There's an abundance of advice, both good and bad, out in the ether regarding training and tips for improving your performance. And today we have a whole set of tools that we can use to better guide our training. But for any technique, program, or tool to be effective, we have to have an awareness of our weaknesses in order to be able to change and improve.
A 2014 study published in The Journal of Strength and Conditioning, Thigpen et.al studied the hydration profile and sweat loss perception of male and female division II basketball players. The authors studied the hydration status of the players as they arrived for practice and the hydration profiles of the athletes during practice. What the study shower was "the majority of ...collegiate basketball players report to practice in a state of hypohydration (dehydrated) and have poor ability to estimate sweat loss."
The cost in performance due to dehydration is well documented. Beginning at 1.1% dehydration, Hoffman et al. demonstrated a 16.5% drop in jumping power during 30sec. tests. At a 2.5% dehydration level, Bosco et al. demonstrated a 5.3% drop in muscular strength. The data is clear, dehydration affects performance, strength, power, high-intensity endurance, and cardiac output. But, if you don't know you're dehydrated, how can you know just how strong you could have been?
In order to get the most out of your training, develop a hydration strategy. Know that most people will lose at least 2 liters of water a day just being alive. That has to be replaced. If you drink coffee or other diuretics your basic water needs increase. Develop a practice of weighing yourself before and after training sessions. Athletes that estimate water loss through sweat greatly underestimate their level of dehydration. Show up for training fully hydrated, even hyperhydrated. Begin by drinking one half to one liter of water 1 to 2 hours before practice. Remember that in the Thigpen study, a majority, 2 out of 3 players showed up to train dehydrated! Actively replace fluids during practice and in competition. If you leave this to chance, you will become dehydrated and you will loose capacity to perform. Make hydration a part of your performance strategy. After practice, get lost fluids into your system as quickly as possible.
Hydrus Performance Concentrate is designed to get fluids into your system faster and works to prevent fatigue! Hydrus re-hydrates at a rate up to 8 times better than other oral re-hydration solutions. On game day there is one factor that you control that if neglected will drain you and leave you wondering where all that hard work went. Get a hydration strategy in your game plan, and make Hydrus part of your program.
Wednesday, March 30, 2016
Friday, January 15, 2016
Dear Mr. Dad, You missed your chance to be a dad!
I had the pleasure of attending a grade 3-6 recreation league wrestling match between Granville and Watkins Memorial last night with my wife. We live in Granville and my wife teaches in the Watkins school district. We knew many of the kids competing. I left practice at Ohio State where I get to work with a world champion, 4 time NCAA champion and many others that I anticipate being in the finals in Madison Square Garden this year, it was refreshing to go see the sport at it's seed stage. Besides seeing some really cute kids win and lose, an observation of a parent really disturbed me. Enough to write this.
Early in the duel meet a young boy walked out to what I think this could have been his first match, if not he didn't have 5 under his belt yet. He was excited, and I noticed his father helping him to prepare and sending him out. The match started and the young boy was thrown directly to his back. Now lets be clear, this happened to at least 10 kids that night, this is rec wrestling. His father yelled to get off his back loudly, to no avail, tonight's match ended in a rather quick pin. This is where Mr. Dad, you missed an opportunity. The young wrestler was upset. When he walked to you, he was not greeted with love and understanding, he was given a reaction of disgust. You didn't want to console or process the match, you pushed him towards his team mates and tossed his t-shirt at him. It was obvious that you were disappointed and had higher expectations for your son.
So, Mr. Dad, I hope you get to read this because I don't want you to miss out on anymore opportunities. These opportunities come quickly and will pass amazingly fast. My daughter began her athletic carrier the same as your son in Granville Rec wrestling, and lost in much the same way. But the difference is that when she returned to her mother and I, there was no doubt in her mind that win or lose, we would never be disappointed with the outcome of an event. Our love is for her, and we support her willingness to explore beyond her boundaries. Losses are opportunities to coach and parent. As my daughter has grown, without-a-doubt, the greatest privilege I have is watching her practice and compete. There is nothing I enjoy more. The season in 8th grade when I was afforded the privilege to coach her and her friends, priceless. As a coach, your athletes have to know you love them, regardless of outcome. My daughter is leaving next year to attend a D1 school and compete athletically. I'm confident, had I greeted her in the same manner as you greeted your son, she wouldn't be in sport today.
Another point of reference, I was privileged to compete at a D1 school in wrestling and was quite successful there. The experience has defined my life. But, my athletic career didn't start out like gang busters. I didn't win my first varsity match until my junior year in high school. In fact, I cried every day in practice as a freshman. But while the experience on the mat may have been disappointing, I knew regardless of the outcome, I was loved, my parents knew losing was part of the growth process, and I knew that I was loved. One time during my senior year in high school as I finished my warm up, to look up to the end of the gym to see my dad standing there in dirty Carhartt's covered in coal dust. My parents worked opposite shifts in order to see that one of them was home with us at all times. My dad was a coal miner and it would have been easy for him to miss my match, he was working. But my dad would schedule his lunch break so he could drive to the school, slip in to see me wrestle, and then go to work and finish his shift. I learned my love and true understanding of sport from the love of my mother and father. I lost a lot, but my dad never missed a chance to be a dad. Mr. Dad, you still have a chance.
I'm attending the funeral of my college coach this week. It's been a difficult time reflecting on our relationship. But as I reflect, and as I think, I want to pass along another story. As I said earlier, I was quite successful as a wrestler in college, eventually qualifying for the national tournament my senior year. I was the only wrestler on my team to qualify that year. My coach didn't attend the nationals with me. He choose to stay home and see his son compete in the state high school tournament. I was quite salty about this for quite a while after. It wasn't until I had my own child and began to watch her compete that it I was able to truly appreciate the sacrifice my coach made for me. I can't imagine missing one of my daughters events. But what dawned on me was that my coach was missing most his own kids events while coaching us. What I've come to understand is that he was giving me more than his own sons and daughter. He made a huge personal sacrifice for me and my teammates. I was privileged to have great role models in parents and coaches. The value of being that father who nurtures your son through life has nothing to do with the number of wins and losses. It has everything to do with how you respond! Please don't miss this opportunity again. It's priceless!
Friday, January 1, 2016
Slaying the 3-headed Monster: Weight cut, fatigue and dehydration.
In my last post I addressed the challenge of keeping key
metabolic hormones in check during your weight-cutting period. This blog segment
focuses on taking down your hidden competitor: Fatigue. And more specifically,
how dehydration empowers fatigue, pushing much of the progress and improvement
you’ve trained for completely out of reach.
Sport scientists define fatigue as a decrement in the force
output of a muscle. Psychologists see fatigue as a ‘sensation’ of
tiredness. And physiologists define fatigue as the failure of a specific
physiological system. Consider that exercise is terminated at exhaustion—and
not at a point of fatigue. It is widely accepted that fatigue is a safety
mechanism that has evolved to prevent injury or death by means of overreaching.
But regardless of how you define it, fatigue is something we all fight with;
and regardless of physical and mental preparation, fatigue will always be
present.
What causes fatigue?
There are many things that can cause fatigue, not the least
of which is engaging in a work event that is beyond your capacity. This
type of fatigue is caused by our body’s inability to deliver the necessary
oxygen or nutrients in the blood to the working muscles. This is why we
train: To increase that capacity. But even if we have trained to, and
have the ability to do the necessary work, other factors can creep in and block
our ability to accomplish our goals.
Hydration levels have a direct impact on the blood volume and contribute to
success and failure rates.
Researchers have identified fatigue mechanisms that
originate in the neuromuscular system. These seem to be protective
systems in the body that can originate as high as the brain in the central
nervous system. Research has shown that in some athletes this level of
fatigue can limit work output by up to 32%. Researchers are not clear on
all of the factors that contribute to this “central governor” fatigue model,
but some that have been clearly shown are an imbalance in electrolyte
concentrations, and the brain perception of a lack of fuel. The ability
to replace key electrolytes and, in-turn, draw water into the blood plasma, is
an important part of strategic rehydration.
Research suggests that sweeter isn’t necessarily better.
In fact, scientists have shown that just sensation of sweetness in the mouth—not
glucose itself—will dampen the fatigue effect. In various studies,
athletes were asked to “swish the fluid around in the mouth, then spit it out.”
Those athletes saw an increase in performance versus those who merely drank
water. Other studies using sugar have also shown that more is not really
“more.” Athletes consuming concentrations as low as 2% have had similar
exercise times to failure as those consuming 18% concentrations. In
another interesting study, athletes were given glucose through an IV; those
athletes saw no improvement in performance over water alone. This is an
area that needs more research, but for now, be confident that a little
sweetness goes a long way.
Our brains monitor hydration levels closely. Because the brain interprets dehydration as stress, it triggers a drop in performance. Too much dehydration triggers production of stress hormones. The brain will limit the number of muscle fibers you can recruit. Remember, a drop in total body water causes a drop in blood plasma volume, which limits the body’s ability to deliver nutrients to the muscles. We see this in combat sports like boxing and wrestling and it’s been documented in sports as diverse as triathlons. Many times hydration is a consideration of safety. Dehydration can lead to cramping, exhaustion and even death due to heat stroke. But long before we get to the point of illness, dehydration is contributing to fatigue and limiting performance. The takeaway: Be sure to harvest all the hard work you’ve done leading up to your event by keeping the opponent of fatigue on the bench. Stay hydrated!
Wednesday, December 2, 2015
Cutting Weight in Wrestling: A Tale of Two Hormones.
Wrestling is hard! It is perhaps the most difficult sport for which to prepare: Wrestling requires athletes to be both strong and fast with great endurance; to possess the flexibility of a gymnast and the ability to prepare technically and tactically for all opponents. Great wrestlers aren’t just well rounded; they must be exceptional at all physical and mental aspects of their game. To make it even harder, the process of cutting weight adds a challenge and stress to wrestling that most other athletes never experience.
In order to be prepared, wrestling has no off season. As soon as the competitive season ends, preparation for the next begins. The off season is dominated by strength and conditioning work. Wrestlers building their bodies, increasing strength and muscle mass to prepare the largest body possible to enter into their weight class. A huge price is paid for every ounce of muscle--wrestlers can’t afford to give that away with poor weight cutting practices. It’s important to understand, that when weight is cut properly, the wrestler can gain a competitive advantage. But done wrong, hours of hard work go down the drain.
Cutting weight correctly gives a wrestler an advantage. It involves two elements: (1)stripping out as much fat as possible and (2) wrestling lean, with short-term dehydration to accomplish the rest.
In order to strip or use body fat, athletes must understand the role of the hormone insulin. Insulin is the dominant hormone involved in fat storage or usage. When insulin is low, stored fat can be used for fuel. When insulin is high, the body will not release fat for fuel, it will simply try to store more fat. The key to lowering insulin is lowering the glycemic index of the food and fluid you consume. If you’re a wrestler cutting weight, you should eliminate refined sugar products from your diet. Drinking sugar-based products (including popular sport drinks and protein bars) is completely counter productive. Not only is the sugar creating a strong insulin response, it passes through the stomach quickly providing no appetite satiation. Being hungry and burning up your valuable protein stores is no way to cut weight and win.
Many wrestlers can successfully dehydrate for short periods of time (less than 24 hours), rehydrating following weigh-in with no remarkable impact on performance. The key, though, is to keep the dehydration period as short as possible. When you dehydrate for longer periods, you body produces another hormone called vasopressin. Vasopressin causes the kidneys to restrict water loss. Your body views this as stress and will not only restrict water loss through urine and sweat, but will also begin to regulate the amount of energy your can produce, causing fatigue and sluggish performance. Being fully hydrated at the time of competition is important. It’s also important to be fully hydrated throughout your training.
Hydrus Performance Hydration Concentrate hits the two things wrestlers need to be lean and fully hydrated at the time of competition. Hydrus has no sugar! No sugar means no insulin response from Hydrus and you stay in fat burning mode longer. When you’ve made weight and it’s time to re-hydrate, Hydrus’ exclusive NanosomeTM Technology provides higher electrolyte and water absorption—"5x and up to 8x more effective"*—than traditional hydration products. That means more water to the cells and your back to full strength at match time.
Bad weight cutting causes you to lose muscle and lose energy. For optimum performance and weight management, the key is to eat a diet high in lean proteins and good fats with low glycemic index carbohydrates which means no sugar.
Friday, June 12, 2015
The Cost of Coach's Bad Communication
As athletes, we invest our soles and, according to researchers, on the average of 10,000 hours of deliberate practice to achieve excellence. As high school coaches we trade time with our families and leave part of ourselves preparing our athletes. As college coaches we pay our bills with the vocation, but our investments in the athletes begin to climb financially too. As professional coaches, our organizational investment in our athletes is beyond belief. This article very elegantly addresses how all of those investments can be vaporized with a single athlete/coach mis/mal-communication. I've excerpted several portions of the article Coaching communication issues with elite female athletes: Two Norwegian case studies Kristiansen 2012 Scandinavian Journal of Medicine & Science in Sports. This is an important read for any coach.
"An important aspect of the coach-elite athlete relationship is to produce enhanced performance and success in elite competitions."
"while communication may seem to be working well from the coach's perspective....athletes often disagree. It is the perceived ineffective communication that may become a major source of strain for elite athletes."
"Coaching is more than talking....it is 'a set of strategies designed to increase a coach's ability to influence the behavior of others more effectively."
"A good coach must be able to see each athlete as a unique persona and adapt his/her performance enhancement system to each athlete's particular needs."
"Part of the demand placed on the athletes was the expectation that they would become '24-hour-athletes." "They went from 'deliberate play' to 'deliberate practice' in one ..jump."
"It was all about 'you follow the routine or you are out of the team.' They would not accept my views...I was labeled difficult and unwilling to work hard."
"finding the right training strategies is very demanding."
"A good coach is characterized by the understanding that "different athletes require different things from their coaches at different points in their careers."
"Having several coaches may negatively affect communication if the roles are unclear within the teams..."
"Different coaches did not seem to talk together about the total training load."
The athletes "perceived that they were the problem and not their interpretation of the training load to which they were assigned: the more they asked, the less they were listened to and they then become difficult "problem athletes'"
"their experiences are not unique. There is documented evidence that a lack of knowledge and awareness of risky strategies may be detrimental to the long-term development of athletes."
"It was quite clear...that they experienced demotivation when they perceived that they were failing to achieve the training load criteria of the coaches. And when their performance also deteriorated, then this was even more demotivational. In the motivational literature, it is recommended that for long-term development and persistence, athletes should have internal criteria of success."
"A mindful organization will notice novel events quickly, such as when an athlete is struggling with recovery. NGBs should have routines that will lead to critical self-reflection, learning, and action. In the sport context, the ability to differentiate between being tired and being in the early stages of burnout may be analyzed by these principles."
"The opposite of being mindful is being mindless. The is a behavior characterized by being rule and routine governed and on autopilot. Hence, to treat all athletes the same way may be considered a mindless behavior."
Sunday, December 16, 2012
Energy Systems - What we can learn from wrestlers cutting weight
ENERGY SYSTEMS - WHAT WE CAN LEARN FROM WRESTLERS CUTTING WEIGHT.
There has been a great deal of discussion regarding energy systems and their application to strength and conditioning coaching. I’ve had an interesting case in my facility over the past three months that I’d like to share.
I’ve had two wrestlers from our local high school team in training with me this fall and winter. These are two kids wrestling adjacent weight classes, but getting to their weights have been divergent journeys. The two athletes began training with me about 6 weeks prior to the start of wrestling season. The lighter of the two wakes up every day within a pound of his weigh class at a natural 5-6% body fat. The heavier, has had to cut about 20 lbs to get to weight. The process has required a very structured eating plan with workouts that have led to and average weight loss of two percent of body weight per week. The two have participated side-by-side in team based training and condition since the beginning of the wrestling season with the only difference in training being the additional work the heavier wrestler has been putting in at my facility following practice 3 days a week and on weekends they’ve not been competing, or morning runs. Additional workouts have averaged 4 per week.
When the two began training they were both power tested. The testing protocol included a power at anaerobic threshold test using a SCIFIT Pro II ergometer and Zephyr Bio harness. I also measure maximum 10 second power output, also using the SCIFIT Pro II. Results of the test are collected using ViA Performance Systems KeyMaster/PowerGraph Software.
The entry testing points included:
Lighter Wrestler Wt. 122 lbs
Peak Wattage 220 watts @ heart rate of 202
Anaerobic Threshold 150 watts @ Heart rate of 178
Heavier Wrestler Wt. 150 lbs
Peak Wattage 180 watts @ heart rate of 182
Anaerobic Threshold 160 watts @ heart rate of 166
The two wrestlers were re-tested during Christmas break.
Lighter Wrestler Wt. 122 lbs
Peak Wattage 230 @ heart rate of 195
Anaerobic Threshold 170 watts @ heart rate of 184
Heavier Wrestler Wt. 135
Peak Wattage 270 watts @ heart rate of 178
Anaerobic Threshold 240 watts @ heart rate of 167
I believe there are two points that coaches need to glean from this example. 1. If you were to only look at the absolute improvement numbers of the two athletes, it looks like one is out working the other. This assumption is true, but the type of work being done is critical. When you look that the energy system component portion of the improvement, both athletes saw around a 4% (10 watts) improvement of total energy output being contributed by high energy (anaerobic) sources. This makes sense when you review the practice habits of wrestlers in general and in particularly this team. Conditioning to this coach is wrestling live, intense intervals and sprinting. And a nearly 5% improvement of energy output in 10 weeks of training is admirable.
But the most impressive thing to learn is the potential that exists when athlete does focus on individual energy systems development. The only difference in the two athletes training was the heavier wrestlers completion of additional low-level (aerobic) training sessions. These sessions were either work load or heart rate limited. When the wrestler was running the morning his was restricted to a heart rate limit of 160. He would wear a heart rate monitor and brought it to me to download and make part of his record. When he trained in my facility, his work loads were programmed to be at or below anaerobic threshold levels and heart rate tracked. That sub-threshold training yielded a power improvement of 80 watts which came from growth in the aerobic (sub-threshold) system.
Two athletes training side-by-side in practice. One on borderline starvation (<1400 Kcal/day) diet. But the athlete who is shrinking, is actually improving power to half again as much as when he started the program.
The new rules regarding weight loss in wrestling are good! But they’re changing more than just weight loss practices. We have to pay attention to what the weight loss practices of the past did for an athlete’s conditioning. Wrestlers who used to cut big weight would do at least two additional workouts per day more than their at-weight team mates. We would put on plastics and sweats in the morning and at night and do a “light” run or jump rope session. We worked just hard enough to break a sweat, we thought we were just cutting weight. What we didn’t know at the time was that we were building low level energy systems! This is a major change in the sport and strength and conditioning coaches need to be cognisant of the entire training portfolio of an athlete.
I’ve had two wrestlers from our local high school team in training with me this fall and winter. These are two kids wrestling adjacent weight classes, but getting to their weights have been divergent journeys. The two athletes began training with me about 6 weeks prior to the start of wrestling season. The lighter of the two wakes up every day within a pound of his weigh class at a natural 5-6% body fat. The heavier, has had to cut about 20 lbs to get to weight. The process has required a very structured eating plan with workouts that have led to and average weight loss of two percent of body weight per week. The two have participated side-by-side in team based training and condition since the beginning of the wrestling season with the only difference in training being the additional work the heavier wrestler has been putting in at my facility following practice 3 days a week and on weekends they’ve not been competing, or morning runs. Additional workouts have averaged 4 per week.
When the two began training they were both power tested. The testing protocol included a power at anaerobic threshold test using a SCIFIT Pro II ergometer and Zephyr Bio harness. I also measure maximum 10 second power output, also using the SCIFIT Pro II. Results of the test are collected using ViA Performance Systems KeyMaster/PowerGraph Software.
The entry testing points included:
Lighter Wrestler Wt. 122 lbs
Peak Wattage 220 watts @ heart rate of 202
Anaerobic Threshold 150 watts @ Heart rate of 178
Heavier Wrestler Wt. 150 lbs
Peak Wattage 180 watts @ heart rate of 182
Anaerobic Threshold 160 watts @ heart rate of 166
The two wrestlers were re-tested during Christmas break.
Lighter Wrestler Wt. 122 lbs
Peak Wattage 230 @ heart rate of 195
Anaerobic Threshold 170 watts @ heart rate of 184
Heavier Wrestler Wt. 135
Peak Wattage 270 watts @ heart rate of 178
Anaerobic Threshold 240 watts @ heart rate of 167
| Peak | A.T. | |||||
| test | Wt | Watts | Heart Rate | Watts | Heart Rate | |
| lighter | 1 | 122 | 220 | 203 | 150 | 179 |
| 2 | 122 | 230 | 195 | 160 | 184 | |
| diff | +10 | +10 | ||||
| heavier | 1 | 150 | 180 | 182 | 160 | 166 |
| 2 | 135 | 270 | 178 | 240 | 167 | |
| -15 | +90 | +80 |
I believe there are two points that coaches need to glean from this example. 1. If you were to only look at the absolute improvement numbers of the two athletes, it looks like one is out working the other. This assumption is true, but the type of work being done is critical. When you look that the energy system component portion of the improvement, both athletes saw around a 4% (10 watts) improvement of total energy output being contributed by high energy (anaerobic) sources. This makes sense when you review the practice habits of wrestlers in general and in particularly this team. Conditioning to this coach is wrestling live, intense intervals and sprinting. And a nearly 5% improvement of energy output in 10 weeks of training is admirable.
But the most impressive thing to learn is the potential that exists when athlete does focus on individual energy systems development. The only difference in the two athletes training was the heavier wrestlers completion of additional low-level (aerobic) training sessions. These sessions were either work load or heart rate limited. When the wrestler was running the morning his was restricted to a heart rate limit of 160. He would wear a heart rate monitor and brought it to me to download and make part of his record. When he trained in my facility, his work loads were programmed to be at or below anaerobic threshold levels and heart rate tracked. That sub-threshold training yielded a power improvement of 80 watts which came from growth in the aerobic (sub-threshold) system.
Two athletes training side-by-side in practice. One on borderline starvation (<1400 Kcal/day) diet. But the athlete who is shrinking, is actually improving power to half again as much as when he started the program.
The new rules regarding weight loss in wrestling are good! But they’re changing more than just weight loss practices. We have to pay attention to what the weight loss practices of the past did for an athlete’s conditioning. Wrestlers who used to cut big weight would do at least two additional workouts per day more than their at-weight team mates. We would put on plastics and sweats in the morning and at night and do a “light” run or jump rope session. We worked just hard enough to break a sweat, we thought we were just cutting weight. What we didn’t know at the time was that we were building low level energy systems! This is a major change in the sport and strength and conditioning coaches need to be cognisant of the entire training portfolio of an athlete.
Fitness and P4 Medicine
FITNESS AND P4 MEDICINE
OK fitness professionals, have you heard of P4 medicine yet? If you haven't, you need to get up to speed! A quick Google search will tell you a lot. P4 stands for Predictive, Preventive, Personalized and Participatory. A fitness pro's groin should be quaking at this point.
One web site states:
I read a great book over the holidays, "What Got You Here Won't Get You There." Keep that title in mind! The opening chapter of the book starts with:
The evidence is that at least 80% of our population is so in-active that hypoactiviity is contributing to increased morbidity and mortality equivalent to smoking a pack of cigarettes a day. And medicine has chosen to treat the diseases of chronic inactivity like diabetes, hyper-tension and arthritis with chemicals. And who can blame them, the face of fitness is CrossFit, P90X, BowFlex, Treadclimbers, VO2 max tests, body fat assessments. These tools of the enthusiasts, frankly scare the not-yet-fit friends of ours. When a non-enthusiast walks into our glass windowed, high-designed, over optioned, hundreds of choices fitness spaces, it's like a babe in the jungle experience for them. They will order the P90X dvd's, but plugging them in, following them, they wind up drawing dust. We have to offer our not-yet-fit brothers and sisters other avenues of entry into the fitness lifestyle and I believe P4 is one of those avenues.
Physicians, fitness is a behavior issue first, and a physiological marker second. Approach the integration of fitness into your practice in that manner. Great tools exist for the assessment of an individual's
stage-of-change relative to physical activity and healthy eating. (http://www.uri.edu/research/
Next use in-office physiological tests that stand a chance of "connecting" to your patients and result in motivation and behavior change. The information provided by the tests must be relevant to the goals and objectives of the patient. VO2 only means something to freaks like us. I can turn on CNBC or Bloomburg during the week and see a million terms and numbers that while important to someone, mean very little to me. If I had to learn them to invest my money, I'd wind up keeping it all in a ball jar in the back yard. That's the effect we have on everyone else with our current fitness assessments. We have to offer "mutual fund" assessment and exercise. I would suggest using the results of the stage-of-change assessment to direct your next steps in physiologic testing. Graded exercise testing should be reserved for those in the Action or Maintenance stage. For those who are in either pre-contemplation, contemplation, or early preparation, use simple heart rate variability test whose results will provide an opportunity to discuss activity volume and intensity. If someone is symptomatic or risk qualified for a stress test, the stress test results will provide the same opportunity. The other physiologic test that can be completed in a medical office environment and will be beneficial is the use of a 4 point BIA body composition assessment. But how the results are presented to the patient are important! I am going to write in an upcoming post about how the goal of weight loss is one of the biggest reasons fitness is failing. But for now, report the results of the BIA in terms of volume of lean mass (how big is your motor) and the ratio of stored energy to lean mass. These are terms that will motivate activity and behaviors that promote healthy patients. At the end of the day, measure the success of your program by how much more your patients are moving!
If your a fitness professional, P4 medicine is one of the opportunities we've been waiting for that provides a real connection between medicine and fitness. If you would like to learn more about systems that can help deliver the kinds of programs discussed here, feel free to contact us. If your a physician, there are great exercise professionals that can help you deliver quality, integrated fitness as part of your practice. If you would like some help doing so, let us know, we can help.
Thanks for your time and consideration,
Don Moxley
One web site states:
"Today's medicine is reactive: we wait until someone is sick before administering treatment. Medicine of the future will be predictive and preventive, examining the unique biology of an individual to assess their probability of developing various diseases and then designing appropriate treatments, even before the onset of a disease. Today's medicine is also myopic: we use only a few measurements to diagnose disease and are generally unable to make fine distinctions between individuals or between subtle variations of the same disease. Medicine of the future will use more sophisticated measurements, as well as more measurements overall, thereby yielding accurate health assessments for truly personalized treatments."I know I'm preaching to the choir here, but lets review:http://www.systemsbiology.org/intro_to_isb_and_systems_ biology/Predictive_Preventive_ Personalized_and_Participatory
"Regular physical activity, fitness, and exercise are critically important for the health and well being of people of all ages. Research has demonstrated that virtually all individuals can benefit from regular physical activity, whether they participate in vigorous exercise or some type of moderate health-enhancing physical activity. Even among frail and very old adults, mobility and functioning can be improved through physical activity. Therefore, physical fitness should be a priority for Americans of all ages. ...physical activity has been shown to reduce the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure."http://aspe.hhs.gov/health/reports/physicalactivity/
I read a great book over the holidays, "What Got You Here Won't Get You There." Keep that title in mind! The opening chapter of the book starts with:
"You know those maps in shopping malls that say, "you are here"? they exist to orient you in unfamiliar territory, to tell you where you are, (help show you) where you want to go, and how to get there. A few people never need these maps. They're blessed with an internal compass that orients them automatically. They always make the correct turn and end up where they intend via the most economical rout. Some people actually go through life with this unerring sense of direction. It guides them not only in shopping malls but in their school years, careers, marriages, and friendships. When we meet people like this, we say their grounded. They know who they are and surprises will only be pleasant surprises. The are our role models and heroes. ... What all of these role models have in common is an exquisite sense of who they are, which translates into perfect pitch about how them come across to others. A few people never seem to need any help in getting to where they want to go. They have a built-in GPS mechanism."We refer to these people with the "built in GPS" in the fitness world as "enthusiasts." The fitness industry has done a great job of creating spaces for "enthusiasts" to play. We sell them a $19 a month membership and forget about them. Some of them are so enthusiastic they invest a portion of their disposable income in us, professionals, in return for our guidance, leadership, but primarily in return for friendship and companionship. The point is that the only successful fitness participants are the enthusiasts, those with the built in GPS.
The evidence is that at least 80% of our population is so in-active that hypoactiviity is contributing to increased morbidity and mortality equivalent to smoking a pack of cigarettes a day. And medicine has chosen to treat the diseases of chronic inactivity like diabetes, hyper-tension and arthritis with chemicals. And who can blame them, the face of fitness is CrossFit, P90X, BowFlex, Treadclimbers, VO2 max tests, body fat assessments. These tools of the enthusiasts, frankly scare the not-yet-fit friends of ours. When a non-enthusiast walks into our glass windowed, high-designed, over optioned, hundreds of choices fitness spaces, it's like a babe in the jungle experience for them. They will order the P90X dvd's, but plugging them in, following them, they wind up drawing dust. We have to offer our not-yet-fit brothers and sisters other avenues of entry into the fitness lifestyle and I believe P4 is one of those avenues.
Physicians, fitness is a behavior issue first, and a physiological marker second. Approach the integration of fitness into your practice in that manner. Great tools exist for the assessment of an individual's
stage-of-change relative to physical activity and healthy eating. (http://www.uri.edu/research/
Next use in-office physiological tests that stand a chance of "connecting" to your patients and result in motivation and behavior change. The information provided by the tests must be relevant to the goals and objectives of the patient. VO2 only means something to freaks like us. I can turn on CNBC or Bloomburg during the week and see a million terms and numbers that while important to someone, mean very little to me. If I had to learn them to invest my money, I'd wind up keeping it all in a ball jar in the back yard. That's the effect we have on everyone else with our current fitness assessments. We have to offer "mutual fund" assessment and exercise. I would suggest using the results of the stage-of-change assessment to direct your next steps in physiologic testing. Graded exercise testing should be reserved for those in the Action or Maintenance stage. For those who are in either pre-contemplation, contemplation, or early preparation, use simple heart rate variability test whose results will provide an opportunity to discuss activity volume and intensity. If someone is symptomatic or risk qualified for a stress test, the stress test results will provide the same opportunity. The other physiologic test that can be completed in a medical office environment and will be beneficial is the use of a 4 point BIA body composition assessment. But how the results are presented to the patient are important! I am going to write in an upcoming post about how the goal of weight loss is one of the biggest reasons fitness is failing. But for now, report the results of the BIA in terms of volume of lean mass (how big is your motor) and the ratio of stored energy to lean mass. These are terms that will motivate activity and behaviors that promote healthy patients. At the end of the day, measure the success of your program by how much more your patients are moving!
If your a fitness professional, P4 medicine is one of the opportunities we've been waiting for that provides a real connection between medicine and fitness. If you would like to learn more about systems that can help deliver the kinds of programs discussed here, feel free to contact us. If your a physician, there are great exercise professionals that can help you deliver quality, integrated fitness as part of your practice. If you would like some help doing so, let us know, we can help.
Thanks for your time and consideration,
Don Moxley
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