in such activity, this recommendation has been clarified to encourage participation in either moderate and/or vigorous intensity physical activity. Vigorous intensity physical activity was implicit in the 1995 recommendations. It is now explicitly an integral part of the physical activity recommendations.
3. Specified: Moderate and vigorous intensity activities are complementary in producing health benefits, and a variety of activities can be combined to meet the recommendations. This combining of activities is based on the amount (intensity x duration) of activity performed during the week and uses the concept of METs (metabolic equivalents) to assign an intensity value to a specific activity.
4. Specified: Aerobic activity is needed in addition to routine activities of daily life. The updated recommendations now clearly state that the recommended amount of aerobic activity (whether of moderate or vigorous intensity) is in addition to routine, light intensity activities of daily living, such as self care, casual walking or grocery shopping or activity that lasts less than 10 minutes such as walking to the parking lot or taking out the trash. Few activities in contemporary life are conducted routinely at a moderate intensity and last for at least 10 minutes. However, moderate or vigorous intensity activities performed as a part of daily life (e.g., brisk walking to work, gardening with shovel, carpentry) performed in bouts of 10 minutes or more can be counted towards this recommendation. This concept was implied but not effectively communicated in the original recommendations.
5. “More is better.” The new recommendations emphasize the important fact that physical activity above the recommended minimum amount provides even greater health benefits. The point of maximum benefit for most health benefits has not been established but likely varies with genetic endowment, age, sex, health status, body composition and other factors. Exceeding the minimum recommendation further reduces the risk of inactivity related chronic disease. Although the dose-response relation was acknowledged in the 1995 recommendations, this fact is now explicit.
6. Short bouts of exercise are OK. The original recommendations introduced the concept of accumulating short bouts of physical activity toward the 30 minute goal, but there was confusion about how short these episodes could be. For consistency, the minimum length of these short bouts is clarified as being 10 minutes.
7. A muscle strengthening recommendation is now included. Muscle strengthening activities have now been incorporated into the physical activity recommendations. The 1995 recommendations mentioned the importance of muscular strength and endurance but stopped short of making specific declarations in this area. Available evidence now allows the integration of muscle strengthening activities into the core recommendations.
8. Wording has been clarified. Minor wording changes in the recommendations have been made to enhance clarity in communications. For example, the term “aerobic,” or endurance, has been added to clarify the type of physical activity being recommended and to differentiate it from muscle strengthening exercises, which are now part of the core recommendations.
The updates also provide a clearer sketch of what combinations of moderate and vigorous intensity activity can be performed to meet this recommendation. Moderate intensity aerobic activity is described as generally equivalent to a brisk walk or activity that noticeably accelerates the heart rate.
The recommendations also summarize new research that links muscular strength to health benefits such as protection against bone loss and a decreased risk of all-cause mortality.
The updated recommendations emphasize that relatively modest amounts of physical activity will improve health. Physical activity for cardiorespiratory fitness and expanded health gains, such as weight loss, may require more than a minimum 30 minutes of moderate activity most days of the week. In general, there are more agreements than differences when it comes to physical activity recommendations. Differences on “minutes-per-day” recommendations appear because they are intended for different groups and may be gender specific or relevant to overweight or obese individuals.
Guidelines for healthy adults under age 65 include:
* Do moderately intense cardio 30 minutes a day, five days a week... OR
* Do vigorously intense cardio 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, eight to 12 repetitions of each exercise twice a week.
Moderate intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary. The 30 minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.
Guidelines for adults over age 65 (or adults 50-64 with chronic conditions such as arthritis) include:
* Do moderate intense aerobic exercise 30 minutes a day, five days a week... OR
* Do vigorous intense aerobic exercise 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, 10 to 15 repetitions of each exercise twice to three times per week... AND
* If you are at risk of falling, perform balance exercises... AND
* Have a physical activity plan.
Both aerobic and muscle strengthening activity is critical for healthy aging. Moderate intensity aerobic exercise means working hard at about a level six intensity on a scale of 10. You should still be able to carry on a conversation during exercise.
Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.
Key Points to the Guidelines for Older Adults
Although the guidelines for older adults and adults with chronic conditions are similar to those for younger adults, there are a few key differences and points to consider.
􀂇 The general recommendation is that older adults should meet or exceed 30 minutes of moderate physical activity on most days of the week. However, it is also recognized that goals below this threshold may be necessary for older adults who have physical impairments or functional limitations.
􀂇 Functional health is an important benefit of physical activity for older adults. Physical activity contributes to the ease of doing everyday activities, such as gardening, walking or cleaning the house.
􀂇 Strength training is extremely important. Strength training is important for all adults, but especially so for older adults, as it prevents loss of muscle mass and bone and is beneficial for functional health.
􀂇 The minimum recommendations are just that: the minimum needed to maintain health and see fitness benefits. If a person can exceed the minimum, he or she can improve personal fitness, improve management of an existing disease or condition and reduce risk for health conditions and mortality.
􀂇 Flexibility is also important. Each day a person should perform aerobic or strength training activities, taking an extra 10 minutes to stretch the major muscle and tendon groups, with 10-30 seconds for each stretch. Repeat each stretch three to four times.
Flexibility training will promote the ease of performing everyday activities.
Flexibility Guidelines
Collagen production and elasticity of the tissues decrease as we age. This impairs both flexibility and range of motion. Scientific evidence, however, suggests that much of this decline is due to inactivity. Stretching and mobilization exercises can effectively increase range of motion and flexibility in older adults, so they are an important part of any fitness program.
To gain true flexibility, you need to use a combination of stretching and “mobilizing.” You might be more familiar with the terms “limbering” or “range of motion” instead of “mobilizing.” This type of exercise is not the same as stretching, but it is closely related. With mobilizing exercises, the emphasis is on movement in the joints rather than stretching the muscles. Mobility exercises consist of active, gentle and controlled movements performed fluidly and consistently. On the other hand, stretching to improve flexibility involves assuming a position and holding it for 10 to 30 seconds to elongate the muscle.
Mobility exercises help loosen up and lubricate the joints with synovial fluid so that the joint moves freely and smoothly. This type of exercise is important for everyone, but even more so for older people, especially those with arthritis. Arthritis reduces a person’s ability to move the joints through a full range of motion. Impaired range of motion translates into a lower functional capacity and lessens a person’s ability to perform the activities of daily living.
A person who begins mobility exercise might hear a variety of grinding, grating and popping noises. These sounds might seem extremely loud to the person exercising, and that person might worry that others can hear them. This is normal, though, and as the joints are limbered, warmed and bathed in synovial fluid, the noises and sensations will go away.
This is actually not a painful condition. The usual stiffness that accompanies arthritis and periods of inactivity should be expected, but there should not be pain associated with the “snap, crackle and pop.”
Mobility exercises in sets of three to five that end in a slight two to three second stretch for each movement are especially beneficial. Two examples include:
1. Arm Raises for Shoulder Range of Motion - To do this exercise, stand with arms hanging at the sides of the body. Raise both arms out to the side and then up towards the ears. As the arms reach parallel with the floor, the palms should be turned towards the ceiling and end up facing each other as they are raised above the head. Arms should be mostly straight, but do not lock the elbows (just keep them slightly bent). Hold arms in the “up position” gently pushing upwards for a couple of seconds. Lower arms and repeat. Remember to use only slow and controlled movements. Think “fluid,” not “jerky.”
2. Standing Hip Extension for Hip Range of Motion - Stand near a wall or other object for balance. While keeping the back straight, bend both knees slightly while keeping them loose and unlocked. Keep one foot in place and pick up the other foot while pressing the leg back behind as far as comfortably possible. Hold for a couple of seconds and repeat. Other examples of mobility or range of motion exercises are elbow curls, side waist bends, wrist circles, finger curls, head turns and tilts, shoulder blade pulls, and ankle circles. If there is a movable joint, move it smoothly and gently through its range of motion to lubricate and warm it.
Stretching
Stretching refers to the process of elongating the muscles. It prevents injuries, keeps muscles relaxed and the body flexible, makes daily activities easier to perform, improves posture and reduces muscle soreness after workouts. When performing stretches, concentrate on muscles that are most frequently used in both normal activities and during training. Don’t leave out any major muscle group.
The basics of stretching include the following:
􀂇 Hold each stretch for 10 to 30 seconds.
􀂇 Rest about 15 seconds before stretching the same muscle again.
ô€‚‡ When the muscle loosens or “releases,” slowly stretch a little further.
􀂇 Stretch only to the point of mild tension, not pain.
ô€‚‡ Stretch slowly and smoothly - don’t bounce.
Inhale through the nose deeply before each stretch and exhale through the mouth while moving into a stretch. Continue breathing while holding the stretch. Make sure your clients do not hold their breath!
It is useful to do mobilization exercises as part of the warm up before strength, endurance or flexibility sessions. You could spend a couple of minutes on range of motion exercises to loosen joints about to be used, five minutes on light aerobics like walking in place or stationary biking and then a short time on a standing stretch sequence for the main muscle groups like the calf stretch, hamstring stretch, quadriceps stretch, chest stretch and upper back stretch. The true flexibility work should only take place once the muscles are warm. This could be after the initial warm up or after other exercises.
Stay tuned for Part 2, where we'll cover updated endurance training and strength training guidelines for older adults!
References:
1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991,1998.
2. Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.
3. Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
4. Tammy Peterson
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
These guidelines state that all healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week.
Further, adults will benefit from performing activities that maintain or increase muscular strength and endurance for at least two days each week. It is recommended that eight to 10 exercises using the major muscle groups be performed on two non-consecutive days. To maximize strength development, a resistance (weight) should be used for eight to 12 repetitions of each exercise resulting in willful fatigue.
The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce risk of chronic disease and premature death.
The companion recommendations similar to the updated ACSM/AHA recommendations for adults is specifically applied to adults aged 65 and older and adults aged 50 to 64 with chronic conditions or physical functional limitations (e.g., arthritis) that affect movement ability or physical fitness.
The recommendations are an update and clarification of the 1995 recommendations from the Centers for Disease Control and Prevention (CDC) and ACSM on the types and amounts of physical activity needed by healthy adults to improve and maintain health. The intent is to provide more comprehensive and explicit public health recommendations for adults based upon available evidence of the health benefits of physical activity.
The core recommendations remain fundamentally unchanged, despite more than 10 years passing since they were issued. New science has been evaluated to understand the biological mechanisms by which physical activity provides health benefits and the physical activity profile (type, intensity and amount) that is associated with enhanced health and quality of life. This publication reflects a review of that evidence and considers key issues not fully clarified in the original recommendations.
The updated recommendations for adults are improved in several ways.
1. Moderate intensity physical activity has been clarified. The 1995 document specified “most, preferably all days per week” as the recommended frequency while the new recommendation identifies five days per week as the recommended minimum.
2. Vigorous intensity physical activity has been explicitly incorporated into the recommendations. To acknowledge both the preferences of some adults for vigorous intensity physical activity and the substantial science base related to participation in such activity, this recommendation has been clarified to encourage participation in either moderate and/or vigorous intensity physical activity. Vigorous intensity physical activity was implicit in the 1995 recommendations. It is now explicitly an integral part of the physical activity recommendations.
3. Specified: Moderate and vigorous intensity activities are complementary in producing health benefits, and a variety of activities can be combined to meet the recommendations. This combining of activities is based on the amount (intensity x duration) of activity performed during the week and uses the concept of METs (metabolic equivalents) to assign an intensity value to a specific activity.
4. Specified: Aerobic activity is needed in addition to routine activities of daily life. The updated recommendations now clearly state that the recommended amount of aerobic activity (whether of moderate or vigorous intensity) is in addition to routine, light intensity activities of daily living, such as self care, casual walking or grocery shopping or activity that lasts less than 10 minutes such as walking to the parking lot or taking out the trash. Few activities in contemporary life are conducted routinely at a moderate intensity and last for at least 10 minutes. However, moderate or vigorous intensity activities performed as a part of daily life (e.g., brisk walking to work, gardening with shovel, carpentry) performed in bouts of 10 minutes or more can be counted towards this recommendation. This concept was implied but not effectively communicated in the original recommendations.
5. “More is better.” The new recommendations emphasize the important fact that physical activity above the recommended minimum amount provides even greater health benefits. The point of maximum benefit for most health benefits has not been established but likely varies with genetic endowment, age, sex, health status, body composition and other factors. Exceeding the minimum recommendation further reduces the risk of inactivity related chronic disease. Although the dose-response relation was acknowledged in the 1995 recommendations, this fact is now explicit.
6. Short bouts of exercise are OK. The original recommendations introduced the concept of accumulating short bouts of physical activity toward the 30 minute goal, but there was confusion about how short these episodes could be. For consistency, the minimum length of these short bouts is clarified as being 10 minutes.
7. A muscle strengthening recommendation is now included. Muscle strengthening activities have now been incorporated into the physical activity recommendations. The 1995 recommendations mentioned the importance of muscular strength and endurance but stopped short of making specific declarations in this area. Available evidence now allows the integration of muscle strengthening activities into the core recommendations.
8. Wording has been clarified. Minor wording changes in the recommendations have been made to enhance clarity in communications. For example, the term “aerobic,” or endurance, has been added to clarify the type of physical activity being recommended and to differentiate it from muscle strengthening exercises, which are now part of the core recommendations.
The updates also provide a clearer sketch of what combinations of moderate and vigorous intensity activity can be performed to meet this recommendation. Moderate intensity aerobic activity is described as generally equivalent to a brisk walk or activity that noticeably accelerates the heart rate.
The recommendations also summarize new research that links muscular strength to health benefits such as protection against bone loss and a decreased risk of all-cause mortality.
The updated recommendations emphasize that relatively modest amounts of physical activity will improve health. Physical activity for cardiorespiratory fitness and expanded health gains, such as weight loss, may require more than a minimum 30 minutes of moderate activity most days of the week. In general, there are more agreements than differences when it comes to physical activity recommendations. Differences on “minutes-per-day” recommendations appear because they are intended for different groups and may be gender specific or relevant to overweight or obese individuals.
Guidelines for healthy adults under age 65 include:
* Do moderately intense cardio 30 minutes a day, five days a week... OR
* Do vigorously intense cardio 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, eight to 12 repetitions of each exercise twice a week.
Moderate intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary. The 30 minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.
Guidelines for adults over age 65 (or adults 50-64 with chronic conditions such as arthritis) include:
* Do moderate intense aerobic exercise 30 minutes a day, five days a week... OR
* Do vigorous intense aerobic exercise 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, 10 to 15 repetitions of each exercise twice to three times per week... AND
* If you are at risk of falling, perform balance exercises... AND
* Have a physical activity plan.
Both aerobic and muscle strengthening activity is critical for healthy aging. Moderate intensity aerobic exercise means working hard at about a level six intensity on a scale of 10. You should still be able to carry on a conversation during exercise.
Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.
Key Points to the Guidelines for Older Adults
Although the guidelines for older adults and adults with chronic conditions are similar to those for younger adults, there are a few key differences and points to consider.
􀂇 The general recommendation is that older adults should meet or exceed 30 minutes of moderate physical activity on most days of the week. However, it is also recognized that goals below this threshold may be necessary for older adults who have physical impairments or functional limitations.
􀂇 Functional health is an important benefit of physical activity for older adults. Physical activity contributes to the ease of doing everyday activities, such as gardening, walking or cleaning the house.
􀂇 Strength training is extremely important. Strength training is important for all adults, but especially so for older adults, as it prevents loss of muscle mass and bone and is beneficial for functional health.
􀂇 The minimum recommendations are just that: the minimum needed to maintain health and see fitness benefits. If a person can exceed the minimum, he or she can improve personal fitness, improve management of an existing disease or condition and reduce risk for health conditions and mortality.
􀂇 Flexibility is also important. Each day a person should perform aerobic or strength training activities, taking an extra 10 minutes to stretch the major muscle and tendon groups, with 10-30 seconds for each stretch. Repeat each stretch three to four times.
Flexibility training will promote the ease of performing everyday activities.
Flexibility Guidelines
Collagen production and elasticity of the tissues decrease as we age. This impairs both flexibility and range of motion. Scientific evidence, however, suggests that much of this decline is due to inactivity. Stretching and mobilization exercises can effectively increase range of motion and flexibility in older adults, so they are an important part of any fitness program.
To gain true flexibility, you need to use a combination of stretching and “mobilizing.” You might be more familiar with the terms “limbering” or “range of motion” instead of “mobilizing.” This type of exercise is not the same as stretching, but it is closely related. With mobilizing exercises, the emphasis is on movement in the joints rather than stretching the muscles. Mobility exercises consist of active, gentle and controlled movements performed fluidly and consistently. On the other hand, stretching to improve flexibility involves assuming a position and holding it for 10 to 30 seconds to elongate the muscle.
Mobility exercises help loosen up and lubricate the joints with synovial fluid so that the joint moves freely and smoothly. This type of exercise is important for everyone, but even more so for older people, especially those with arthritis. Arthritis reduces a person’s ability to move the joints through a full range of motion. Impaired range of motion translates into a lower functional capacity and lessens a person’s ability to perform the activities of daily living.
A person who begins mobility exercise might hear a variety of grinding, grating and popping noises. These sounds might seem extremely loud to the person exercising, and that person might worry that others can hear them. This is normal, though, and as the joints are limbered, warmed and bathed in synovial fluid, the noises and sensations will go away.
This is actually not a painful condition. The usual stiffness that accompanies arthritis and periods of inactivity should be expected, but there should not be pain associated with the “snap, crackle and pop.”
Mobility exercises in sets of three to five that end in a slight two to three second stretch for each movement are especially beneficial. Two examples include:
1. Arm Raises for Shoulder Range of Motion - To do this exercise, stand with arms hanging at the sides of the body. Raise both arms out to the side and then up towards the ears. As the arms reach parallel with the floor, the palms should be turned towards the ceiling and end up facing each other as they are raised above the head. Arms should be mostly straight, but do not lock the elbows (just keep them slightly bent). Hold arms in the “up position” gently pushing upwards for a couple of seconds. Lower arms and repeat. Remember to use only slow and controlled movements. Think “fluid,” not “jerky.”
2. Standing Hip Extension for Hip Range of Motion - Stand near a wall or other object for balance. While keeping the back straight, bend both knees slightly while keeping them loose and unlocked. Keep one foot in place and pick up the other foot while pressing the leg back behind as far as comfortably possible. Hold for a couple of seconds and repeat. Other examples of mobility or range of motion exercises are elbow curls, side waist bends, wrist circles, finger curls, head turns and tilts, shoulder blade pulls, and ankle circles. If there is a movable joint, move it smoothly and gently through its range of motion to lubricate and warm it.
Stretching
Stretching refers to the process of elongating the muscles. It prevents injuries, keeps muscles relaxed and the body flexible, makes daily activities easier to perform, improves posture and reduces muscle soreness after workouts. When performing stretches, concentrate on muscles that are most frequently used in both normal activities and during training. Don’t leave out any major muscle group.
The basics of stretching include the following:
􀂇 Hold each stretch for 10 to 30 seconds.
􀂇 Rest about 15 seconds before stretching the same muscle again.
ô€‚‡ When the muscle loosens or “releases,” slowly stretch a little further.
􀂇 Stretch only to the point of mild tension, not pain.
ô€‚‡ Stretch slowly and smoothly - don’t bounce.
Inhale through the nose deeply before each stretch and exhale through the mouth while moving into a stretch. Continue breathing while holding the stretch. Make sure your clients do not hold their breath!
It is useful to do mobilization exercises as part of the warm up before strength, endurance or flexibility sessions. You could spend a couple of minutes on range of motion exercises to loosen joints about to be used, five minutes on light aerobics like walking in place or stationary biking and then a short time on a standing stretch sequence for the main muscle groups like the calf stretch, hamstring stretch, quadriceps stretch, chest stretch and upper back stretch. The true flexibility work should only take place once the muscles are warm. This could be after the initial warm up or after other exercises.
Stay tuned for Part 2, where we'll cover updated endurance training and strength training guidelines for older adults!
References:
1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991,1998.
2. Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.
3. Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
4. Tammy Peterson
By, Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Recipe Of The Week/ Natalie Pyles/ 11/01/08
Walnut Crusted Salmon
INGREDIENTS:
• 4 4-oz filets of salmon
• 1/4 cup walnuts, chopped and crushed with a pinch of cinnamon
• Drizzle of olive oil
• 8 cups salad greens
INSTRUCTIONS:
1. Coat salmon filets with walnut-cinnamon mixture.
2. In a nonstick pan with a drizzle of olive oil, sear the fish on both sides to desired temperature, or when fish begins to flake.
3. On four plates divide salad greens and serve salmon on top.
Nutrients per serving (1 fillet and 2 cups greens):
Calories: 228, Total Fat: 13 g, Sat. Fat: 2 g, Mono Fat: 4 g, Trans Fat: 0 g, Poly Fat: 6.5 g, Carbs: 3 g, Dietary Fiber: 1 g, Protein: 24 g, Sugars: 0 g, Sodium: 57 mg, Cholesterol: 62 mg
Enjoy!!
Natalie Pyles
Fitness & Nutrition Expert, Author, Speaker
Saturday, November 1, 2008
"How To Incorporate The Updated Food Pyramid for Older Adults To Fit Their Lifestyle"
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