Stop, pause & reset

I’m not only human out-there, whom is dopamine fulled and goal oriented at work! I love nothing more than being organised (as I am pedant), a philomath, and most importantly, caring and providing the best for my clients.

There are times however, where consistently working at the proximal end can leave one feeling exhausted, and the main premise of this blog: being less present.

Now, I don’t imply being less present metaphorically. More so a paradox: physically being there, but unawares and distracted.

Let me elaborate further.

When the mind becomes a combustion of to-do lists, deadlines and so forth. We know from contemporary neuroscience that the brain can only store and manipulate small bits of information at any given time—sorry ladies, one cannot multitasker to the extent that one thinks he/she can! In fact, when one is multitasking, the brain is releasing the reward based neurotransmitter dopamine. As the brain is misled to believe: that ‘it’ is getting more work done, at an efficient rate… far from the truth I’m afraid.

I want you’ll to reflect, before my next blog on the following Socratic questions.

• Have you ever been on a mobile device whilst a colleague has been in dialogue with you?

• Have you been seated for over an hour without getting up to move?

• Have you reacted strongly to an email or comment, without fully, ‘mindfully’ processing?

The three aforementioned can really have dire consequences on: loosing trust, degradation in health, and ineffective communication.

Sit and ponder. And I’ll provide some simple tips to be more present in the moment in my next blog.

James

Advertisements

Language

Mental health is a big passion of mine. Especially within the well-being of young men. Earlier in June. Men’s Health Week was used to promote all things relating to a man’s well-being. What prompted this meditation was an incident I observed at my local gym. Along with my passion for men’s health. To keep details short: a male in his early twenties was spotting on the bench press another male in his early twenties. The male whom was spotting the other male chose to use rather colorful profanity to motivate the male bench-pressing, especially when fatiguing. So what was the big deal? The use of the profanity along with homophobic suggestions took my attention greatly and was the catalyst for this meditation. It is well documented that young men are wrestling with ideology— whilst being exposed to oppressive behavior, whether this is subliminal or not. Reflecting back on the males comments: the males comments give off a vibe that is overly masculine and oppressive, whilst being demeaning to the subject. Now don’t get me wrong, or call me a bigot— some ruff and tumble play (especially with father-son) has good evidence for social skill development and security attachment according to Dr. Jordan B Peterson. However, if I may use the word ‘toxic masculinity’ then I have a problem with the aforementioned scenario. Research shows that young men from the ages 14-21 need two-three good mentors in their life along with their father. The adolescent brain is highly malleable and plastic, and the environment that the young man is exposed too is going to create an ideology of sorts, for an expectation of what it is to be a man. Young men need a safe space to feel vulnerable, to express masculinity and femininity without being degraded, or stereotyped into a classification. For example: I had no idea of the term: Spornosexual until recently. Which for the record is: a man whom is concerned with his physical appearance. Which within a healthy scope is very acceptable, and beneficial for self-esteem. However, fabricated ideas, expectations and pressures may further increase the risk of a body-dysmorphia; along with risk taking behaviors. Navigating one’s world is hard work! Being authentically true, to acknowledge the array of emotions a human feels— and most importantly: reaching out for help is a form of masculinity in my views (to which I may be wrong). Show some humility when speaking to others. And always seek to grow, learn, feel, critically evaluate, and gravitate to good male role-models.

James

More Proof To Move!

Disclaimer: my following blog is going to be highly persuasive, with a confirming bias.

Now that I have gotten the aforementioned out of the way: it’s time to discuss with you about a protein named Irisin— and it’s newly found role in the brain as an exercise-induced messenger (1). Irisin, or: Fibronectin type III domain-containing protein 5, which is an absolute mouthful! and will not be used for the entirety of this blog! is a myokine—  a type of cytokine (protein) that was first discovered and involved in fat -metabolism (1). Recently, Irisin has been found to be involved in neuroprotection, especially in Alzheimer’s rodent models (2).

So how does Irisin work with exercise?

Irisin is released in the muscle during exercise (muscle contractions). Which initiates a cell-signalling pathway, that is able to facilitate the human cortex by the means of plasticity (in lame terms). Studies in vivo Alzheimer’s rodent models have shown that: exercise was able to prevent the aggregation of the well known protein: Amyloid-beta in Alzheimer phenotypical rodents which is a neurotoxic protein (1). Amyloid-Beta, are plaques that interfere with neuronal signaling— just like plaques in an artery that can cause atherosclerosis. Although big pharma companies have been unable to discover a drug that removes amyloid-beta from the human cortex. There are other well established adjuncts, such as aerobic exercise— that is a well known panacea for the cognitively aging (and young!), whilst also being incredibly important for an array of other health benefits which will not be discussed. Irisin, via exercise-induced signalling: targets the neurotoxic proteins by increasing the strength of the dendritic spine of the neuron/s (neuronal communication) which thus can promote long term potentiation (1) which is the consolidation of short term memory, to long term memory. I think of Irisin like the well-studied nuerotrophin: Brain-Derived-Neurotrophic-Factor (BDNF). BDNF is known in lame terms as fertilizer for the brain. And just as a plant requires a process to grow and develop; so too do nerve cells. Exercise is an acute stress. Acute stressors are excellent from: bone and tissue stress during strength training, a cognitively demanding task, to aerobic exercise. For neurons to survive. They require stress (as one means among many). And stress via aerobic exercise is an excellent means to activate powerful cellular pathways such as Irisin and BDNF. I get super excited knowing that each time I hop (metaphorically speaking) on the cross-trainer; I am activating such a powerful pathway, whilst increasing my longevity— and significantly decreasing the risk of dementia later in life.

From an aerobic exercise prescription. Physical activity guidelines recommend: One-hundred and fifty minutes of moderate intensity aerobic activity over ones week. Or, seventy-minutes of intense physical activity once per week. With consultation with one’s GP and exercise physiologist. One can be guided safely through exercise; that is in concordance with ones current level of cardiovascular fitness. This will ensure appropriate prescription and safety. Now, any exercise at any age is beneficial. However, exercising at a earlier age, and maintaining through ones life has the best evidence for robustness against dementia. And going a little beyond the physical activity guidelines, by introducing- strength training, or some short high-intensity-intervals will contribute as a drug on it’s own accord!

So think of exercise (especially aerobic) like your superannuation: each time you exercise, you are investing in your long-term health. So move! seek expert advice! and give your brain the best health that it deserves.

James

References

1. Chen, X. and Gan, L. (2019). An exercise-induced messenger boosts memory in Alzheimer’s disease. Nature Medicine, 25(1), pp.20-21.

2. Lourenco, M., Frozza, R., de Freitas, G., Zhang, H., Kincheski, G., Ribeiro, F., Gonçalves, R., Clarke, J., Beckman, D., Staniszewski, A., Berman, H., Guerra, L., Forny-Germano, L., Meier, S., Wilcock, D., de Souza, J., Alves-Leon, S., Prado, V., Prado, M., Abisambra, J., Tovar-Moll, F., Mattos, P., Arancio, O., Ferreira, S. and De Felice, F. (2019). Exercise-linked FNDC5/irisin rescues synaptic plasticity and memory defects in Alzheimer’s models. Nature Medicine, 25(1), pp.165-175.

Consensus to Move.

In my previous blog I discussed: incidental physical activity. And all the interrogatives that one needed to know. This blog is going to further discuss physical activity— with leading researchers from around the world recently got together, to develop a consensus on: physical activity and ageing.

Here is some empirical data first:

Higher social-economic country’s are poorly inactive. Due to the high demands commercialism places on individuals. And advances in technology.

Poor access to physical activity. Whether this be: bike path/lanes, parkland’s on-route to work, outdoor equipment and so forth lead to more sedentary behaviors.

Easy access to high-processed foods at the touch of a button have an impact on the current obesity epidemic.

You get the point!

Collectively, the aforementioned increase the risk for anyone of the nine known comorbidities that ‘we’ are currently facing: (hypertension, type II diabetes mellitus, chronic pain just to name a few). It is therefore of the utmost importance— that human population ages and flourishes well. With advances in medicine & technology; ‘we’ are living longer lives there is no doubt about it. However, some are aging with comorbidities which decreases quality of life, whilst burdening ‘are’ medical system. There is also more evidence that: being physically active between the ages of 15-45 decreases the chances of a bony fracture later in life. Or, having a robust plastic cardiorespiratory system— decreases the risk of dementia and cardiovascular disease in later life.

I could go on!

 

The Copenhagen Consensus statement discussed earlier. Has four themes. Which provide evidence for the benefits of physical activity and ageing (1). I will briefly discuss the four—  whilst provide the reference for further reading.

 

Theme 1: Functional Capacity and Health. 

Adults that are physically active over inactive adults: are less dependent, have fewer musculoskeletal  issues, have improved immunity, increased cognitive function and are less likely to have cardiovascular diseases.

Theme 2: Brain Health and Cognitive Function. 

Neurodegeneration (such as Alzheimer’s) can be slowed or delayed in physically active adults; according to longitudinal studies.

Theme 3: Behavior Change, Intention and Habits. 

“Physical activity is an individual behavior that is influenced by interpersonal, environmental and policy factors”. (1)

Theme 4: Sociological Perspectives.

Lifelong physical activity habits and experiences, influence participation in later life. “When physical activity is meaningful to them, older adults are more likely to continue participation”. (1)

 

As you can gauge from the aforementioned. Physical activity is not just going to the gym. Although great! Having access to open environmentally friendly spaces; such as: parks with safe equipment, bike paths that lead into the CBD, scenic views that increase awe and enjoyment, lastly, promotion and investment from the government; are all going to increase adherence to move more, and more frequently.

So even if you are in you’re 20’s or 50’s. Find ways to move more— which resonate with you! Of course, the Exercise Physiology team here at iNform Health  can safely guide you through your movement. Enabling you to feel safe, adept and confident to tackle any bike path, or hike.

 

Best,

James

Reference

Bangsbo J, Blackwell J, Boraxbekk C, et al
Copenhagen Consensus statement 2019: physical activity and ageing
Br J Sports MedPublished Online First: 21 February 2019. doi: 10.1136/bjsports-2018-100451

 

 

Incidental no-more!

Who would have thought: that an anxiety-provoking sprint after the bus could illicit; and even add to your physical activity day?

Some neat new research into: Incidental Physical Activity; has eluded some unsuspecting findings that I will further elaborate. First and foremost, I will provide a definition of what incidental physical activity is (IPA).

 

So what is incidental physical activity?

IPA: is any form of activity of one’s daily living- that is not associated with the purpose of health- nor a sacrifice of one’s time (1). Examples include: walking a short distance to the bus-stop, or, taking flights of stairs at work (notice the suffix is stairs), and riding to and fro work. As mundane as these repetitive tasks may be. There is a great opportunity to utilize more energy- or for any nerds out their: ATP! In a editorial published in the reputable journal: British Journal of Sports Medicine. Stamatakis et al, took two sedentary healthy groups, with the active group asked: to walk three flight of stairs, every four hours of his/her working day- three days per week for two weeks. The control group remained sedentary for the two-weeks of the short study; with the independent variable measuring cardio-respiratory fitness- which we have good evidence is a strong predictor for mortality. Findings from the aforementioned found: that the active group’s cardio-respiratory fitness had a significant statistical improvement, over the control group. Now there are limitations to this study (age cohort, duration of study). However, to mandate IPA as a genuine form of physical activity is great, and I hope to see IPA implemented, along with the physical activity guidelines, which are: 150 minutes of moderate aerobic physical activity a week; along with two resistance sessions per week.

So what is the punch line?

Intensity will also contribute to overall cardio-respiratory fitness. There is continuing evidence that short bursts of high intensity exercise. Lasting 5-10 seconds, is extremely beneficial to the power-house of the cell: Muscle Mitochondria Biosynthesis (1). Climbing a few flight of stairs with a little vigor- will nicely spike the heart rate for a short period. And may even help with an adrenaline release, if one is on their way to an important meeting.

 

So now that I’ve got the gist of IPA. What would this look like in a typical day?

For example: 2 minutes walk up-hill to the bus stop (am), 1 minute walk up the stairs to work (am), Brisk walk to the bus stop- 2 minutes (pm), playing with your children/participating in their physical activity 3 minutes + (pm), carrying the shopping into the house 1+ minute (pm).

As you can see. There are ample times in the day to increase one’s heart rate, utilize strength, and fast-twitch muscle recruitment.

 

Have a good think about what resources you have access to.  Make a conscious effort to utilize your resources. And have a good go! Of course. Always consult with your GP and Exercise Physiologist when increasing your level of physical activity.

 

James

 

References:

  1. Stamatakis, E., Johnson, N., Powell, L., Hamer, M., Rangul, V. and Holtermann, A. (2019). Short and sporadic bouts in the 2018 US physical activity guidelines: is high-intensity incidental physical activity the new HIIT?. British Journal of Sports Medicine, pp.bjsports-2018-100397.

Challenging the Aerobic Exercise Status Quo.

Following on from my previous blog: that same guy anecdotally tells you to ignore aerobic exercise- with the fear of atrophy and post-traumatic-atrophy-syndrome (fake psychopathology).

Is that guy really telling you the truth?

Let’s have a quick look at the evidence…

Aerobic exercise and resistance training have proposed competing adaptations, along with varying intracellular signalling responses. The aforementioned is based on The Chronic Interference Hypothesis.

Let me explain.

Aerobic exercise relies on selective activation of AMPK (‘5 adenosine monophosphate- activated protein kinase)- whilst, resistance exercise relies on: mTORC1 (mechanistic target of rapamycin complex 1) stay with me ladies and gentlemen! Although AMPK acts as a catabolic signal in steady state aerobic exercise; there is good evidence that training aerobically within 80% of ones maximal heart rate activates the switch: Akt (protein kinase B) which binds to AMPK (AMPK-Akt), which thus finally promotes anabolic signalling, due to mechanisms that is taking this blog to far down the nerd hole! All you need to take home from the aforementioned: is that aerobic exercise isn’t necessarily a blunt on muscle hypertrophy; there are ways of creating an anabolic environment- whilst still enjoying your aerobic exercise!

Now that I have covered the nerdy bits; what are the benefits of aerobic exercise as an adjunct with resistance training?

  • Increased insulin signalling
  • Increased basal postabsorptive muscle protein synthesis
  • Increased amino acid delivery
  • Increased blood flow
  • Decreased chronic inflammation (interleukin-6)

The above benefits are purely from a muscle hypertrophy standpoint- without exhausting the cardio respiratory system and the brain!

So how should one go about incorporating aerobic exercise into his/her’s regime?

  • There is some evidence that completing aerobic exercise on alternative days to ones resistance session maybe of benefit.
  • Running before a maximal lifting session may impede on muscle fibre contractile ability, perhaps time in your run nicely!
  • As touched on: working within 80% of your maximal heart rate has more robust evidence over steady state aerobic exercise for muscle hypertrophy.
  • >30 minutes of aerobic exercise is suffice with accordance to the national physical activity guidelines. Whilst, will also elicit some great endogenous effects: (cannabinoids, enkephalins) which will get you up-and-about!

So, reject ‘that guy’ again- with his anecdotes! I will happily provide papers if asked; and of course: whenever participating in physical activity, always consult with your medical professional and friendly exercise physiologist!

James 👨🏼‍⚕️

Three Reasons Why You Should Exercise With An Expert.

    It would be rhetorical to say: that your body is special. And you would only want the best to be guiding you through your health and well-being safely. And yet, one can still be suggestible- picking up dodgy anecdotal tips from ‘that guy’ on the lat-pull-down machine.
    I have personally experienced the benefits, being safely loaded, and moving with confidence with one of my colleagues. Leaving my body and surrendering to an expert has given myself a deeper appreciation of the importance of finding an expert in human movement. I have always been on the other side to what I have been accustomed too- and as bias as it sounds: my colleagues here at iNform health really know how to manage and care for their clients.

Here are three reasons why you should be working with an expert.

1. Your tissues need time to adapt to load. Your tissues, all the way down to the extracellular matrix- are for ever adapting to stressors and making proteins. Prescribing appropriate load- will ensure ones tissues will safely adapt; which will add a host of benefits to ones neuromuscular system: reduced risk of tendonopathies, appropriate motor learning and myonuclei growth (muscle hypertrophy). On the contrary, excessive loading that exceeds the capacity of the neuromuscular system can induce the contra effects to the aforementioned: tendon pathology, disorganised motor learning due to inappropriate load and systemic inflammation (abnormal prostaglandin levels) due to poor tissue healing.

2. Assessing the capacity of the neuromuscular system before undertaking load is paramount- and if neglected, your ‘health professional’ is going in blind. If there is a muscle inhibition due to deconditioned tissues, or a previous pathology that was poorly rehabilitated. Would you feel safe to be loaded- if you were unable to co-contract your gluteus maximums, or have adequate lumbo-pelvic control? And yet, you may still be subjected to axial loading in your first session…! A thorough musculoskeletal assessment can identify any red flags, and give your health professional valuable subjective/objective information to prescribe appropriate exercise correctives- which thus will ensure more complex movements are performed safely.

3. Co-care is so important in addressing the whole individual. Here at iNform, our clients are closely monitored by a wonderful internal/external team of allied health professionals; ranging from: GP’s, physio’s, osteo’s, chiros, pod’s and psychologist (without exhausting). All working and communicating together for the greater good of your physical and mental health. Co-care leads to better clinical outcomes, a proper working diagnosis, and the right form of treatments that benefit you the individual.

So, next time you are wanting to move with confidence. Be interrogative with your research. Find an evidence based approach that doesn’t involve a lecture from ‘that guy’ wearing a weight belt with a skimpy muscle singlet (stereotyping much?).

James

Heart Healthy

Cardiovascular risk factors are well known to increase one’s risk of a stroke, and or vascular dementia. There is a lot one can do to prevent cardiovascular disease (CVD) and stroke- and I am sure you would like to know the evidence based risk factors for the aforementioned?

What are the risk factors for CVD and stroke?

In a recent paper published in the journal JAMA: Williamson et al used modifiable, evidence based risk factors in young adults (18-40 years) whom without any known evidence of  cerebrovascular disease. To investigate using magnetic resonance imaging (MRI), if subjects brains were showing early signs of cerebrovascular disease. Cardiovascular risk factors that were measured ranged from: body mass index <25, cardiovascular fitness, alcohol consumption >8 drinks/week, non-smoker >6 months, blood pressure >130/80 mm Hg, cholesterol and fasting glucose.

What were the findings?

Each of the aforementioned risk factors were assigned a rating of 1, in a 8 point scale (8 separate risk factors). Scoring higher was inferred as having a low risk of cerebrovascular disease. Subjects that had more clinical risk factors (< 2 points), did show some early signs of cerebrovascular disease on MRI (1). Researchers found white matter hyperintensities, which are lesions contributing to demyelination of important neural fiber tracts in the central nervous system in subjects with <2 points. What does this mean? less connectivity = slower brain processes (executive functioning, working memory et cetera). For 18-40 year olds showing clinical signs this early- intervening with evidence based modalities would benefit the individual greatly.

So, how do I reduce the risk of developing cerebrovascular disease? 

First of all- DON’T PANIC! although published in a reputable journal, the paper was a preliminary study, with further longitudinal studies required with a larger sample that is ethnically diverse. HOWEVER, all of the mentioned cardiovascular risk factors can be modifiable, simply with following:

Aerobic exercise: following the physical activity guidelines with 150 minutes of moderate aerobic activity per week. If you are sedentary >8 hours per day: aim for 75 minuets of accumulated physical activity per day.

High intensity interval training: 1-2 sessions per week, following a evidence based protocol, with guidance from your exercise physiologist and GP. Three 7-10 second sprints with a balanced work to rest ratio is suffice according to the literature.

Strength Training: 2-3 strength training sessions a week with accordance of the Exercise Sport Science Australia guidelines, with guidance from a accredited professional.

Sleep: although I am not a sleep physiologist, there is ample evidence relating poor sleep <6 hours/per night with CVD and insulin resistance. Sleeping 7-8 hours per night with optimal sleep hygiene is recommended by experts.

Nutrition: again, without being a nutritional expert: following evidence based guidelines (CSIRO), will ensure targeted bloods are met! and less plaque build up (atherosclerosis).

So there you go peeps! so many preventative ways you can keep your brain tissue myelinated! and your cardiovascular system- “heart healthy”.

James 👨🏼‍⚕️

Reference.

1. Williamson, W., Lewandowski, A., Forkert, N., Griffanti, L., Okell, T., Betts, J., Boardman, H., Siepmann, T., McKean, D., Huckstep, O., Francis, J., Neubauer, S., Phellan, R., Jenkinson, M., Doherty, A., Dawes, H., Frangou, E., Malamateniou, C., Foster, C. and Leeson, P. (2018). Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults. JAMA, 320(7), p.665.

Doctor Doctor

Surgeons are well known for their fine motor skills. However, standing in theatre for long periods- whilst maintaining finicky postures is hard work, and requires more gross stability from the outer extremities. It is common for a physician to experience musculoskeletal pain with his/her craft. A recent surgeon of mine has received many compliments on his improvements in postural stability whilst consulting and in theatre. Recent compliments have sparked interest in strength training among other surgeons- leading to myself and other colleagues seeing more surgeons in the clinic wanting to improve his/her musculoskeletal pain.

Now, in no way am I a hero here. Managing musculoskeletal pain suits my own finicky personality; nor is a complex algorithm required. Taking a sound clinical history along with a good understanding of contemporary pain science goes a long way! What I want discuss is utilising time under tension (TUT) with surgeons- along with other age cohorts when prescribing strength exercises. Keeping this blog anecdotal. TUT can be described as: time taking to complete a single repetition. With any exercise, one has to withstand forces great enough to complete each lift. Surgeons are required (as mentioned) to maintain gross stability, sometimes hours on end. Movements such as: deadlifts, bent over rows, KB front squats, kneeling fitball roll outs and seated rows in hip flexion. Are all great movements to introduce TUT into ones exercise regime. Using a TUT of: 5-1-2 for a deadlift for example, for a set of 5 repetitions equates to a total set volume of 40 seconds. Now 40 seconds does not seem like much. However, if you include 5 sets, now you have 3.33 minuets for the exercise alone. Add two to three more exercises that were aforementioned- you then have 10 minuets of TUT! Next would be prescribing a safe adequate load that doesn’t mess with his/her loading mechanics. O’Sullivan & colleagues (2014) systematic review on heavy slow resistance training is a neat read and complimentary. Lastly, gradually increasing TUT and load improves gross motor control- which is especially helpful in theatre and in the everyday contexts, while also strengthening neuromotor pathways (which anecdotally) is one of the biggest winners in improving gross motor tone- reducing the “stiffness” that is often subjectively reported. Through brain plasticity: the brain learns how to turn on, and turn off tone.. winning! Turning off tone can be a surgeons omen..

As always: consult with your GP and exercise physiologist/scientist to be cleared to move with safety.

James 👨🏼‍⚕️🧠🏋🏼‍♂️💪🏼

LIVING LARGE

Living large is a term typically used for one living a life that is extravagant. Extravagant can be synonymous to large portion sizes and long periods at the desk or television- you get the idea. Recent epidemiological statistics agree: that Australians are living an extravagant lifestyle that is not worth bragging about. One in two Australians have a current chronic medical condition at even given time. There are eight noteworthy chronic conditions according to public health experts- which are: cancer, cardiovascular disease, mental health conditions, arthritis, back pain and problems, chronic obstructive pulmonary disease, asthma and diabetes. You may have noticed that I have highlighted six out of the eight chronic conditions- as empirically I like to cluster the aforementioned affecting each other at some capacity such as: back pain reducing mobility, which increases sedentary behavior- and thus increasing insulin resistance. Each chronic condition is a blog on it’s own. So, as I always like to spark a few gamma waves that may entice you to deconstruct your own confirmation bias’s- that the highlighted chronic conditions are not just treatable beyond pharmacology, but are preventable and curable by moving more- whether it is a bit more huff-and puffing (aerobic activity), or applying forces against gravity (lifting weights, spending time in the garden). One in four Australians have a chronic condition- with mental illness and coronary artery disease being among the most common. What is most saddening, is that 87% of deaths are accounted for by a chronic condition. Socrates famous dictum: “The unexamined life is not worth living” is provoked by living a life that is deep in thought,  is rational and logic and has a touch of agape (unabiding love). If I replaced ‘unexamined’ with “unhealthy”, one would hopefully agree with me- that “A unhealthy life is not worth living”. Here I come back to the metaphor of living large. Why not commit to your own dictum of living a healthy life, that is provoked by moving well and regularly, following evidence based food guidelines, seeing your GP for regular check ups, embracing your default mode network by finding time to be creative and playful, and lastly- maintain strong social ties, which we know decreases ones risk of cardiovascular diseases and metal illness.

 

James 🙂

Sourced from the ABC: