Cardiac Patients Doing Weight Training

Fifteen years ago the idea of anyone doing weight or resistance training a month after a heart attack was seen as very dangerous.

I'm still absorbing what I learned at last week's ACSM Health & Fitness Summit in Atlanta, GA. Heart health had a great deal of attention. The presentation by Paul Sorace, James Churilla and Peter Ronai was a great example of too the point education.

One exciting idea from them was to take the existing guidelines on exercise and then get through the typical 10 to 12 exercises for all the major muscle groups in about 15 to 20 minutes. In other words combine machine resistance and free weights exercise into one flowing circuit training workout.

Take each set reasonably steadily, don't rush it and allow about 30 to 60 seconds between each exercise.You should be able to get through 10 to 12 exercises with around 12 to 15 repetitions in each set in 20 minutes - maybe less.

Now that a weight and resistance is so compacted down timewise, you can think about adding strength training after a typical heart recovery, cardio workout. By reducing the recovery time between sets you will keep the heart rate up but not too high. So this workout should, if you are sensible, be safe.

When can you (or really should) start weights and resistance training ?

• You've had cardiac surgery (maybe a heart attack as well); then you've been doing your cardiac rehabilitation program exactly as specified for 4 weeks, then it's time to get into a resistance training activity as well
• You've had a transcatheter procedure; then you've been steadily doing cardiac rehab for at least 2 weeks; time to start some resistance training.

Of course you've got to be sensible! There are a whole bunch of conditions when you'd not want to start resistance training quite so soon:

• Congestive Heart Failure
• Valvular Disease
• Hypertension not under control with your top blood pressure number (Systolic) above 160; or your lower number (diastolic) above 100.
• Uncontrolled dysrhythmias
• Marfans.

But these items excluded it still leaves a lot of people able to get into building up their strength amazingly quickly after severe heart procedures.


That just leaves a couple of questions ?

1. Why build up your strength ? Is it worth the effort ?
2. Exactly how to go about it.

Why Build up your strength ?

• It decreases depression and that on it's own is probably a good enough reason.
• It increases your chances of staying independent
• You are able to do all the ordinary things of life so much more easily. All the way from just getting up out of a chair to picking up grandchildren
  
• If you've had a heart attack or a by-pass or a defibrilator implanted then the chances are that you have some other health issues as well - maybe diabetes, arthritis, osteoporosis - getting stronger muscles and bones will help all of these issues.

Then there is the question of how to go about increasing your strength safely.

• Chances are your medical insurance will stop paying for cardiac rehabilitation at some point. It's best to find a Personal Trainer who understands all of these issues.
• The American College of Sports Medicine will help you find someone knowledgeable.
  
• The American Council on Exercise helps you find a Personal Trainer.
• Put in Post Code 30022 ( north of Atlanta, GA) and I should come up, with several others, in the search results.
• Look at these videos which give you an idea of an easy start to exercise and progressing to very hard (after a suitable period of build up).
  

ACSM Health & Fitness Summit 2009

The American College of Sports Medicine brought their annual Health & Fitness Summit to Atlanta and I felt that I had to attend. About 1200 others thought the same way and an informative time was had.

I did feel sorry for the people coming from the northern states - this was an opportunity to enjoy some sun and warmth. Would you believe it but Atlanta was under a perpetual deluge for the entire conference.


The first session for me was 1pm Wednesday "Follow the evidence" with Chuck Thigpen talking about preventing & rehabing shoulder injuries and ended Saturday lunch time with Len Kravitz giving a wonderful presentation.


There were many highlights but the presenter that stuck in my mind was Ralph LaForge talking about Managing the Metabolic Syndrome and the related topic of Managing Dyslipidemia.


What did I learn from Ralph LaForge and how much of that is relevant to my clients ?

• The first objective of managing metabolic syndrome is to delay and maybe prevent diabetes. If a client moves on from pre-diabetic to diabetic then all the health issues and health costs escalate severely. Then after diabetes, heart issues will eventually arrive. If diabetes can be delayed then the heart issues will also be delayed - possibly prevented altogether.
• When looking at Lab Test results, total cholesterol is nowadays seen as not so important. Total Non-HDLC cholesterol is a very important number. However the ratio of Total Cholesterol to HDLC is important. One wants this ratio below 4. Ralph said that if a person has had a heart attack and then gets the ratio of Total Cholesterol to HDLC below 3 then there has not been a single incidence ever of a second heart attack.
• Tri-glycerides are also very important. Exercise makes the body oxidized i.e. use, tri-glycerides and thus their concentraion in the blood reduces. This is not true for cholesterol. High tri-glycerides are a concern because if they are really high, above 1,000, then pancreatitis can result.
• Exercise can reduce the bad affects of a heavy meal. If one gets about 400 calories of exercise [for instance by walking about 4 miles] within 8 to 12 hours of the meal then the tri-glyceride peak from the meal is reduced by about half.
• Exercise is the way to deal with the Metabolic Syndrome. Get at least 1,500 calories of exercise a week. This means walking 15 miles a week - 2 or 3 miles a week or do it all at the week-end with a couple of long walks. It's the total calorie burn that has a healthy impact.
• Use a pedometer - Ralph recommends a simple yet robust design such as Accusplit Eage 120 XLM. Walking 2,000 steps will burn 1,000 calories. Ralph recommends buying in bulk because in his experience clients are going to lose 2 or 3 pedometers a year.
• Exercise reduces the risk even if there is no weight loss. Exercise reduces the number of cholesterol particles in the blood, and even if the total cholesterol number does not come down, reducing the number of particles in the blood guards against the development od diabetes.
• Ralph said that a soda with sugar (around 100 grams) and caffeine, spikes blood triglycerides faster than anything - faster than anything containing fat. This is not at all intuitive. As a result Ralph asks his clients (patients) how many 'encounters' they have had with fast food. He said that a typical American has 25 to 35 'encounters' with fast food a week (including sodas).

There were many other great sessions which I'll have to pick up on in future posts:

• Ellen Coleman talking about Muscle Building Supplements (very sceptically) was lovely
• Annette Lang presenting on training the pregnant client was a total delight and very informative.
  
• Nanette Wenger, Chief of Cardiology at Grady Hospital, Atlanta (plus working at Emory) made an important presentation about womens' heart health
  
• Then there were the three Clinical Exercise Specialists (Paul Sorace, James Churilla, Peter Ronai) who presented on the benefits of resistance training for heart disease and diabetes.

Chances of getting Type 2 Diabetes

What's the chance of developing Type 2 Diabetes ?

You'd think this lady was low risk but it turns out she's high risk.

So I tried the Diabetes risk calculator at The American Diabetes Association and they said I was at risk. After looking closely at the way they calculate the risk it became obvious that everyone over 56 is scored as at risk.

Maybe the British need their own Diabetes risk calculator and they have it. Try the British version of the risk calculator. It turns out that ethnicity is a huge part of the risk. The British calculator also takes into account where you live. I lived at the northern edge of London for a long time so I entered N14 6BE into the box for postcode (similar to Zip code in the USA - but with smaller areas).

The British Medical Journal (BMJ) published this long article on how the risk calculator was calibrated.

Of course, if you are Australian you'd want to use the Australian test. This has a number of interesting questions that the other do calculators don't have - like waist size and eating fruit and vegetables.

Brains get bigger and better with Aerobic Exercise

Can you believe that walking, swimming, cycling, running can make your brain bigger and better ?

It seems so. Look at these images.


The images come from research on people in their 60s and 70s who went through 6 months of aerobic training. The blue areas in the image show areas of grey brain matter that became bigger after aerobic exercise. The yellow areas in the images show white brain matter areas that became larger.

As usual with a clinical trial there was a control group who did light exercise and stretching. They all had their brains MRI scanned before and after the 6 month trial. Result: white and gray matter within the brains of the aerobic exercisers but no change to the brains of the light exercisers.

The researchers also investigated people in the age range 18 to 30 to find out if aerobic exercise increased the size of their brains. The answer: no; aerobic exercise had no impact on brain size in this group.

The research report starts off with a scaring thought "Beginning in the third decade of life, the human brain shows structural decline, which is disproportionately large in the frontal, parietal, and temporal lobes of the brain. This decline is contemporaneously associated with deterioration in a broad array of cognitive processes."

An interview with one of the authors of the study - Art Kramer.

ACSM's Health & Fitness Journal has an article "Exercising the Brain" by Janet Fletcher Brady. She Has a few thoughts on types of exercises that improve brain health:

• Movements across the mid-line of the body. The swing action of arms across the body while running or walking fast might fall into this category.
• Reaction movements. These are rapid movements in reaction to a signal - say a light flashing.

AARP Magazine has a piece on "How breaking a sweat and doing yoga can make you smarter."

It includes this interesting idea of how to modify a Yoga exercise to make it more brain productive. While yoga has long been shown to affect mood, one yoga move in particular is getting attention for boosting brainpower. Superbrain Yoga, as the exercise is called, is being practiced across the country as an antidote to brain drain. Go ahead. Try it!

This simple move, shown at right, boosts brain function by stimulating acupressure points on the earlobes, according to Yale-trained neurobiologist Eugenius Ang, Ph.D.

Step 1 Place your left hand on your right earlobe, thumb on the front of the lobe with fingernail facing outward and second finger behind the earlobe. Then, with your right hand, grasp your left earlobe, again keeping your thumb on the front of the lobe, facing outward. Press both earlobes simultaneously, making sure your left arm is close to your chest and inside your right (which devotees say helps energy travel upward to the brain).

Step 2 As you press on the earlobes, squat down, keeping your back straight. Do 10 to 12 deep bends, inhaling through the nose on the way down and exhaling through the mouth coming up. You may place a chair underneath you as a safety precaution.

Step 3 Repeat daily. “It’s like putting more gas in your brain’s tank,” says Ang. To learn more, read Superbrain Yoga by Master Choa Kok Sui. —Janet Kinosian.

If you want to catch up with the research then start reading these interviews with leading neuroscience and cognitive scientists.

One last thought. What exactly is aerobic exercise? Is it 50% maximum heart rate or 60% maximum heart rate or something else ? Even if you happen to know your maximum heart rate, trying to guess if you are at 50% or 60% or some other % is too difficult. The safe and easy answer - after 10 minutes are you sweating just a little. If so, it's aerobic exercise.

Exercise for a better brain.

How to Look Muscular, Look Lean, Look Fit. It's called HYPERTROPHY

Summers coming, your healthy, you want to look lean, you want to look good and that means you need a workout plan for HYPERTROPHY.

This video shows you what to do.

This is your plan.

Why follow this plan?

• This is a 2 month plan and there are 2 months until school is out for the Summer and we are into swim suit season
• Workout 4 times every 6 days: Legs; Chest & Back; Arms and Shoulders; Whole Body. Hit the abs at every workout. Abs are key to looking great.
• Easy to remember workout. No need to take a book to the gym.
• Each workout has just 3 exercises. You do 10 sets of each exercise and try to get 10 reps on every set. Of course you usually will fall short and not make it to 10 reps on the later sets. That's OK. That's the way it is supposed to be.
• 3 different exercise and 10 sets of each means 30 sets in a workout - easy. No. You will sweat and probably curse a little because you are going to have to concentrate and tough out the last few sets.
• Do the 30 sets in 30 minutes. That's right 1 set every minute. So no time to socialize. Just concentrate on the end result.
• The weights used are not really heavy. Use a weight you can do 20 reps with but only do 10 reps each set. Remember there are 10 sets for every exercise!
• You are unlikely to get injured because weights used are not enormous.
• Nothing tricky with the weights. No increasing or decreasing weights at each set. Pick a weight for that exercise for that day and stick to it and let the sweat roll off you.
• The idea is to work alternate muscles, for example front of thighs (quads) and the back of thighs (hamstrings) or front of arms (biceps) and then back of arms (triceps). Each muscle has about 2 1/2 minutes to recover from one set before the muscle is working again. But you do 10 sets in total on each muscle so that each muscle gets sufficient stimulus to grow and grow big.
  

What do you need to know to get started ?

1. Can you do a pull-up ? If the answer is no then you need a different program. Concentrate on getting stronger before trying out this program.
2. Can you do reverse curls on an incline bench. Look at the video to see what I mean by a reverse curl. If the answer is no then once again this is not the workout program for you.
3. For the 12 exercises used in the program what weight or resistance allows you to just get to 20 reps.
4. Another way to go at this is to find out what is the maximum weight or resistance you can move then take 60% of that weight.
5. Record all the weights on last 2 pages of workout plan.

What then ?

• For each exercise, perfection is getting all sets done and achieving 10 reps on every set. Most days you do not get to perfection but you try to get close to perfection.
• You really want to get out to set 6 or 7 and are still able to hit 10 reps a set. If you do not then the weight is too heavy. Next time ease back a few pounds. Do not change the weight during a workout.
• What if you are perfect on the day and all 10 sets for an exercise result in 10 reps? Time to move the weight up just a few pounds - not too much.
• Each workout you have just a few things to remember going to the gym: the 3 exercises for the day; weight for each.
• After each workout what do you need to write into your training record? Write in which sets you got to 10 reps. Write in the reps for the sets you did not get to 10 on. Write what you think the weight should be next time (less or more).
• Remember your start and finish time. This is to give you an incentive to really hustle and get through 30 sets in 30 minutes.

What else ?

• Eating is key to getting ripped and muscular - NOT and I repeat NOT by starving yourself.
• Ideally eat a mixture of protein, carbs and some fat 60 minutes before working out. A small cheese and tomato sandwich is just about ideal and very easy to prepare.
• If you are working out just after waking up then a glass of skim milk with a teaspoon of whey protein powder plus a couple of dried figs will get some protein into your body fast.
• Take a post-workout drink to the gym with you. A glass of non-fat milk with a teaspoon of whey protein powder is fast to prepare and easy to transport. Drink it down the moment you finish working out. Before you shower!
• One to two hours later have a 'proper' meal - making sure it's high in protein.Tuna with green vegetables is a good combination. Easy to prepare and to take with you.
• Think about supplementing with creatine monohydrate every day (about 5 grams a day). Your decision on creatine.

Anything Else ?

• Stretch
• Future Options.

Exercise makes your brain grow

Senior moments are one of those standing jokes - but serious nevertheless. The good news from research by Kirk Erickson and Arthur Kramer (both medical doctors) is that exercise can help the brain grow (even in those of us who are getting "on" in years).


What happens to the inside of the brain as things start to wear ?

The take away points from this research:

• It's never too late to start exercising. Aerobic exercise will reverse mental decline. In many cases even if one is into the early stages of Alzheimer's, hard(ish) aerobic exercise will reverse decline (at least for a few years and maybe longer).
• Aerobic exercise (if it's hard enough) can increase the volume of white and grey matter in the brain.
• This good news extends to the 'Executive control functions' of the brain such as working memory, ease of change from one task to another, task co-ordination, planning, knowing and working towards goals.
• Muscle toning and stretching type of exercises, as useful as these might be, do not improve brain function.
• Higher fitness levels going into old age is correlated with less mental decline later. So workout hard while still middle age part of life.
• Hormone replacement for women is not well thought of currently but it is associated with better brain function. However exercise improvements to brain function are achieved even if a women is on hormone therapy.

So what is the exercise recipe to protect and improve brain function ?

• 6 days a week
• 30 minutes a day
• if you miss a day then make up the time with 60 minutes of exercise
• aerobic exercise has to be hard enough to make you breathless (if you are new to exercise then have your doctor check if your heart can take this)
• walking is a good aerobic exercise but stride it out - uphill is good
  
• 6 months on this exercise program should be enough to make your brain bigger and more productive.

What if you are trying to lose weight, so you are reducing the calories while increasing the exercise. The aerobic exercise can expand your brain but be careful about exactly which diet you go onto.

Holly Taylor, a professor at Tufts, has discovered that very low carb diets, like Atkins, reduce cognitive brain functions. She published her work in Appetite and said "The popular low-carb, no carb diets have the strongest potential for negative impact on thinking and cognition. The brain needs glucose for energy and diets low in carbohydrates can be detrimental to learning, memory and thinking." The longer one is on a low or no-carb diet the more brain function goes down but starts to reverse as soon as carbs are re-introduced to one's diet.




This clip from CBS morning show is worth listening to.

Old Dog Running

Last week had St David's Day - lots of Welsh emotion. Yesterday I put the Welsh National Anthem onto my blog. Listen to the singing.

France beat Wales at Rugby. I'll get over that in the end because it's still a good season because Wales beat England and there is still a chance of ending the season as champions.

Running went well. I ran 6 miles and that's the farthest I've run in a long time. The 6 miles took 60 minutes but I was very pleased with doing the distance. Then later in the week I ran intervals at 9.0mph. Only 220 yards each interval but I did 4 to get me to 880 yards. So I'm pleased. After getting my knees lubricated the over-riding priority was to not let me knees get that bad again.

In July 2008 I started running again with 1/4 mile run. To start with, each week I added on just a 1/4 mile a week to the longest run for the week. It took patience.

At the start of 2009 I set myself some running targets.
The big one is to run a 10K race on the road in under 60 minutes.

Supporting objectives to get to a sub-one hour 10K:

• 6 miles in under 57 minutes
• 3.1 miles (5K) in 26 minutes
• 1 mile under 7 minutes

10 K this year, maybe half-marathon next year and who knows a marathon the year after.

This year, and last, the running plan is mine. However for longer distances I like the approach of Furman University to try to achieve more with less training. They emphasize the dangers of over-training.

I like their plan to run a marathon with just 3 days a week of running training.

Look at Furman's complete running plans.

Welsh National Anthem

Today, March 1st is St David's Day -
the day that the Welsh celebrate as their very own.

Here in the Atlanta area we have our own Welsh Society
and today we had an excellent lunch at Seasons 52.

Enjoy the music - tomorrow I'll be blogging about running.