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Health

What’s Your Opinion?

Bob Gurney – PhD, C. Mgr. www.nav4success.org

I like to read reports in the media regarding health issues – to keep informed and read public opinions in response to interviews from government officials, on health issues. As we know governments, especially Health Agencies, have been warning us to the dangers and health costs linked to unhealthy lifestyles. The big topics on health have been focusing on smoking and obesity. Below are some quotes from the public opinions, as reference to a Health Minister’s media interview – “Obesity is the next big epidemic that’s coming in the same way smoking was,’’ he said. “It will need the same sort of combined efforts of [all levels] governments and the population itself to target it.”

Public Opinions – Quotes

“Why don’t [all levels of] government put their focus on alcohol?  When is alcohol going to be sold in plain packaging with gross photos on it?  When is alcohol going to have an overnight 25% tax slapped on it, followed by an annual 25% tax hike? When is the advertising of alcohol going to be banned? When it consumption of alcohol at sporting and other events going to be banned? If people can’t have a cigarette at a sporting event why should people be allowed to have alcohol and turn into drunken yobbos? I have never heard of a smoker, after having smoked 10 smokes, driving under the influence of nicotine and killing someone or a junk-food addict going out and crashing their car into another one because they are under the influence of trans-fats. Oh, hang on…it would be because a hefty tax on alcohol would affect the politicians.”

“What [the Health Minister] is really saying is that Governments need to control our eating habits. Why? I see another Tax coming our way very soon.”

“Geez I thought I was good giving up smoking for health reasons, now I eat more and will be targeted again for being obese. What can I do? I know, I’ll take up drinking because apparently that’s okay to do and is never targeted even though there are many more deaths and consequences from alcohol.”

“I have been informed via government sources and Quit that only 1 in 6 people smoke. I reckon they should put the question to the people in the next census. ‘Do you smoke?’ or ‘How many people residing at your residence smoke?’ and maybe, ‘If you were a smoker, when did you give up and how long did you smoke for and how long since your last cigarette?’ Only then will we get an accurate picture as to how many people smoke. I say this because a/ I was once a smoker for 33 years and have not had one for 67 months and b/ most people I see are smoking, or smoke at some stage during the course of a day. The Government and Quit put out this propaganda so that it looks like they are winning. But a warning (and I’m sure our censor will not like this), if no one smoked that would leave a big hole in the Government’s revenue. In wonder how they would make it up.”

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

 

Exercise and Mental Health

Robert (Bob) Gurney, PhD   www.nav4success.org

Mental health issues in Canada have recently generated a great amount of interest from researchers, medical professions and the media. I have taken a different approach for the readers of the50zone/health, in terms of moving from an article presentation to identifying accredited resources that address mental health and exercise.

First, the URL below is a video of a by: Roger Walsh, M.D., Ph.D. DHL.- Is a graduate from Australia’s Queensland University with degrees in psychology, physiology, neuroscience, and medicine, and then came to the United States as a Fulbright Scholar.  He is now at the University of California at Irvine where he is professor of psychiatry, philosophy, and anthropology, as well as a professor in the religious studies program. His research has included work in the nature of psychological health and wellbeing. The video presentation – Exercise Benefits Body, Brain, and Mind. Exercise Can Prevent and Heal Disorders Such as Anxiety, Depression & Age-Related Memory Loss – Part 2 of 10 part series on Lifestyle and Mental Health.

http://www.youtube.com/watch?v=XHQVYq6bVpA

Two more videos of interest, provide discussions on exercise and mental health, as follows:

http://www.youtube.com/watch?v=KnMYqYUV0Eg

http://www.youtube.com/watch?v=mp5RG6sWEtM

The Exercise and Sports Sciences Australia (ESSA) have recently released a position paper on mental health and exercise: Exercise and Mental Health: An Exercise and Sports Science Australia Commissioned Review

http://www.essa.org.au/wp/wp-content/uploads/Exercise-and-Mental-Health-An-Exercise-and-Sports-Science-Australia-Commissioned-Review.pdf

In conclusion, we would very much enjoy hearing from you, the readers, as a means to stimulate discussions on this topic.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

 

What we may not know and what we thought were good health practices. The media informs us and can be quite convincing.

(Bob Gurney, Ph.D); www.nav4success.org

   Recently I was watching TV and flipping through the channels and my attention was attracted to a TV show that reports on interest issues. The first segment of the show investigated controversial assessments of patients by various dentists. The next segment of the TV show discussed recent research on BPA (bisphenol A), which is an industrial chemical that has been used to make certain plastics and resins that line food cans, bottle tops, water supply lines and some dental sealants and composites. The concerns of BPA are directed towards health issues of the brain, mental behaviour and prostate gland (infants and youth). The TV show commentators discussed the current literature of possible link of BPA to obesity. The commentator’s review of research suggests that BPA may affect fetal programming of genetic systems … leading to chances of increased obesity in adults. The information suggested that BPA was introduced into our consumer products in 1950, so those people born in 1950 or later are susceptible to health risks associated with BPA.

We know that the number of fat cells in humans becomes fixed as we move through puberty … this is well established as scientific fact. Thus, if a fetus, infant and/or child is exposed (to what degree?) to products that have BPA then we can make possible links to obesity. But what about genetics (heredity), lack of physical activity, nutrition, etc? Do we bring public pressure to eliminate BPA in our food containers? What will they replace BPA with? The questions can go on and on and if we are able to eliminate things such as BPA, how do we know that the replacement chemicals will be better. It took over 50 years for us to be informed about BPA … what’s next on the list of health risks that we thought were OK? Details of the scientific evidence can be found in accredited science journals such as: Molecular and Cellular Endocrinology, Journal of Clinical Endocrinology and Metabolism, and Endocrinology.

The next day I was watching the news and the segment on ‘Health Matters’ discussed new research in linking omega 3 fatty acids to prostate cancer. Always believing the understanding that Omega 3 FA were good for heart health remains true still, but with a negative twist linked to prostate cancer is not welcome information. Well I am becoming very concerned about the information being disseminated through the media. Imagine a person who is watching TV shows and reading info from other media sources … confusion … and if the person believes everything can affect them personally … then one could be drastically changing their buy canadian viagra health lifestyle rapidly or believe that they are doomed. Is the media aware of the added stress to people resulting from their reporting of health issues? Especially when the reporting does not emphasize that the information may not be conclusive for all people. Or does the media assume that the viewer understands the limitations of the research being reported? Or is it the responsibility of the viewer to determine the validity of the information?

In conclusion, as we continue the path of scientific investigations, the uncovering of suggested information can be quite disturbing to people trying to live healthy. On a daily basis, traditional and social media are delivering a massive amount of health information to those who engage in it. Maybe we should be producing more positive information through the media that reassures us that we are doing the right things to improve our health. Any information on negative things that we did not know or thought was good for us, should be clearly presented as suggested and not confirmed for all people … only the population studied … that the people studied may have some underlying health issues that others don’t have. As a final thought … how do we proceed to build a healthy lifestyle when we are being informed that good practices are essential to our healthy living or those thought to be good practices have demonstrated links to other health concerns? I enjoy developing my knowledge, but ‘too much knowledge may be dangerous’. My changes in lifestyle at this point in my life are in response to what my physical and mental feelings are telling me and the changes are incremental … however I am not at any point of making lifestyle radical changes on a frequent basis in response to a massive amount of controversial information … as this type of practice can be stressful to both our physical and mental wellbeing, and we know stress is not good. We would enjoy hearing your comments on this issue. Please send your comments to…

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

 

Information Overload -Who do you believe?

(Bob Gurney, Ph.D); www.nav4success.org

During the past months and years I have been viewing a large amount of information on the internet and TV shows – that advises people to exercise/physical activity for personal health. For the general population, people must be overwhelmed with the amount of information that they view through a variety of social media sources. Who do you believe? I have concluded that a high percentage of information on this issue appears to be founded on non-scientific evidence, quick fix remedies and hidden agendas of getting your hard earned money for nothing. We should be aware that many of the exercise/physical activity promotions on social media are for $$$ profits of the advisors and fail to address specifics to each individual – because they have not personally working with you. Therefore, information is non-specific to you personally and lacks any understanding of who you are and what your interests and needs are. I also read research papers published in accredited journals – that are very specific and based on scientific evidence. However, the general population may not have access to the data base holding the papers and the general population may not be able to interpret (for application) the scientific complexity (jargon) in the papers.

For me personally, I follow a simple approach to exercise/physical activity. Yes, I engage in exercise/physical activity for maintaining a personal level of health/fitness and interests in the activities. Over the years I have continued to become aware of my physical activity abilities and try to adjust the activities based on interest and capabilities. On occasion I find myself thinking I am still in my late teens or early-late 20’s, but then my physical body reminds me that those days are in the past. So, I now walk to and from work and long walks on nice weather days. Running is no longer an interest … if I can’t perform to the level I want … then walking is the better choice. I swim, workout in the gym (low resistance), kayak, golf, cross-country ski, snowshoe, skate, mountain bike and play squash. Over the years, I have moved from high impact physical activities (heavy weights, hockey) to lower impact activities. Also, I have reduced the intensities of the activities that I enjoy to a level that is conducive to my physical abilities. So, my opinion is – 1) move to new activities that are of lower impact – enjoyable, beneficial and physically achievable (limits chances of injury); 2) Engage in the activities that you have enjoyed for years and just change the intensity to meet the demands and limitations of your physical abilities. When I work out in the gym (ie. bench press) – I start my first set with just the bar and no additional weights – work towards a large number of repetitions. The young guys in the weight room that I know say “hey Bob do you need a spot” and they laugh. I say “watch closely … this is your future” (all in fun as part of the social experience). If you have been diagnosed with health issues, consult with your health care professional – for do’s and don’ts.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

 

 

Robert (Bob) Gurney, Ph.D

www.nav4success.org

imune-systemPhysical Activity and the Immune System

Current research in the study of physical activity and immune system functions has shown that immune system activity is enhanced or strengthened with moderate or short-term intense exercise (Bergendiová & Tibenská 2009). With regard to gender and immune response in physical activity, research has demonstrated that there is no significant difference between males and females (Gleeson, Bishop, Oliveira, McCauley, & Tauler 2011). This is important since it may support generalizations of physical activity recommendations across both males and females. Research has also demonstrated that physical activity helps to increase specific indicators of immune function regardless of fitness level, although the type of training (endurance versus resistance) has shown different types of immune response (Said et al., 2009). Immune responses have been shown to decrease in the elderly (Malaguarnera, Cristaldi, Lipari, & Malaguarnera 2008), however this notion is not conclusive in that “regular exercise in the elderly may improve the alterations in acquired immunity which follow the physiological process of aging, allowing a major resistance against external pathogens and a better quality of life” (Malaguarnera et al., 2008 p. 61). Conclusively, the current research demonstrates that immune response can be increased by physical activity regardless of age, gender, or fitness level. This is very desirable since it will allow future researchers to generate principles, which will be applicable to a more generalized population.

Literature developed from the perspective of Physical Therapists in this subject area, have revealed that there has been some recent studies conducted looking at the effects of physical therapy programs on the immune system. Most studies looked at specific immunodeficiency diseases and studied individuals presenting with such diseases and compared the effects of an exercise group compared to a non-exercise control group. For instance, Veljkovic et al (2010) found that regular aerobic exercise was able to increase the production of natural antibodies, which were able to block the receptors for the HIV virus. Their results indicate that exercise may be a safe and inexpensive way to slow down or prevent disease progression. A recent study that supports these findings states, “[o]verall training can improve the muscle and aerobic fitness of HIV-infected patients with no negative effect on their immunological function” (Farinatti, Borges, Gomes, Lima, & Fleck, 2010, p.511). This importance of exercise for battling the symptoms of a weak immune system indicates the significance physical therapy can have in this regard.

As our aging population continues to grow in numbers, we need to develop a better understanding of the effects of various types of physical activity on our immune system functions. We also need to investigate the effects of physical activity modes on patients with health disorders that are identified as immune system diseases.

Bibliography

Bergendiová, K., & Tibenská, E. (2009). Effects of physical activity and sport on the immune system and possibilities of their modulation. Medicina Sportiva Bohemica Et Slovaca, 18(4), 163-174.

Farinatti, P., Borges, J., Gomes, R., Lima, D., & Fleck, S., (2010). Effects of a supervised exercise program on the physical fitness and immunological function of HIV-infected patients. Journal of Sports Medicine & Physical Fitness, 50(4), 511-518.

Gleeson, M., Bishop, N., Oliveira, M., McCauley, T., & Tauler, P. (2011). Sex differences in immune variables and respiratory infection incidence in an athletic population. Exercise Immunology Review, 17122-135.

J. Romeo, J. Wärnberg, T. Pozo and A. Marcos (2010). Physical activity, immunity and infection. Proceedings of the Nutrition Society, 69 , pp 390-399

Malaguarnera, L., Cristaldi, E., Lipari, H., & Malaguarnera, M. (2008). Acquired immunity: immunosenescence and physical activity. European Reviews of Aging & Physical Activity, 5(2), 61-68.

Said, M. M., Feki, Y. Y., Aouni, Z. Z., Machghoul, S. S., Hamza, M. M., & Amri, M. M. (2009). Effects of sustained intensive physical activities on immune cells circulating and pro-inflammatory cytokines production in trained and untrained humans. Science & Sports, 24(5), 229-237

Veljkovic, M. M., Dopsaj, V. V., Stringer, W. W., Sakarellos-Daitsiotis, M. M., Zevgiti, S. S., Veljkovic, V. V., & … Dopsaj, M. M. (2010). Aerobic exercise training as a potential source of natural antibodies protective against human immunodeficiency virus-1. Scandinavian Journal of Medicine & Science in Sports, 20(3), 469-474.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

 

 

 

Endocrine Changes and Aging – Part II; Bob Gurney, PhD       www.nav4success.org

To follow-up on the article last month, select endocrine changes in the aging process will be provided in this brief. If you were waiting to read any significant research connecting hormone changes linked to aging and exercise, then you will be disappointed. In healthy adults, hormone changes are a fact of life and any notion that exercise can significantly change the release of hormones and endocrine related actions tends to be limited in conclusive evidence. The following table illustrates a summary of the literature addressing select hormone changes in older adults.

Hormone                        Changes with Aging  Potential Clinical Signs                    Comments

edocrinechart 

Endocrine changes in the functions of glands such as the pituitary, pancreas, adrenal and thyroid have been linked to type 2 – diabetes, as a result of impaired glucose tolerance. Diseases of this kind have been associated with elderly and tend to be related to factors of poor diet, inadequate physical activity and increases in body fat – especially in the organ areas of the abdomen.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

 

Endocrine Changes and Aging – Part I Bob Gurney,

PhD www.nav4success.org

When we speak of ‘endocrine’ in the context of the human body, we are referring to glands that secrete hormones into the circulatory system. The hormones play vital roles in regulating numerous body functions. Although there are numerous hormones and endocrine glands, we will focus on those that tend to demonstrate changes with age and their linkages to physical activity and aging. We start with developing a working knowledge of some of the structures and hormones that play significant roles. The hypothalamus (a small structure well protected deep in the brain) functions to regulate metabolic rate and temperature, and further influences activity of the autonomic nervous system and other functions to maintain the body’s internal control. The hypothalamus links to the pituitary gland located below. The pituitary gland is sectioned into anterior and posterior parts. The anterior pituitary produces 6 primary hormones grouped as follows: Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) and Thyroid Stimulating Hormone (TSH); Growth hormone (GH) and prolactin; Adrenocorticotrophic hormone (ACTH). LH and FSH are Gonadotropic hormones. LH and FSH have an effect on ovaries and testes. TSH has an effect on the thyroid gland. GH has an effect the liver and other tissues. ACTH has an effect on the adrenal glands (adrenal cortex). Older adults are influenced by changes in the secretion of the above hormones which in turn may present a variety of health benefits and/or concerns. However, regular physical activity combined with good nutritional practices and lower body fat can be instrumental in delaying related adverse health issues. The following schematic illustrates the structures and hormones (above) and will be furthered described in terms of changes in elderly adults, in the next edition of ‘the50Zone’.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney


 

Understanding Physical Activity &Metabolism for Weight Loss & Weight Loss Managemen

Robert (Bob) Gurney, PhD

The non-scientific data on how to lose weight is quite weak. The following is a description of the first few results of a Google search of “how to lose weight”. The search results are herbal magic weight loss (“Lose 20 lbs by New Years Eve”), Dr. Bernstein diet (“Lose up to 20 lbs by Christmas), Slimband, a website about weight loss basics which is fundamentally correct if not a little overly simple, and a blog about how to lose 20lbs of fat in 30 days. Of the first group of top results in Google, only one discusses anything that has basis in fact and is reasonable for the public to do. There is a need for a study in this aspect because the average person will not be researching scientific databases to supplement their current knowledge of this topic. Majority of people will simply use Google to search and this will be the extent of their researching.

The scientific literature on how to properly manage or lose weight is not very accessible to the non-academic communities; it is only accessible through scholarly search engines which the average person will not typically use or have access to. If one can find it, the scientific literature includes a substantial amount terminologies, concepts and statistics to prove its validity, which the layperson may not understand. This notion has encouraged us to shows bring the scientific literature in more simplistic terms for understanding and application.

In its simplest of terms, weight loss (ideally adipose tissue) is achieved through a negative energy balance where the calories ingested through diet are negated and further exacerbated through physical activity (Donnelly et al., 2009). Any form of physical activity will cause an increase in caloric expenditure, while higher amounts of physical activity has been shown to promote long-term weight loss more effectively (Jeffrey, Wing, Sherwood & Tate, 2003). Non-Exercise Activity Thermogenesis, or NEAT (Levine, Vander Weg, Hill, & Klesges 2005), includes energy expenditure from any physical activity other than planned sport-like events. Small changes in lifestyle physical activity can greatly influence energy expenditure each day; changes can vary in up to 2000 kcal per today in individuals of similar size which is in part due to the type of activities and time spent not being sedentary (Levine et al., 2005). Any type of lifestyle change that reduces the amount of sedentary time is important for reducing weight and NEAT is just one way to approach weight management. Research shows that with a goal of decreasing health risks through decreasing fat mass, a person must also be conscious of maintaining or increasing lean body mass as well (Stiegler & Cunliffe, 2006).

The American College of Sports Medicine (ACSM) recognizes that a dose response relationship does exist for exercise and weight loss (Donnelly et al., 2009). They recommend for weight maintenance that at least 150min/week of moderate-intensity exercise (or expenditure of 1200 kcal/week) should prevent weight regain. For weight loss, a higher amount of physical activity is needed and recommendations of between 250-300min/week (2000 kcal/week) of moderate-intensity physical activity should elicit weight loss in the average adult. In regards to diet and exercise, the ACSM supports the use of moderate restriction diets supplemented with exercise but they recognize that severe restrictions to diet along with physical activity may diminish any additive effects (Donnelly et al., 2009).

What is scientific evidence and what is not remains an issue in providing consumers with sound advice to health. We can help you find and interpret scientific – academic research into information that can be understood and beneficial to your needs and desires to seek proven health information.

Contact us at: robert@nav4success.org or visit us at www.nav4success.org

Donnelly, J.E., Blair, S.N.P., Jakicic, M., Manore, M.M., Rankin, J.W., & Smith, B,K. (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise, 41(2), 459-471.

Jeffrey, R.W., Wing, R.R., Sherwood, N.E., & Tate, D.F. (2003). Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? American Journal of Clinical Nutrition, 78(4), 684-689.

Levine, J.A., Vander Weg, M.W., Hill, J.O., & Klesges, R.C. (2005). Non-Exercise Activity Thermogenesis: The crouching tiger hidden dragon of societal weight gain. Journal of the American Heart Association, 25, 2451–2462.

Stiegler, P., & Cunliffe, A. (2006). The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Medicine, 36(3), 239-262.

Tremblay, A., Simoneau, J-A., & Bouchard, C. (1994). Impact of exercise intensity on body fatness and skeletal muscle metablism. Metabolism, 43(7), 814-818.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

 

 

Renal Functions and Exercise

by Bob Gurney

What we know?

We know that the kidneys act to regulate fluid and electrolyte balance through processes of filtration, secretion and reabsorption. The kidney is also an endocrine organ, involved in activating: a) erythropoietin (EPO) which acts to stimulate bone marrow for the production of red blood cells, b) releases renin, which works to regulate blood pressure, and c) releases calcitriol (the active form of Vitamin D) which helps maintain calcium for bones and chemical balance in the human body.

Structurally, the kidney has 3 distinction regions. The cortex is the outer section of the kidney and receives blood and acts to reabsorb filtered material. Moving inward, the medulla is highly active in metabolic work to concentrate urine. The internal section of the kidney is the pelvis which collects the urine and moves it outward through the ureters to the bladder for excretion. The functional units of the kidney are known as nephrons, which occupy areas of the cortex and medulla. There are 5 functional parts to a single nephron. The functional process works to (in order) filter plasma from blood, reabsorb essential nutrients and chemicals back into the body system, concentrates chemicals to form urine, reabsorbs water and sodium and collects urine for excretion.

We know that regular physical exercise has demonstrated benefits to patients rehabilitating from dialysis and kidney transplant. Low levels of endurance training: a) reduces muscle protein degradation in moderate renal insufficiency patients; b) reduces resting blood pressure in some hemodialysis patients and; c) provides varying degrees of aerobic capacity improvements in patients undergoing hemodialysis.

What we don’t know?

The current research literature does not inform us to longitudinal data concerning aerobic training effects or regular physical activity on patients with kidney disorders and/or kidney transplant. We are also somewhat in the dark as to the effects of regular physical activity on the health of renal functions, in people who have no apparent renal disorders. In an attempt to develop knowledge to what we don’t know, we at the50zone would appreciate your communications to us, with respect to personal experiences or any scientific literature you are aware of. We appreciate your help on what we don’t know … in advance.

The functional unit of the kidney is the nephron. There are five parts of the nephron: 1. The glomerulus, which is the blood kidney interface, plasma is filtered from capillaries into the Bowman’s capsule. 2. The proximal convoluted tubule, which reabsorbs most of the filtered load, including nutrients and electrolytes. 3. The loop of Henle, which, depending on it’s length, concentrates urine by increasing the osmolality of surrounding tissue and filtrate. 4. The distal convoluted tubule, which reabsorbs water and sodium depending on needs, 5. The collecting system, which collects urine for excretion. There are two types of nephrons, those localized to the cortex, and those extending into the medulla. The latter are characterized by long loops of Henle, and are more metabolically active.

The kidneys are a pair of vital organs that perform many functions to keep the blood clean and chemically balanced. Understanding how the kidneys work can help a person keep them healthy.

What do the kidneys do?

The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination.

Wastes in the blood come from the normal breakdown of active tissues, such as muscles, and from food. The body uses food for energy and self-repairs. After the body has taken what it needs from food, wastes are sent to the blood. If the kidneys did not remove them, these wastes would build up in the blood and damage the body.

The actual removal of wastes occurs in tiny units inside the kidneys called nephrons. Each kidney has about a million nephrons. In the nephron, a glomerulus-which is a tiny blood vessel, or capillary-intertwines with a tiny urine-collecting tube called a tubule. The glomerulus acts as a filtering unit, or sieve, and keeps normal proteins and cells in the bloodstream, allowing extra fluid and wastes to pass through. A complicated chemical exchange takes place, as waste materials and water leave the blood and enter the urinary system.

At first, the tubules receive a combination of waste materials and chemicals the body can still use. The kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, the kidneys regulate the body’s level of these substances. The right balance is necessary for life.

In addition to removing wastes, the kidneys release three important hormones:

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

 

Respiratory Health and Aging

by Bob Gurney

Changes associated with aging include both structural and functional aspects of the respiratory-pulmonary systems. Such changes can limit participation of older adults in both moderate and strenuous physical activity.

Question:

What are some respiratory structural changes as we move past 50 years of age?

Answer:

  • Reduced alveolar elastic recoil
  • Changes in chest wall structures (bones and muscles)
  • Decreases in respiratory muscle strength
  • Reduced alveolar surface area
  • Reduced structural integrity of respiratory passages (trachea, bronchi, bronchioles)

 

Note: reduced or loss of alveolar elastic recoil is the most dramatic structural change, and can lead to a progressive increase in residual lung volume (RLV). RLV, also referred to as residual volume (RV) is the volume of air remaining in the lungs after a maximal expiration. RV increases in individuals with chronic obstructive lung disease and also as the anatomical structures weaken with aging.

Question:

During the normal aging process, changes are evident in maximal oxygen uptake (VO2 max). What are the changes? What is the evidence of regular exercise on the aging changes of VO2 max?

Answer:

VO2 max tends to decline 8% to 10% (approximately) per decade after age 30. Research studies have illustrated that these values may be as great as a 24% decline per decade after age 30. Studies have informed us that regular exercise (aerobic) training regimes demonstrate a reduction in the age-associated decline in VO2 max, and this has partially been attributed to decreases in maximal heart rate and stroke volume, thus a decrease in cardiac output.

Question:

What are the functional changes in respiratory measures with aging?

Answer:

Maximal ventilation (VE max) declines with age.  However, there is a higher submaximal VO2 and VE, therefore the ventilator equivalent (VE/VO2) is higher in older adults. Changes in lung functions with older adults, make it more difficult to move air in and out of the lungs, but do not demonstrate limitations in pulmonary gas exchange. During low-moderate exercise older adults tend to increase ventilation by increasing tidal volume versus breathing frequency (more common in younger people). This increase in tidal volume may act as a compensatory mechanism to the structural-functional changes with aging.

Age related structural and functional changes are summarized as follows:

  • Increased stiffness of costo-vertebral joints (structural) may lead to increase kyphosis (functional)
  • Decrease in compliance of chest wall (structural) may lead to increased work efforts of breathing (functional)
  • Decreased size of alveoli and alveolar ducts (structural) may lead to reduced efficiencies of mixing alveolar and inspired air and decreased surface area for diffusion (functional)
  • Decreased number and thickness of elastic fibers (structural) may increase the air flow resistance in small airways, decrease in elastic recoil of lungs, decrease in vital capacity and increased residual volume (functional)

 

Although these structural and functional changes are inevitable with aging, healthy older individuals who engage in regular exercise have demonstrated better adaptations to the changes, versus the more sedentary older individuals.

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

You can connect with me on Linkedin – Robert (Bob) Gurney

.

Exercise/Physical Activity and the Circulatory System

by Bob Gurney

This is the fourth topic of presentation in a series outlined in the ‘Health’ section of ‘The50ZoneMagazine’.  To date the ‘Health’ issues have addressed physical activity and bone, muscular and nervous health. If you were to perform a search on the web with key words ‘circulatory system and exercise’ you will find some enlightening accredited articles filled with terminologies and concepts that may be unfamiliar. The purpose of this current article for presentation is to bring you a broad overview of information concerning the effects of exercise on the circulatory system, as a means to develop an understanding of the importance of physical activity in circulatory health. We start with identifying and defining appropriate terminologies.

Pulmonary Circulation – the movement of blood from the heart (via arteries) to the lungs and back to the heart (via veins).

Systemic Circulation – the movement of blood from the heart (via arteries) to all areas of the body and then back to the heart (via veins).

Stroke Volume (SV) – the volume of blood pumped from each heart ventricle per heartbeat.

Cardiac Output – is the product of heart rate and stroke volume.  (Normal resting cardiac output in adults is 5 litres per minute). In exercise states, cardiac output can increase at least 5 times that of resting.

Blood Pressure – a blood pressure of 120/80 refers to: the 120 is mm Hg (pressure) elicited to move the blood (contraction of the left heart ventricle) out to the systemic system. The 80 is mm Hg (pressure) elicited in the relaxation phase of left ventricle during the filling phase of blood into the left ventricle. These pressures are normally interpreted from measuring the blood pressure in a large artery of the upper arm (using a sphygmomanometer).

It is important to note that not all exercises produce the same cardiac responses. Dynamic exercises bring about increases in heart rate (HR), stroke volume, cardiac output and blood pressure. Isometric exercises tend to elicit greater demands on cardiac functions versus dynamic exercises. Isometric exercises elicit higher blood pressures due to the muscular contractions (isometric) constricting blood vessels. Dynamic upper body exercise (smaller muscle mass) elicit cardiac responses of higher blood pressure, lower stroke volume and no differences in cardiac output versus dynamic lower body exercise (larger muscle mass). Exercises using small muscle mass tends to elicit higher blood pressures due to the smaller muscle mass (arms versus legs) and thus greater peripheral resistance.

Training regimes are generally placed into two broad categories: a) long-term endurance, and b) short-term muscular endurance, strength and power. Cardiac Index (CI) is defined as: cardiac output per unit of time divided by body surface area. The literature informs us that CI decreases with age (decrease of approximately 20% from ages 40 to 60; and an additional decrease of approximately 10% from ages 60 to 80). Cardiac Index is greater in people who regularly train for long-term endurance versus short-term muscular endurance, strength and power. However, the studies in this area have been investigated only on subjects over a short period of time (weeks and months) and thus lack understandings over numerous years of training. Studies also vary as many have not considered genetic differences of subject’s natural abilities to different training modes.

In conclusion, it is worthwhile to take a look at articles (internet search) involving exercise and circulatory and aging. Articles produced in accredited journals are scientific based research. Caution of creditability is advised to the validity and reliability of the non-accredited, non-peer reviewed articles. Contact the author of this article for questions and/or clarifications of unclear terminologies/concepts and creditability of publication sources of articles.

Below is a table that identifies changes associated with training and aging in relationship to a few circulatory functions.

Circulatory Functions                                        Exercise Training                      Aging

Maximal Heart Rate increase decrease
Cardiac Output (HR x SV) increase decrease
Blood Pressure Same or decrease increase
Vascular Resistance decrease increase

Author: Bob Gurney

Email: navigatingforsuccess11@gmail.com

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Nervous System Health and Physical Activity

by Bob Gurney

During the months of November and December 2011, Kinesiology/Physical Education students – University of Alberta – PEDS 409 – Research Methodology, provided a presentation, as part of the course assignment requirements. The students are as follows: Lauren Glenister, Amy Heidebrecht, Claire Altares, Jaclyn Ellis, and Christopher Hills. This paper has been edited by Robert Gurney.

Diabetic neuropathy (DN) is the most common form of neuropathy in the western world and is the most prevalent complication currently affecting nearly 50 per cent of patients with diabetes mellitus (Dejgaard, 1997; Aring, Jones & Falko, 2005). Diabetic Neuropathy can develop in patients with type 1 or 2 diabetes and can occur at any stage, however, is more common in patients with Type 2 diabetes mellitus (T2DM) and, chronic poor glycemic control (Aring, et al., 2005). Type 2 diabetes mellitus has achieved proportions of a real epidemic and, according to the International Diabetes Federation (IDF) the disease now affects over 240 million people (Teixeira-Lemos, Nunes, Teixeira, & Reis, 2011). Studies have shown that the longer duration a person has T2DM the higher risk they are for DN (Edwards, Vincent, Cheng, & Feldman, 2008). Early detection and control of diabetes and co-existing risk factors for neuropathy can prevent or delay the progression of DN (Aring, et al., 2005). Symptoms depend on the part of the nervous system that is affected but are commonly associated with muscle weakness, pain, decreased motility, amputation and other co-morbid complications that has a detrimental effect on the quality of life, and has greatly increased the risk of mortality (Edwards, et al., 2008). Classifications of DN can be found in the research of Aring, et al., (2005). Insulin deficiency and hyperglycemia have been found to initiate progression of all types of DN (Tesfaye, Harris, Wilson, Ward, 1992). Therefore, glycemic control has been correlated to reduce both incidence and progression of DN (Edwards, et al. 2008).

Current information included in the National Diabetes Information Clearinghouse provides basic how-to- management information for individuals with Diabetes (National Diabetes Information Clearinghouse, 2009). The problem with the information provided is that the individual is required to seek out many additional sources of information on how they can improve their neural health and eliminate root causes. The goal for our how-to guide is to express specific measures through multiple disciplines. Compiling the information into one how-to guide, will create material that can be referenced to improve neural health and help in the prevention of neural damage.

This guide will be looking at the causes of DN and how it can be self-managed through changes in lifestyle, including physical activity and nutrition. Looking through the research there are no how-to guides, based on scientific evidence, to advise the diabetic population on how to effectively management the progression of their disease through an interdisciplinary approach.

Physiology

Chronic hyperglycemia leads to an inability to transmit signals through nerves, slowing nerve conduction velocity (NCV) and increasing vasoconstriction (Tesfaye, et al., 1992). Nerve conduction velocity is a non-invasive measure of nerve function (Said, 2007). In tissues where glucose is transported independently (nerve, eye and kidney), hyperglycemia causes higher concentrations of intracellular glucose, leading to functional impairment of nerves (Dejgaard, 1997). When high concentrations of glucose are converted to sorbitol within the cell, there is a reduction in myo-inositol, inhibiting ionic activity within the cell. Tesfaye et al. (1992) found that after direct warming of the limb, in subjects with DN and subjects without, NCV increased. This implies that warmer temperature, initiated by a warming modality or exercise can be a potential treatment for DN symptoms.

Balducci, et al. (2006) illustrated that long term aerobic exercise training can prevent the onset or progression of DN. Aerobic and resistive exercise improves sodium, potassium and ATPase concentrations; which are beneficial to NCV, nerve function, vasodilatation, blood flow, and improving oxygen utilization (Balducci, et al. 2006). Improving glucose metabolism through exercise training occurs primarily through 3 distinct mechanisms: 1) stimulation of glucose transport to muscle, 2) increased insulin action on cells of organs involved in exercise, 3) positive regulation of the signalling pathway stimulated by insulin as a result of regular exercise (Teixeira-lemos et. al, 2011). Resistance and aerobic exercise can improve insulin sensitivity to approximately the same extent, and therefore, should be implemented to manage the progression of DN (Signal, Kenny, Wassermam, Castaneda-Sceppa, White, 2006).

Nutrition

Individual nutrition plays a huge role in diabetic complications including DN. High blood glucose, the main risk factor for DN has been proven to be manageable through diet. Diet can improve glycemic control, even when selecting diets without professional help that are based on American Diabetes Association recommendations (Pi-Sunyer, Maggio, Mccarron, Reusser, Stern, Haynes & Mcmahon, 1999). Decreasing the overall amount of carbohydrate (CHO) intake, by eating low glycemic index foods (including fruits and vegetables, diary, legumes and whole grains), have proven to decrease blood glucose levels in diabetic patients (Gonçalves Reis & Dullius, 2011). Tight glycemic control, through diet, is one of the most effective ways of managing or preventing the progression of DN. However, changes to lifestyle and diet can be some of the hardest things to change. Some micronutrients have been found to decrease the oxidative stress levels, alleviating pain brought on by DN. Low levels of Vitamin B, E, C, and Magnesium are often diminished in patients with DN and can contribute to the development of DN. By supplementing daily diets with vitamin B, C, E and Magnesium, pain scores for patients with DN decrease significantly (Farvid, Homayouni, Amiri & Adelmanesh, 2011).

Physiotherapy

Physiotherapists play an important role in the management of DN, and preventing its progression. Physiotherapists provide essential information on exercise prescription, which is vital in managing blood glucose levels, and therefore, DN. Exercise is also associated with the prevention of T2DM becoming DN (Teixeira-lemos et. al, 2011). Patients with DN who regularly participate in physical activity improve their glycemic control (Teixeira-lemos et. al, 201). An effective exercise program ensures cardio respiratory and muscular fitness, as well as an effective tool to manage and prevent the progression of DN. Participation of regular moderate physical activity has the capacity to improve insulin sensitivity, increase high density lipoprotein, decrease triglyceride levels and normalize blood pressure (Kruse et. al, 2010). Therefore, exercise training contributes to the regulation of blood glucose levels, helping to prevent and manage DN.

Pharmacology

Diabetic neuropathy is best treated with a combination of pharmacological and non-pharmacological strategies (Mann, 2009). Therefore the best treatment of DN comes from an integrated approach of pharmaceutical drugs and daily life management, one method being physical activity. Engaging in daily physical activity can be challenging for an individual with DN. These challenges come from the side effects of the medications, which regulate DN. Most people with DN are placed on multiple drugs to help deal with the degeneration of the nerve as well as dealing with the pain (Mann, 2009; Wamboldt & Kapustin, 2006). Some of the common drugs administered for DN are anti-convulsants, tricyclic antidepressants and opioids. These all have common side effects such as drowsiness/ fatigue, low blood pressure, nausea, dizziness/ vertigo, gait disturbance and/or peripheral edema. These side effects and DN itself cause difficulties in performing physical activity because of disturbance to balance, ulcers on feet, added challenge to movement due to the swelling in limbs or inability to experience ones somatosensory system and/or general weakness. However, with this said, the importance of physical activity in one’s life is still essential in managing DN in a non-pharmaceutical manner. The how to guide we are proposing to create will provide physical activity that is appropriate to perform and engage in while under the influence of the DN medications.

Bibliography

Aring, A., Jones., Falko, J. (2005). Evaluation and prevention of Diabetic Neuropathy. American Family Physician, 71:2123-8.

Balducci, S., Lacobellis, G., Parisi, L., Di Biase, N., Calandriello, E., Leonetti, F., & Fallucca, F. (2006). Exercise training can modify the natural history of diabetic peripheral neuropathy. Journal of diabetes and its complications, 20(4): 216-223.

Dejgaard, A. (1998). Pathophysiology and Treatment of Diabetic Neuropathy. Diabetic Medicine, 15: 97-112.

Edwards, J. L., Vincent, A. M., Cheng, H. T., & Feldman, E. L. (2008). Diabetic neuropathy: Mechanisms to management. Pharmacology & Therapeutics, 120(1), 1-34.

Farvid, M., Homayouni, F., Amiri, Z., & Adelmanesh, F. (2011). Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation. Diabetes Research & Clinical Practice, 93(1), 86-94.

Gonçalves Reis, C. E., & Dullius, J. J. (2011). Glycemic acute changes in type 2 diabetics caused by low and high glycemic index diets. Nutricion Hospitalaria, 26(3), 546-552.

Kruse, R., LeMaster, J., & Madsen, R. (2010). Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “Feet First” randomized control trial. Physical Therapy, 90(11) 1568 – 1578.

Mann, E. (2009). Diabetic neuropathy, part 1: pharmacology. Practice Nursing, 20(5), 246.

Pi-Sunyer, F., Maggio, C. A., Mccarron, D. A., Reusser, M. E., Stern, J. S., Haynes, R., & Mcmahon, M. (1999). Multicenter Randomized Trial of a Comprehensive Prepared Meal Program in Type 2 Diabetes. Diabetes Care, 22(2), 191.

National Diabetes Information Clearinghouse. (2009). Diabetic Neuropathies: The Nerve Damage of Diabetes. NIH Publication No. 09–3185.

Said, G. (2007). Diagnosis of Diabetic Neuropathy: Nerve conduction studies. National Clinical Practical Neurology Journal, 3(6) 331-340.

Sigal, R., Kenny, G., Wasserman, D., Castaneda-Sceppa, C., White, R. (2006). Physical Activity/Exercise and type 2 diabetes. Diabetes care, 29(6) 1433-1438.

Teixeira-Lemos, E., Nunes, S., Teixeira, F., & Reis, F. (2011). Regular physical exercise training assists in preventing type 2 diabetes development on its antioxidant and anti-inflammatory properties. Cardiovascular Diabetology, 10(12) 1-15.

Tesfaye, S., Harris, N.D., Wilson, R.M. & Ward, J.D. (1992). Exercise-induced conduction velocity increment: a marker of impaired peripheral nerve blood flow in diabetic neuropathy. Diabetologia, 35(2) 155-159.

Wamboldt, C., & Kapustin, J. (2006). Continuing Education: Evidence-Based Treatment of Diabetic Peripheral Neuropathy. The Journal For Nurse Practitioners, 2370-378.

Author: Bob Gurney

 

Muscle Health and Physical Activity

by Bob Gurney

Are you finding that your abilities to lift or move objects have gradually declined over the past years? The current literature informs us that there is a decline in skeletal muscle mass as we move past age 40, which may explain any limitations in our muscular strength and endurance. Sometime around the age of 40, muscular strength begins to decline slowly, and is further accelerated in the decline process following age 60. The loss of muscular strength can be influential in your quality of life, and may also reduce your length of life. The loss of skeletal muscle mass as we age has been linked to changes in our physical activity habits. That is the lack of physical activity that promotes muscular strength and endurance. What can be done to change this process associated with aging? During the past 20 years, exercise and sports scientists have reported outcomes of increasing muscular strength and endurance in the elderly. Prescribed resistance training programs have demonstrated significant muscular strength gains in elderly men and women. Participants who engaged in prescribed muscular strength training programs illustrated strength increases – 100 per cent to 200 per cent in the thigh area (quadriceps and hamstrings). In addition, low-intensity prescribed muscle exercises for the elderly (men and women) resulted in significant improvements in strength, balance and flexibility.

There are 2 main categories of skeletal muscle fibers. Type I muscle fibers contain a large amount of myoglobin, which is the oxygen binding protein. Meaning that the Type I fibers are associated with our actions of muscular endurance. They are slow to fatigue because of their ability to perform oxidative metabolism to generate ATP (adenosine tri phosphate) – an energy chemical produced in the mitochondria of muscle fibers (cells). Type II fibers are suited for muscular power and tend to fatigue quicker than Type I fibers. Type II fibers differ in their myoglobin levels and thus rely mainly on anaerobic glycolysis – the ability to produce ATP through a shorter pathway, versus aerobic Type I fibers. Type II fibers are further differentiated into 3 sub-categories (Type II a – high in myoglobin– for long-term anaerobic work – less than 30 min; Type II x – low in myoglobin – for short-term anaerobic work – less than 5 min; and Type II b – very low in myoglobin – very short-term anaerobic work – less than 30 seconds). Type I fibers are best suited for our need to perform muscular work over a lengthy period of time – including balance, posture and stability. Type II fibers provide the power and strength to perform moderate to heavy muscular work in short bursts of time. It should be noted that Type II fibers are capable of regenerating energy in a shorter period of time, versus the Type I fibers. Therefore, longer rest periods are recommended (to replenish energy levels) between aerobic physical activities, such as endurance work – running, walking, swimming, cycling, cross-country skiing, etc.

References

McArdle, W.D., Katch, F.I. and Katch, V.L (2007). Exercise Physiology: Energy, Nutrition & Human Performance. (6th edition). Baltimore Maryland: Lippcott, Williams and Wilkins.

Questions for you to consider:

1. Do you combine muscular endurance physical activity and muscular strength activity on alternate days – regularly?

2. If yes to above, do you find your performance of doing daily muscular work tasks – comfortable?

3. If no, consult with your Physician to discover opportunities and programs for muscular strength and endurance.

Author: Bob Gurney

 

Bone Health and Physical Activity

by Bob Gurney

For years, people have been aware of osteoporosis as a major issue facing our aging population. Although this disorder has been emphasized among postmenopausal women, men are also susceptible to this disease. However, men have an internal mechanism to help reduce this risk. In males, estradiol (an active metabolic product of testosterone) works to stimulate a more positive balance of calcium in bone. Osteoporosis is a progressive condition that causes loss of bone mass as the bones demineralize and becomes porous. The literature informs us that bone mass can decrease by 30 to 50% in persons moving past the age of 50. Linked to low levels of hormones influencing calcium deficit in bones is osteopenia (meaning – bone poverty), a condition where bones weaken and thus increase the risk of fractures. In attempts to educate people to osteoporosis and osteopenia, recommendations of checking calcium intake and maintaining appropriate levels, along with regular weight-bearing exercises combined with resistance exercises can slow the process of bone loss and has been proven to stimulate bone mass in both men and women, over 50 years of age. Regular exercise combined with resistance exercises provides local bone development and bone deposition. As you near your optimal biological bone density levels, further density gains requires greater efforts to check calcium levels and exercise regimes. Discontinuing exercise reverses the bone development effects that have been gained. It is very important to understand that more (excessive physical training) is not necessarily better. Nutritional factors that contribute to bone health have been known for many years. Vitamins A, D and C are the classic ones that have been publicized and reinforced by the health sciences and medicine professions.

Risk factors for osteoporosis include, but are not limited to: history of bone fractures in adulthood, history of fractures in a parent or sibling, cigarette smoking*, sedentary lifestyle, eating disorders, high protein (animal protein) intakes, excess sodium intake, alcohol abuse, excess caffeine intake, low testosterone levels*, steroid use*, deficiencies in vitamin D and calcium.

*main osteoporosis risk factors in men.

This article has been developed from the literature, primarily:

McArdle, W.D., Katch, F.I. and Katch, V.L (2007). Exercise Physiology: Energy, Nutrition & Human Performance (6th edition). Baltimore Maryland: Lippcott, Williams and Wilkins.

Questions for you to consider:

1. What are your risk factors in osteoporosis?

2. What do you do to lower your risk factors for osteoporosis?

Author: Bob Gurney

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Physical Activity and Health – Part III

by Bob Gurney

Physical Activity and Health articles over the course of the following months will provide readers with summaries of current research addressing physical activity and health of human body systems. The body systems include:

  • Skeletal
  • Muscular
  • Nervous
  • Circulatory
  • Respiratory
  • Urinary
  • Digestive
  • Endocrine
  • Immune

Next month, bone health has been identified as an important health concern for older adults. Physical activity and regular exercise (including low impact resistance training) promotes good mechanical stress on bones which promotes metabolic activities, and thus facilitates bone strength and integrity. Current research has suggested that older adults who engaged in prescribed muscle power training programs also demonstrated an increase in bone strength.

More to come on this topic ….. next month.

Author: Bob Gurney

 

Physical Activity and Health – Part II

by Bob Gurney

The previous article informs the reader to exercise/physical counselling in the medical profession. Although Physicians are very positive in their attitudes towards the importance of exercise/physical activity, some Physicians may be limited in their knowledge of the current literature and practices, and/or lack of time to discuss exercise/physical activity with patients.

To explore the role of the Physician in discussing exercise/physical activity with patients, we invite the readers to engage with the contributors of The 50 Zone in terms of providing feedback for discussion to the following questions:

1. Have you ever discussed exercise/physical activity with your Physician? If no, why? If yes, please describe your level of satisfaction?

2. Do you manage your own personal exercise/physical activity practices? If no, why? If yes, please provide a brief description of your management?

3. Do you consult with and/or receive advice from exercise/physical activity experts? If no, why?
If yes, what qualifications do the experts hold? Please describe your level of satisfaction gained from the experts.

Please submit the questions above and your answers to: fitquestions@the50zone.com

Thank-you for your participation. We will promptly respond to your answers and summarize information in the next addition of  The 50 Zone. Confidentiality of respondents identity will be maintained.

Author: Bob Gurney

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Physical Activity and Health – Part I

by Bob Gurney

In the previous article presented in ‘the 50 zone’, health providers in sports sciences and medicine were identified and described. In this article, we review challenges and solutions for health care professionals addressing strategies of physical activity in the management of patients.

The increasing burden of chronic disease places greater demands on Health Care Providers to develop and implement strategies to manage lifestyle risk factors presented by their patients. Physical activity has been identified as a prescription for managing health risk factors, however effective prescriptions and exercise management strategies are absent in rural health care. The literature has been extensive over the past few decades, claiming that prescribed physical activity has been effective in managing patients with risk factors of poor health and chronic disease. The literature and practices of exercise strategies are supportive in managing patients at risk, yet neglect the patients who would benefit from exercise/physical activity prescriptions as preventative measures prior to symptoms prompting such intervention.

Primary care may benefit from further counselling, support systems and collaboration with exercise specialists. General Practitioners, (Eley and Eley, 2009) report that there are limited resources available in rural Queensland (Australia), to support family physicians in developing exercise/physical activity prescriptions and counselling for patients. These same physicians recommend formalization of referral pathways and follow-up could be of valuable assistance to rural medical doctors in providing their patients with effective exercise/physical activity prescriptions and counselling.

Buffart and colleagues (2009) describe the literature reporting the importance of exercise and physical activity. Health benefits include a lower risk of hypertension, diabetes, cardiovascular disease, obesity, overweight, some forms of cancer, depression and many other factors that improve quality of life. Physical inactivity and a lack of exercise are recognized as a leading contributor to disease. Medical practices should be an important setting for promoting physical activity, for several reasons. First, health professionals can reach a large population because the majority of people visit a health professional at least once a year. Second, patients have identified health professionals as a credible source of information and their abilities to provide patients with referrals to address their health concerns, issues and interests. Third, health care professionals usually have a long lasting relationship with their patients, which enable them to offer long-term health management and follow-up. Fourth, a range of intervention studies and numerous literature reviews have reported that health care provider’s recommendations of patient referrals to exercise/physical activity specialists can increase the adoption of exercise by patients. The American College of Preventative Medicine takes the position that primary care health should include physical activity counseling into routine patient visits.

Aittasalo (2008) describes the attitudes of health care professionals towards exercise/physical activity counseling as being positive, and the importance of exercise/physical activity for long-term health is well acknowledged in the literature. However, the practice of providing exercise/physical activity counseling is generally low among physicians. Physicians that provide exercise/physical activity counseling neglect the use of formalized instruments, written materials, and referrals are seldom practiced. Physician counseling also lacks patient-centeredness, which is an important factor from the effectiveness point of view. The most frequently indicated barrier for not promoting exercise/physical activity to patients has been reported by physicians, indicating the lack of time. Other barriers have included the physician’s lack of skills, confidence and knowledge in the field of exercise/physical activity prescriptions and counseling. The literature acknowledges that to effectively promote and implement exercise/physical activity through the medical professions, support through pathways of patient referrals to exercise specialists is critical to the success.

References

Aittasalo, M. (2008). Physical activity counseling in primary health care.

Scand J Med Sci Sports: 18: 261-262.

Buffart, L.M, et al (2009). General practitioners’ perceptions and practices of physical activity

Counseling: changes over the past 10 years. Br J Sports Med: 43: 1149-1153.

Eley, D. and Eley, R. (2009). How do rural GPs manage their inactive and overweight patients? A pilot study of rural GPs in Queensland. Australian Family Physician. Vol. 38, No. 9, September.

Author: Bob Gurney


Professions of the Sports Medicine Team

by Bob Gurney

As a follow-up to the previous article, indicating the need to identify health care professionals in the field of sports medicine, the following questions are explored:

  1. What are the professions in health care services that have evolved into specializations and constitute the broad field of sports medicine?
  2. How are these professions defined?
  3. How do I find out more about these professions?

Common knowledge found in textbooks of sports medicine, such as Prentice (2006) provide a brief overview of sports medicine and roles the professions play in their contribution to the field of sports medicine. Sports medicine as a concept is presented in the context of various professions contributing to the health and care of sports enthusiasts, and athletes. Although some may argue that one or more particular profession(s) dominate in the practices of sports medicine, the current textbook literature clearly indicates that each profession plays an important role in the field of sports medicine. The medical doctors are indicated as the primary health care providers (Prentice, 2006) in treating injuries of sporting enthusiasts and athletes.

Specialty fields of medicine (family medicine and orthopaedists) and physical therapy are well established historically, in the treating of sports related injuries. In the second half of the twentieth century traditional professions and new fields of allied health emerged through specialized training programs and became established in the team of professions working in sports medicine (Prentice, 2006). Medical doctors expanded their specializations into a new field of ‘sports physician’, where one must complete the requirements of post graduate training in this field. The profession of physiotherapy expanded to sports physiotherapy (Prentice, 2006) which involves the development and supervision of physical therapy rehabilitation for the injured athlete. Both the medical and physiotherapy practices are viewed historically as the traditional professions that have provided care and management of the injured athlete. Podiatry evolved into sports podiatry, as a specialized field, dealing with the study and care of foot injuries. Exercise and sports science is a field that emerged in the 1970s and provides athletes with training and conditioning techniques specific to the performance demands of a sport. Psychology expanded its specialty areas to sports psychology and provides advice on matters related to mental preparation for sport performance and the psychological aspects of the rehabilitation process for the athlete. Dieticians expanded their knowledge sets into sports nutrition and provide consulting advice for dietary programs that are geared to the needs of persons in a particular sport or physical activity.

This general knowledge of understanding professions, as described above, informs us that differences exist between the traditional professions of health sciences, and modern emerging professions in the field of sports medicine. To develop a better understanding of these professions a list of professional associations and web sites are indicated below. I have selected professional groups in Australia for two reasons. Firstly, my research work involved these groups and, secondly the information provided by these professional groups is both comprehensive and informative.

Australasian Association for Podiatric Sports Medicinewww.aapsm.org.au

Australasian College of Sports Physicians: www.acsp.org.au

APA – Sports Physiotherapy Australia: www.physiotherapy.asn.au

APS College of Sports Psychologists: www.groups.psychology.org.au

Exercise and Sports Science Australia: www.essa.org.au

Sports Dietitians Australia: www.sportsdietitians.com.au/

Sports Doctors Australia: www.sportsdoctors.com.au

References

Prentice, W.E. (2006).  Arnheim’s Principles of Athletic Training. (12th ed). Toronto. ON: McGraw Hill.

Author: Bob Gurney

 

What’s Driving You…

to think and act on health opportunities for men in the 50+ age group?

by Bob Gurney

Something must have stimulated you to come to this website and seek answers to questions, and/or become aware of questions that need to be asked. You are over 50 years of age and have many questions concerning personal health and opportunities of physical activity. Although this article is limited in being able to address all your questions – here are a few questions that you may need answers to …

1.   Now that I am over 50 years of age, what health issues should I be concerned about – personal status and in terms of common health concerns connected to this age group?

2.  How valid is the health information being disseminated through the traditional media and new social media?

3.  How do I find legitimate resources to guide me through activities of good health?

4.  The health literature and promotions are overwhelming … information overload – how do I determine which path to take?

The Game Plan to addressing the above questions …

1.   Start with completing the Physical Activity Readiness Questionnaire (PAR-Q) that you can download free and print (http://www.csep.ca/english/view.asp?x=698). Also, download (free) and print the PARmedX form at the same URL site as above.

2.  Make an appointment to see your medical doctor. Show your doctor your completed PAR-Q and if advised, work collaboratively with your doctor to complete the PARmedX form. Ask questions concerning your current health and what health assessments need to be undertaken – request referrals to professionals that can provide the needed assessments.  This information will give you a good foundation to building your health – physical activity plan.

3.  Now you can start to build your health – physical activity resource team. Who do you need on your team? Your medical doctor (GP) is best to be the manager of your team, supported by Dietitian or Sports Nutritionist, Physiotherapist, Personal Trainer/Exercise Physiologist. There may be others that your Physician recommends.

4.  Other resources include searching for sport health professionals and resources through membership can be found within the Sports Medicine Council of Alberta (http://www.sportmedab.ca/).

Author: Bob Gurney


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