Plank with Photos

Earlier this week I promised a few photos to go with tougher versions of the plank. So Janet and myself rolled up the garage door, laid down a carpet and took a few pictures.

• The toughened up Plank that I currently like involves elbows forward. The full exercise goes something like this: get up on toes and elbows; get the abs really tight and then walk the elbows forward; hold for 5 to 10 seconds; walk elbows back and then touch down briefly (say for 2 to 5 seconds); then repeat. Aim for 5 reps but pick the number that really gives your abs a testing time.
  
• 
• 
  
• The next variation of the Plank is to raise one arm off the ground. In the picture below Janet has her hips level (horizontal); that is perfect. If you let the hips swivel the exercise gets easier (and you would not want that !). Of course you do one side then the other. This exercise challenges the whole set of core muscles to keep your body stable.
• 
• 
  
• The next version has one leg off the ground. It has the same advantages as the arm raise but by logically working around both arms then both legs you challenge the core from all directions.
• 
  
• 
  
• Is this the end of the challenge you can set yourself ? Of course not. The next step along this road is to take one foot and one arm off the ground for a real core challenge. It's opposite arm and leg by the way and do you tend to sway as your brain has to work out how to stabilize your body.
• 
  
• 

And then what ? Is this the final frontier for core challenges using the Plank exercise ? 

No. There is much more but this is enough for now.

Gareth in Tahiti 2005

I needed to get my photo into my profile and publishing it on my blog is probably the easiest way to do it. This is me in 2005 in Tahiti.Shortly after this picture I had the enormous please and excitment of being in the water with a shoal of Manta Ray's which came up and nuzzled. As far as I could tell they seemed to enjoy the physical contact with a human. I certainly enjoyed the experience.

Running

This is the week-end I should have run a half-marathon with my daughter but it was not to be. I've run half-marathons before but one with my daughter would have been very special. The build up did not go well - knees were the problem and in particular the left one. This is nothing new but this time I did something I'd never done before - I went to see my doctor - just in case she could help. My knees have hurt after hard runs for at least 20 years but this time they hurt bad enough to think a doctor might be able to help.

Did the doctor actually help ? The sequence went something like this: X-ray which showed nothing; then physical therapy on the left knee (physical therapy was interesting, good fun even but after 4 weeks the knee hurt even worse than at the start); back to doctor who prescribed an anti-inflammatory; not much improvement so back to doctor who ordered an MRI; off to see a knee specialist. This was an exciting moment, would he produce a miracle in pain reduction ?

He changed the anti-inflammatory to Diclofenac 75 mg once or twice a day which as drugs go is reasonably safe and side-affect free. Diclofenac has been in use for 30 years but the mechanism which makes it effective is still not fully know !

One has to check for contra-indications and problems and the list is as usual long and scary:

http://www.drugs.com/diclofenac.html

Currently I'm still drinking beer despite the advice against alcohol and thus far without problems.

The Knee Specialist did help me get my head straight. In essence I said "How much do you want to Run ?" "How much pain can you take ?" Balance one out against the other. Build up slowly, cross train and do not think about surgery - you do not need it.

I'm back to running - every third day - and in between I use the stationery cycles and rowers in the gym. I am cross training. I take Diclofenac about 30 minutes before running and another one at the end of the day if the knee is very stiff. Of course I ice after running as well.

After 20 years of running pain was the doctor visit useful ? The one important thing I learned was that there is no cartilage left behind either knee cap. I had worried that my continuing to run I was doing damage whereas it turns out all the damage has already been done and I can stop worrying. The disks (menisci) inside the knees are all OK - really good news.

Yesterday I ran 3 miles on the treadmill - fairly slowly - it took more than 30 minutes but definitely a good step forward.

Maybe if I take it slowly I can run a half-marathon with my daughter in 2008.

Plank

The Plank, you know the exercise where you lie flat, face down supported on elbows and toes, has become a staple abs exercise for many people. It's a great exercise, strengthens all of the abs muscles plus low back muscles and legs, chest, shoulders and arms all have to assist keeping your body stable in this extended position. So what's the problem ?

Only that so many people are starting to become really very good at the Plank and can hold the position for a minute and even more. Once an exercise gets out to being a minute long it gets just a tad boring and it's time to toughen up the exercise. So how exactly do you 'toughen up' the Plank ?

My favorite way at the moment to add challenge to the Plank is walk the elbows forward. Try it and see how more demanding it makes the Plank. Is there a 'recipe' for this tougher version of the Plank ?

Here is my recipe for gradually adding pain, oops I mean challenge to the Plank. Try these variations after you can get to a 30 seconds hold in the basic Plank.

• Get into the Plank and then walk your elbows forward about 6 inches and then walk them right back. Feel the difference ! Now repeat enough times to feel you have really been challenged.
• Get in the Plank and walk your elbows forward and hold for 10 seconds. Holding the Plank for 10 seconds with the elbows forward is like 60 seconds in the usual position. More bang for your workout time.
• Now to get some movement into the Plank. It is a great exercise but very static and our bodies react better to exercise involving dynamic movement. Lie flat to the floor, elbows and toes ready to move into a Plank; up into a Plank; walk out elbows as far as you can and still hold the Plank; count 10 seconds; walk your elbows back; touch down; back up and repeat the exercise to a number of reps that is challenging.
• Get up into a Plank; this time push one arm forward (parallel with the ground) so that only one elbow is supporting you at the head end; hold for 10 seconds; repeat on the other side. Do this until you've done it 5 times on each side.
• Now try the one leg off the ground version of the Plank. Get up into a Plank, this time around, lift one leg off the ground; hold for 10 seconds.
• If you are still not pushed to your physical limits, try one more variant of the Plank. Come up into a Plank, push the left arm forward and out of contact with the floor, then raise your right leg off the ground. You are now supported on just the right arm and left leg. Your core muscles have to keep you and stop you twisting around. Hold the position for 10 seconds. Touch down and take a few seconds to recover, then go again but this time using the other diagonal of arms and legs.

I must get some photos of these and other variants and post them on my web site. If you are in a hurry to see these Plank variants in action email me: garethphilips@bodyrestored.com

Combining Cardio and Muscle Strength Training

You might be tempted to think that cardio (aerobic exercise) and muscle strengthening exercises (weights and/or resistance) are totally different beasts. You either do one or the other - right ?

Not necessarily. Muscle strengthening exercise done right can certainly get your heart rate racing and you breathing heavily. The tricks, if these tips are tricks, are just a few in number:

1. Do not push any one set to muscle exaustion. Choose a number of reps which will always (or at least most of the time) leave you with a couple reps in hand at the end of a set.
2. Keep the interval between sets short, 5 to 10 seconds most of the time - enough to change position or pick up a different weight but not any more than that.
3. Every set attacks a different group of muscles for example. This is the opposite of doing repeated sets of exactly the same exercise with lengthy waits between sets for the muscles to recover and are able to work again. 
4. You need a workout plan prepared in advance for this form of training because there's no time during the workout to think about what to do next. The plan in the first place is best in written form but after a few sessions you'll have in in your head - the best place.
5. Always have a Plan B ! In a busy gym there is always the chance that the piece of equipment you want is in use - most likely by someone doing repeated sets of the same exercise with lengthy rest intervals between.

So what might an interval workout which is both cardio and strength training look like? Below is an outline description of such a workout I did with a client this morning, it's a little short on detail because that would make it too long for this post:

• Start with step ups on a Reebok step 5 rungs high. Change legs. About 20 reps on each leg and heart rate should be starting to rise.
• Push ups with feet on Reebok step and hands on the floor. About 8 reps.
• Move to a back row machine and do 12 reps when client could have done 15. The Reebok step was set up close to the back row machine for a fast changeover.
• Use the bench of the back row machine to step up onto (its higher than the Reebok step and thus more demanding). 8 reps. Change legs and another 8 reps.
• Push ups again with feet on Reebok Step - 8 reps.
• Another set of back rows
• Sit on Rebok step and stand up i.e. this is a bench squat with just body weight - 10 reps.
• Lie on floor, possibly with a rubber mat for comfort and hygene, and with hands in the air crunch up - 15 reps.
• Another set of bench squats but this time with 1 less rungs i.e. 4 rungs.
• Another set of crunches - this time with a 10 pound dumbbell in each hand (with hands held vertically above face).
• Another set of bench squats with 1 less rung again i.e. 3 rungs
• Time to move on. By now about 12 to 15 minutes have passed and the sweat is flowing. A good time is being had by all - especially all those watching.
• Shoulder press using a barbell (in this case it was a 20 pound barbell even though the client is capable of shoulder pressing at least a 45 pound dumbbell). The use of a barbell forces the wrists and forearm to work hard.
• Change hands as soon as the pace of pushing the barbell up starts to slow.
• Do another set on each side.
• Sit at the end of a bench with feet up on the bench, with your Personal Trainer holding feet down, crunch with your shoulders going down below the level of the bench for 8 reps.
• Pick up a reasonable size dumbbell off the weight rack and perform a single arm chest press. This is done lying on the bench used for the abs exercise. 8 reps were good.
• Change arms and repeat.
• More abs crunches off end of bench.
• More single arm chest presses. Stick with 8 reps.
• By now about 25 minutes have passed and thus far it has been an intense workout.
• Time to move across onto a treadmill to finish off the workout. Ha ha you think - finishing with cardio ? In this case the way I use the treadmill is not to switch it on !
• The Treadmill exercise is what I call the Hundred Strides. With the Treadmill switched off  place both hands on the handle so that you are leaning forward, push the belt with your feet to start it moving. I count 1 every time the right foot pushes backwards. Ideally you try to run but most people slow to a walk somewhare before 100. Your arms get to work pretty hard as well because you are pushing our weight against your arms.
• Time to cool down and stretch. 
• Switch on the treadmill to an easy pace - maybe 2.5 to 3.0 mph and walk easy for 2 or 3  minutes.
• Stretching time. I do something called PNF stretching with clients. PNF stands for Proprioceptive Neuromuscular Facilitation. Just about everybody loves it. A great way to end a tough workout. 

Muscle Strength Exercise, Supplements and the over 65's

As we get older body fat increases, there's more fat relative to muscle, less muscle, less strength and we are slower. It all adds up to bad news - best not to get old. Earlier this month (October 2007) a really encouraging paper was published " Creatine Monohydrate and Conjugated Linoleic Acid Improve Strength and Body Composition Following Resistance Exercise in Older Adults".

Men and women were involved in the trial with ages ranging between 65 and 85. All were pretty reasonably healthy in that they were independent and did not have any of the major health nasties (heart disease, uncontrolled hypertension, chronic obstructive pulmonary disease, diabetes, kidney failure) and none of them smoked.

This group contrasts with an earlier posting (October 7, 2007) where I referenced the Type 2 Diabetes Exercise Trial in Ottawa, Ontario, where all those participants had Type 2 Diabetes (fairly obviously).

The good news from this research is that muscle strength training increases muscle strength, luckily.

One group in the trial just did the exercise and took no supplements. They did well in both strength gain and tests of functional capabilities. The other group did the muscle strength exercises and took the two supplements and this group did even better than the first group.

As a Personal trainer I'm always reluctant to recommend supplements as most don't work and some have unpleasant side affects. This research gives me some solid information to share with clients.

This trial involved Creatine (supplied as Creatine Monohydrate) and Conjugated Linoleic Acid (CLA), together with regular resistance exercise and in this case, as well as muscle strength gains, there were significant loss of fat and an improvement in body composition - less fat and more muscle. The researchers think that most of the gain was due to the CLA. However using the two supplements together is interesting.

I'm sufficiently impressed with the results of taking Creatine and CLA to start my own personal trial - more at a future date. If you want to start your own trial the researchers provided 5 grams of Creatine Monohydrate and 6 grams of CLA every day.

A couple of things to note:
- The participants only did resistance training, NO cardio. Moreover the participants had not done any muscle strength training in the previous two years and for most of them never. Doing only resistance training is generally not a good idea if you are exercising for health reasons. the good results reported here might be related to a previous lack of muscle strengthening exercises.
- The picture on cholesterol was not so good. On one hand the ratio of good to bad (HDL/LDL) cholesterol did not change over the course of the trial but LDL (bad) cholesterol and total cholesterol increased. One can guess that this was related to lack of cardio and hence easily corrected.

One thing about this trial I especially liked was the use of functional tests - tests of capability related to normal everyday life. They used five tests:
1. Walking as fast as possible about 350 feet.
2. Balancing along a line on the ground for about 30 feet
3. Sit and stand - as many times as possible in 30 seconds
4. Get up from a chair, walk about 30 feet around a post and sit back into chair - as fast as possible
5.Climb two flights of stairs.

You can look up the results of these functional tests at the bottom of page 6 of the research report.

Interval training

After talking about Type 2 Diabetes, turning to Interval Training might look like a stretch to being called a segway. Type 2 Diabetes is addressed and helped by doing both cardio and strength training. The two together have a synergistic affect which far exceeds the impact of doing just one or the other.

With one of my client's, he's fit and strong, I've been trying to blur the edges between cardio and strength training. The Ron Segal research showed the advantages of doing intense cardio and then moving on directly to strength training and again working out hard. For some people spending 75 minutes (or more) in the gym is just too much. It's either too time consuming, too boring or too exausting. The answer might just be Interval Training.

The idea behind Interval training is to target different muscle groups in quick succession so that the heart rate is pushed up high without totally exausting any one muscle group. This form of exercise should have the advantage of insulin-sensitizing all of the muscle groups exercised.

A typical work-out with this client might be:
- walk on treadmill
- jog on treadmill
- sprint on treadmill
- walk to recover after sprint
- 3 to 5 more pairs of sprints for 20 to 30 seconds followed by 40 to 60 seconds of walkin
- move onto weighta and select a barbell of reasonably challenging weight
- use barbell for Olympic clean and jerk for 3 sets of 10 reps
- by now the sweat should be flowing. Make sure client stays hydrated. Keep checking that client is not going hypoglycemic (feeling low blood sugar). I keep M&M's, raisins and protein bars available to deal with signs of hypoglycemia. The client would obviously not consume all of these during a work-out but the feeling woozy and strange that can come upon a Type 2 Diabetic during a hard work-out needs to be addressed by some fast to digest food.
- Now we'll alternate between hard upper and lower body exercises. A typical example might be: Pull ups to work back and shoulders; vertical jumps to work legs hard.
- Abs work such as Medicine Ball throws to client on an incline bench add in hard, dynamic movement while legs and arms are recovering.

This hard workout which is both cardio and strength combined into one seamless exercise session should increase insulin sensitivity for the next 48 to 72 hours.

"Life's a bitch" is not a new thought but maybe appropriate here. 

After the last couple of day's posts on exercise and Type 2 diabetes you might be tempted to relax, think I know the prescription, I can get this under control. 

Then along comes this article:

Gina Kolata in the New York Times wrote this article a couple of months ago (August 20, 2007)   Looking Past Blood Sugar to Survive With Diabetes.

You have to look after cholesterol as well and blood presure. Don't just get fixated to getting blood sugar under control. 

Gina's article is part of a fun series :The Six Killers - great Halloween reading. 

To end on a cheery note "Yet, said Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, when you think about it, it s not the diabetes that kills you, it s the diabetes causing cardiovascular disease that kills you."

Physical Activity and Type 2 Diabetes

I've just made the connection between the Sept 2007 research I blog'd on yesterday " Effects of Aerobic Training, Resistance Training, or Both on Glycemic control in Type 2 Diabetes" and the consensus statement from the American Diabetes Association entitled " Physical Activity/Exercise and Type 2 Diabetes" published June 2006 in Diabetes Care. The connection is the lead author Dr Ronald J. Sigal from the University of Ottawa, Ontario.

They are both leading down the same route but now Dr Segal does not have to reference other people's research on the beneficial impact of exercise on Type 2 Diabetes, he's conducted his own trial. Over the 15 months between the two papers the importance of hard, heavy resistance to accompany the cardio (aerobic) exercise has been emphasised. Equally on the cardio front the beneficial effects on blood glucose control obtained from intense cardio has also gone up a little.

Both forms of exercise, if sufficiently intense, improve insulin sensitivity for 24 to 72 hours after exercise and maybe a bit longer in the case of tough weight or resistance exercise. So not having 2 days without any exercise is critical.Hence 3 times per week to work out hard (cardio and weights) is just about right. Every second day is even better - why take the whole week-end off ?

The June 2006 paper also offers an insight that weight loss on its own has minimal, maybe no, impact on glucose control in those with Type 2 Diabetes.

Type 2 Diabetes

Type 2 Diabetes is a killer - everyone knows this, everyone knows it kills you slowly and unpleasantly (leg needs amputation; blindness). Exercise helps. Medication helps. Exercise and medication are better. So exactly what kind of exercise has best effect?

The September 2007 edition of the Annals of Internal Medicine published the results of the trial in Ottawa, Ontario which addressed this question. The trial, lead by Dr. Ron Segal, selected sufficient participants so that the results would be satistically significant i.e. you could believe the conclusions from the trial. Four trial groups were randomly formed. One group was the no exercise group which continued with no or minimal exercise. 

The other three groups were all provided with a free gym membership for 6 months and a personal trainer:

- cardio only group did aerobic exercise either on a treadmill or stationery bicyle. 

- the resistance only group did muscle strengthening exercises but no aerobic exercise. 

- the last group did both cardio and resistance exercise. This group had the biggest impact of all on their blood sugar control. This group doing both forms of exercise three times every week did more exercise that the other groups. However the design of the trial ruled out the possibility that it was just exercise volume that made the difference. 

From the measurement of Hemoglobin 1C, which gives an average blood sugar level over the last 2 to 3 months, the trial showed that doing muscle strengthening exercise multipled the impact of cardio exercise about 3 fold i.e. a big, big impact.

If you want details on exactly what cardio or exactly what resistance exercises were followed then go to;

http://www.bodyrestored.com

From there you can access links to Dr Segal's paper in Annals of Internal Medicine (it's free).

One more interesting thing from this Ottawa exercise trial on Type 2 Diabetes; the exercise regime used with cardio and resistance was very effective in controlling blood sugar but it had only a small impact on either blood pressure or blood lipid levels. 

This means that this particularly effective exercise plan for Type 2 Diabetes is not the magic bullet for all major health issues. If you have hypertension or high cholesterol then you'll probably need to increase the exercise volume.