Exercising in osteoporosis

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Nicole Picas, registered biokineticist in Johannesburg, who gives some insight into the role of exercise in managing and preventing osteoporosis.

Osteoporosis refers to a decrease in bone mass and bone quality, mainly due to increasing age. After the age of 35 years, there is a reduction in the activity of the cells that contribute to bone formation. This results in reduced bone mass. This is a concern because it puts these weaker bones at an increased risk for fracture. A bone density scan is the most accurate way to diagnose osteoporosis. 

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The American College of Sports Medicine (ACSM) found that every 1 in 2 women and 1 in 8 men over the age of 50 are likely to experience an osteoporotic fracture at some stage in their lives. Women are at a much higher risk for osteoporosis due to the reduction in estrogen levels following menopause, while men generally experience bone loss much later on in life (after age 70) and to a much lesser extent, as a result of reduced testosterone production.

ACSM identifies the following risk factors for osteoporosis:

·         Females are at a higher risk than males

·         Increasing age

·         Race – Caucasian/Asian

·         Family history of osteoporosis

·         Low body weight for height (individuals with small frames)

·         Early menopause

·         Prolonged premenopausal amenorrhea (missed periods over a long duration)

·         Low testosterone levels in men

·         Lack of physical activity

·         Smoking

·         Excessive alcohol consumption

·         Low dietary calcium intake

·         Chronic use of medications causing bone loss (e.g. steroids)

It is essential that adequate calcium is ingested as part of one’s diet, particularly during a child’s growth years, as this is when the bones are forming and developing. The Good Life Dietitians can provide more insight into dietary requirements for osteoporosis.

In terms of exercise, it is essential that individuals keep physically active throughout their lives in order to prevent osteoporosis. This means performing aerobic, weight-bearing activity at least 3 times per week for 30 to 45 minutes. If you already have osteoporosis, then the types of exercises you can perform depend on the degree of severity of osteoporosis, as one does not want to increase the risk for injury or fracture. Weight-bearing exercises are particularly important in building bone strength. These exercises include walking, squats and lunges. ACSM recommends aerobic, weight-bearing activities 4 days per week and resistance exercises 2 to 3 days per week. By strengthening the muscles around the bones, bone mass is conserved and the muscles can support the weaker bones. It is essential that balance exercises are performed on a regular basis in order to reduce the risk of falling and thus injury or fracture. Functional exercises that will assist an individual to perform the activities of daily living are also recommended.

For more interesting articles by Nicole, log on to her blog: Nicole Picas biokineticist- www.nicolepicasbiokineticist.blogspot.com.

Exercising in arthritis

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Biokineticist Nicole Picas discusses the importance of exercise in managing arthritis.

Two common forms of arthritis exist, namely osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint disease in which the cartilage of a specific joint degenerates, resulting in localized pain and inflammation within that joint. The most common joints affected by osteoarthritis are the hands, spine, hips and knees. Rheumatoid arthritis is an inflammatory, multi-joint disease in which numerous joints and organ systems may be affected as a result of an autoimmune response. The most commonly affected joints include the wrists, hands, knees, feet and neck.

When exercising a person with osteoarthritis, one needs to consider the degree of articular cartilage degeneration in the specific joint, the level of pain and discomfort in that joint, the range of motion of the joint, the strength of the surrounding muscles of the affected joint, and finally, whether or not the individual is having a flare up. Osteoarthritis will periodically flare up and then may almost go into remission. During a flare up, pain will be much more severe. Common features associated with exercise include joint pain and stiffness, osteophytes (small bony formations) and cartilage destruction. It is important to strengthen the muscles surrounding the affected joints so that they can support those joints. However, these exercises must be performed carefully, placing minimal stress and impact on those joints. It is also essential to stretch the muscles surrounding the affected joints in order to maintain their range of motion and reduce joint stiffness.

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When selecting exercises for individuals with rheumatoid arthritis, you need to know if the individual is having a flare up – increased pain will be the primary symptom. Common features associated with rheumatoid arthritis include morning stiffness that lasts longer than 30 minutes, acute and chronic inflammation, chronic pain and reduced joint integrity. Low-intensity and low-impact exercises, with lots of stretching, are recommended for these individuals.

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For any form of arthritis, it is important that individuals do regular low-impact, aerobic exercise, such as swimming or cycling, and lots of stretching. Any exercises that place heavy stress on the affected joints should be avoided. During flare ups, vigorous exercise must be avoided. Water therapy and water aerobics are highly recommended for individuals who suffer from arthritis.

Arthritis is a common condition, which often leaves people afraid to do any form of physical activity. However, exercise is important in managing the condition and maintaining mobility. So, if you suffer from arthritis, see a biokineticist to have a comprehensive assessment and be given an appropriate exercise programme. This will allow you to function more normally and improve your quality of life.

For more articles by Nicole, 
log on to her blog- Nicole Picas Biokineticst.

The Science of Stiffness

Biokineticist Nicole Picas tells us more about stiffness after exercise. 

Anyone who has done any form of strenuous activity will have felt that painful ache in the muscles for a few days after exercise. A lot of you may have decided that this pain couldn’t possibly be good for you and, therefore, have avoided any exercise since. Some of you might have decided you quite like that achy feeling, reminding you of what a good workout you had the day before. Basically, this mild discomfort is not bad for you and the good news is it won’t last forever.

Various myths regarding muscle soreness as a result of exercise exist. The most common is the idea that a build up of lactic acid in the muscle causes muscle soreness the next day. It is true that there is a build up of lactic acid in the muscle tissue with strenuous exercise; however, this lactic acid is removed within an hour of finishing exercise. Thus, it is not the cause for pain and stiffness that materializes the following day.

Muscle stiffness or pain after exercise is termed delayed onset muscle soreness (DOMS). There are two key models to explain this exercise effect. The first is known as the Local Ischemic Model. This model suggests that following either strenuous exercise, or even moderate, non-traumatic exercise, there is swelling in the soft tissue. This causes an increase in tissue pressure and a local reduction in blood and oxygen supply to the muscle (ischemia). This in turn causes muscle spasm and the pain known as DOMS.

The second model is known as the Mechanical Trauma Model. Here, it is suggested that there is structural damage (microtears) to the muscle tissue as a result of increased mechanical forces during muscle contraction. This again leads to swelling and inflammation in the muscle tissue, resulting in pain.

Neither of these models suggests that there is permanent damage to the muscle tissue. In fact, it is recommended that one repeats the same exercise on a regular basis so that the muscle tissue can adapt to the increased force placed on it. This is called the “repeated-bout effect”. The more the exercise is performed, the quicker the muscle tissue adapts, reducing muscle soreness.

So, next time you wake up the morning after exercise, cursing your trainer, the gym, exercise and life in general because you can’t walk up stairs or stand up from the toilet, think of the positive changes taking place to the muscle. Take yourself off to the gym and do a light exercise session with a good cardiovascular warm-up and lots of stretching – even if it hurts a little. This will increase blood flow to the sore muscle tissue, improve flexibility and thus reduce pain and stiffness.

For more by Nicole, visit her blog at www.nicolepicasbiokineticist.blogspot.com.

Simply Stretched

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Stretching should be an important part of your exercise routine. Nicole Picas, biokineticist and regular contributor to the fit life, tells us about stretching.

You have no doubt been told by someone at some stage that you should always stretch before doing any exercise. But why, you may ask. You don’t sweat or lose weight or build muscle from stretching, so why do it? Well, stretching is actually a crucial element in physical fitness and performance.

The first important point is that stretching should be done before and after exercise, as part of a warm up and cool down. Stretching before exercise assists in reducing the risk of injury. Stretching after exercise helps maintain increased flexibility of muscles and helps to reduce muscular pain and stiffness following exercise. Remember: never stretch a cold muscle, so do a gentle warm up such as a walk or light jog and then stretch before starting any strenuous exercise.

Secondly, people of all ages should stretch on a regular basis. With age, we lose flexibility, resulting in muscular pain and joint stiffness. This can affect one’s ability to perform various activities, from regular daily activities like reaching into high cupboards to specific sporting activities like moving across a tennis court.

When stretching, one should feel slight discomfort, not pain. Overstretching a muscle beyond its limits can cause damage to the tissue. The range of movement at a joint, or this point of slight discomfort, will increase as flexibility improves with regular stretching. Every joint is unique and flexibility will vary depending on the joint, activity levels and types of activities performed on a regular basis.

Muscle tightness is often associated with numerous orthopaedic conditions, such as lower back pain, neck pain or knee pain, amongst others. By carefully stretching tight structures and strengthening weak ones surrounding a joint, symptoms can be alleviated, often with immediate, but temporary relief. By performing appropriate stretching and strengthening exercise on a regular basis, more permanent relief can be achieved.

There are various types of stretching techniques that can be used to improve flexibility. The most common is static stretching. Here, a muscles is taken to the end of its range (slight discomfort) and held for about 15 seconds while the muscle is completely relaxed. Static stretching is most effective after exercise to reduce muscle pain and stiffness. 

Dynamic stretching involves the individual moving his/her own leg through its range. As the muscle warms up, the individual can swing the limb further and further through its range, never taking it more than the point of slight discomfort. Dynamic stretching is most commonly used prior to strenuous exercise.

Ballistic stretching is a slightly more risky technique, as it involves taking the muscle to its end range and gently bouncing the limb at this range. This technique is generally not advised, unless done under careful supervision of a Biokineticist.

Proprioceptive neuromuscular facilitation (PNF) is a highly effective form of

stretching, performed with the assistance of a therapist. It involves a contraction of the muscle to be stretched, which is held for about three seconds against the resistance of the therapist. The contraction is then released and the therapist pushes the limb slightly further.

Active-isolated stretching is another highly effective technique to improve flexibility while reducing the risk of injury. This technique must also be performed by a trained therapist. The individual contracts the opposite muscle those being stretched, thus assisting the therapist in moving the limb through its full range. By contracting the opposite muscle, one ensures that the muscle to be stretch is completely relaxed, thus reducing the risk of injury. This technique is particularly effective in more apprehensive patients who find it difficult to relax when being stretched.

Finally, stretching provides a great form of relaxation and stress relief. So, whether you are young or old, active or sedentary, you need to stretch to reduce the risk of injury, maintain joint mobility and keep the body moving with ease and minimal pain. 

For more by Nicole, log on to her blog: Nicole Picas Biokineticist

4 Simple Steps to Start the Exercise Habit

This Fitness Thursday we introduce the Good Life readers to Leo Babauta, author Zen Habits, one of the world’s most popular blogs. With over 200 000 followers, all of Zen Habits posts are uncopyrighted allowing us to share with you some of the pearls of wisdom from this avid runner and vegan.

I have to admit that I have my ups and downs with the exercise habit. So I know that it’s not the easiest habit for most people, and most people’s experiences consist of starting and stopping and starting again. Which is fine- don’t beat yourself up about it. The important thing is starting again. I’ve written before about how to build the exercise habit (and even have a guest post on it), but today I thought I’d revisit the topic for those who still have trouble.

So why do most people have trouble making exercise a regular habit? Well, there are probably a number of factors, but here are the main ones as I see it:

Too difficult. People set out with a lot of ambition and enthusiasm, and start out with a big goal. “I’m going to go to the gym for an hour a day!” or “I’m going to run 30 minutes every day!” The problem is that the goal is too difficult to sustain for very long. You can do it for a few days, but you soon run out of energy, and it becomes a drag to do it.

Too many goals. Often we set out to do too much. We want to run, and lift weights, and eat healthy and quit sweets, and stop drinking soda. Well, those are multiple goals, and you cannot focus on the exercise habit if you’re trying to do all the others at the same time. Or we might start with one goal, but then get caught up in another goal (to stop procrastinating, for example), and lose our focus on the first one.

Not enough motivation. It’s not a lack of discipline; it’s a lack of motivation. The most powerful motivators, in my experience, are logging your habit and public pressure. There are many others that help as well.

So how do we solve those problems? Keep it simple. Here are the 4 simple steps to start the exercise habit (and keep it going). I should note that you can use these 4 steps to start any habit.

1.       Set one easy, specific, measurable goal

  There are several keys to setting this crucial goal:

Written: Write this down. Post it up. If you don’t write it down, it’s not important.

Easy: Don’t — DO NOT — set a difficult goal. Set one that is super, super easy. Five minutes of exercise a day. You can do that. Work your way to 10 minutes after a month. Then go to 15 after 2 months. You can see what I mean: make it easy to start with, so you can build your habit, and then gradually increase.

Specific: By specific, I mean what activities are you going to do, at what time of day, and where? Don’t just say “exercise” or “I’m going to walk”. You have to set a time and place. Make it an appointment you can’t miss.

Trigger: I recommend that you have a “trigger” right before you do your habit. For example, you might always brush your teeth right after you shower. The shower is the trigger for brushing your teeth, and because of that, you never forget to brush your teeth. Well, what will you do right before you exercise? Is it right after you wake up? Right after your coffee? Right when you get home? As soon as you take off for lunch? A trigger that you do every single day is important.

Measurable: By measurable, I mean that you should be able to say, definitely, whether you hit or miss your goal today. Examples: run for 10 minutes. Walk 1/2 a mile. Do 3 sets of 5 pushups. Each of those has a number that you can shoot for.

One goal: Stick to this one goal for at least a month. Two months if you can bear it. Don’t start up a second goal during that 30-day period. If you do, you are scrapping this goal.

2.       Log it daily

 This is the key habit. If you can log your workout, you will start to see your progress, and it will motivate you to keep going. And you have to make it a habit to log it right away. Don’t put it off, and say you’ll do it before you go to bed. As soon as you’re done working out, log it. No exceptions. And don’t make the log complicated — that will only make you resist doing the log. Just the date, time, and what you did.

3.       Report to others

 I think this is key. You can do it on your blog, on an online forum, with your spouse, or friends or family, or a workout partner, or a coach, or a group, or a class. However you set it up, make it part of the process that you have to report your daily workout to other people. It could be using an online log, or on a forum, or through email, or the phone, or just by telling your co-workers what you did this morning. But be sure that they know your goal, and that you are going to report to them, and be sure that they are expecting it every day.

4.       Add motivation as needed

 The first three steps might be enough for you to get the habit going. But if not, don’t just give up. If you miss two consecutive workouts, you need to look at why, and add a new motivation. Rewards, more public pressure, inspiration, whatever it takes. You can add one additional motivator, and then see if it works. If you miss two more consecutive workouts at any time, add another motivator. And so on, until the exercise habit sticks.