Midfoot Running Miracles

Posted on February 17, 2012 by Dr. Katherine Hartmann

Benefits of non-heel-strike running continue to appear in the research literature. The topic was ignited in 2010 by Harvard engineer Daniel Lieberman’s high profile scientific publication elegantly documenting that heel strike running generates greater collision forces to be transferred to the joints and results in a faster rate of loading of those forces with less compliance (shock absorption) with the impact. In essence heel strike running is a set up for injury. The force of the road is moving in one direction and the force of the body in direct opposition – each forward step is applying the brakes. This transfer of forces occurs despite the elevated cushioned heel in modern running shoes.

Habitually barefoot runners don’t heel strike. They land on the fore-foot to midfoot. This is not the ball of the foot, as in Pose running, but a smooth transition from just in front of the arch through to complete midfoot contact. Lieberman’s team carefully builds the argument that habitually barefoot runners are likely running in the form that is most natural for the body. The implication is not that we all run barefoot but that we transition to the fore/midfoot.

What is required to make the transition from heel strike to midfoot? First an appreciation that heel strike results from inter-related factors. To heel strike, runners use the full leg as a pendulum swinging the lower leg ahead of the body for the heel to land first. This is accomplished by 1) push off using the calf muscle and hamstrings as the rear foot leaves the ground, 2) dorsiflexion of the foot, lifting the toe and keeping the foot near a right angle with the lower leg, using the muscle along the front of the calf, 3) engagement of the hip flexors, and 4) recruitment of the quadriceps in the anterior thigh for lift. This is done in concert to extend the leg and foot ahead of the body – much of stride length is in front of the runner. In order to swing the leg forward, running posture with heel strike is relatively vertical. With midfoot strike the majority of the stride is behind the runner. Push off, dorsiflexion, and muscle use to maximize forward swing are not required. Momentum is obtained not by “power running” – pushing off and pulling the body forward – but through a lean that begins in the ankles and exploits gravity.

Danny Dreyer, the originator of the best know midfoot training program, ChiRunning, notes that we need look no further than the playground to see beautiful midfoot running in motion. Young children naturally exploit the lean, land on midfoot, and achieve economy of motion. Midfoot running engages the core more than the leg. To successfully make the conversion runners need to create an alignment so that the entire frame of the body is available to support the foot strike rather than having the foot lead the body. Initially a shorter stride (with normal cadence) and a sense that the legs flow out behind the body as the lean pulls one forward are the focus. With basic instruction and video review of one’s gait, virtually all runners can make the conversion to midfoot in a single day. With the conversion they immediately report less muscle work, joint pressure, and effort of running. Within weeks many are extending mileage and most clocking better times. With a modest investment in learning new form the promise of “painfree running for life” seems plausible. One elite athlete who had given up running from injury offered that mastering the midfoot “feels like a miracle.”

K. Hartmann, MD, PhD

khartmann@thedelta.com

References:

Lieberman D. What we can learn about running from barefoot running:  an evolutionary medical perspective. Exercise and Sport Science Reviews,  Jan 2012. [Epub ahead of print] PMID: 22257937

Diebal AR, Gregory R, Alitz C, Gerber JP. Effects of forefoot running on chronic exertional compartment syndrome: a case series. International Journal of Sports and Physical Therapy, December 2011;6(4):312-21. PMID: 22163093

Lieberman D, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runner. Nature, January 2010; 463(28):531-36. PMID: 20111000

Dreyer, D. and Dreyer, K. Chi Running. Simon and Schuster, New York, New York; 2009.

 

 

 

Posted in Aerobic activity, Fitness, Running, Walking | Tagged , , , , , , , , , | Leave a comment

Fall in Love with Intervals

Posted on February 14, 2012 by Dr. Katherine Hartmann

Intervals are a sweetheart. Compared to steady state endurance exercise, intervals deliver:

  • Greater fat oxidation (i.e. fat burning as an energy source) during exercise.
  • Physiologic improvements in measures like efficiency of oxygen use within two weeks of initiating interval training.
  • Improved blood glucose levels after meals, including in those with Type 2 diabetes.
  • Ability to customize to fitness level – just lengthen recovery time between intervals.
  • Sustained elevations in metabolic rate for hours after the interval training session.
  • Higher calorie expenditure for the same duration of exercise.
  • Ease of adapting almost every steady state exercise (running, swimming, elliptical, stairmaster, etc.) to interval-style sessions.

What’s not to love? You can get more benefit from shorter exercise sessions, and if you want to keep your work-out time the same, you can get even more rewards.

Research evidence consistently shows benefits in measures of function and athletic performance. For example, fit young women were found after only seven session of HIIT training over two weeks to consume 36% more fat as an energy source during steady state exercise than they did before they began interval training. Effects are also dramatic among those just starting fitness training who have been sedentary and for those who are overweight or obese with and without diabetes.

University of Nebraska researchers provide detailed physiologic data from evaluation of 12 adult athletes (7 men and 5 women) that suggests shorter intervals at 90% maximal effort result in: 1) more energy expenditure as measured by total and maximal oxygen consumption, 2) less lactic acid build up, and 3) ability to continue high intensity intervals for a longer period of time. They evaluated all four combinations of common high intensity interval training parameters: short interval length (30 second) vs. long (3 minutes) along with 90% maximal effort vs. 100% maximal effort. In each instance, the shorter intervals were superior to longer; and modestly less intense, 90% effort, superior to 100% effort.* Overall, the combination of shorter and 90% was superior to the other three possible combinations.

Take home: while longer intervals at maximal intensity are often viewed as more challenging and effective for training, the capacity to extend the workout session and maximize aerobic/anaerobic training benefit while minimizing muscle fatigue and delayed soreness may be better for short intervals. When you are getting started sustain a short interval (15, 20, or 30 seconds) and then allow your heart rate to return to the 120s to 130s.* Once returned to that recovery zone launch into the next interval. Make record of what your recovery time requirement is and work over time to lengthen high intensity intervals to 30 seconds (for instance sprint for a block followed by jogging). Shorter recovery time will be a natural by-product of HIIT and you can track your progress by how rapidly you are able to adapt during a 8 to 10 week period of doing HIIT 2 to 4 times a week. But don’t go crazy – some endurance training, resistance training, and real recovery days are both part of a well-rounded training plan.

So get out the timer and add some intensity – you’ll love it.

K. Hartmann, MD, PhD

khartmann@thedelta.com

* This blog is not intended to provide medical advice.  Consult with your care providers and trainers to plan an appropriate program to help you reach you fitness and performance goals.

Selected References

Gibala MJ, Little JP, Macdonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease. Journal of Physiology. jphysiol.2001.224725; epub ahead of print January 30, 2012.

Zuniga JM, Berg  K, Noble J, Harder J, and colleagues. Physiological responses during interval training with different intensities and duration of exercise. Journal of Strength and Conditioning Research; May 2011; 25(5): 1279-1284

Gibala MJ, McGee SL. Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain? Exercise and Sport Sciences Reviews. 2008; 36(2):58–63.

Talanian JL, Stuart D. R. Galloway, George J. F. Heigenhauser, and colleagues. Two weeks of high intensity aerobic high intensity exercise in women increases the capacity for fat oxidation during exercise. Journal of Applied Physiology; 2007;102:1439-1447.

Posted in Aerobic activity, Energy, Fitness, Interval Training, Metabolism, Research Evidence | Tagged , , , , , , , , | Leave a comment

Breakfast is Non-Negotiable

Posted on February 2, 2012 by Dr. Katherine Hartmann

More than one in five Americans skips breakfast. Regularly eating breakfast can help prevent weight gain, enhance weight loss, promote maintenance, and facilitate loss of body fat from training. If you are not in one of the those groups you can quit reading.

If the evidence supports breakfast why do health and fitness magazines convey different levels of enthusiasm?

Three factors influence interpretation of this research: 1) not all breakfasts are created equal; 2) studies examine different health effects; and 3) there is a fundamental difference between evaluating those who make a pattern of eating a healthy breakfast versus evaluating the effectiveness of instructions to do so. Last point first, the randomized trial of breakfast with the longest follow-up (6 months) was done within a weight loss study that did not have targets for exercise. The study hinged on a 1200 kcal diet and modification of eating habits. Those randomly assigned to eat breakfast had the best results if they previously were a breakfast skipper. Among all women assigned to eat breakfast every day, adherence was not directly reported, but the group as a whole reported less impulsive eating, consumed fewer calories as fat, and consumed fewer calories in the dinner meal, than the no-breakfast comparison group.  Group sessions and counseling continued for 12 weeks and by six months there was no weight difference between groups.  They don’t report results by whether individuals continued to eat breakfast or not.

Shorter studies consistently find breakfast benefits overall eating patterns and calorie intake as well as metabolic response but none have been large or long enough to detect benefits based on whether or not participants continued the habit. No evidence suggests outcomes are worse for those who eat breakfast. Data about how physiology is influenced by breakfast tips the scales in favor.

What health effects may be in play? Overnight the body is fasting – drawing down energy reserves – this is a good thing because blood sugar and insulin levels drop and remain in the low normal range while metabolism of fat for energy needs rises. However, when we sustain a fast longer than the body expects, it perceives that situation as a risk that needs might not be met and begins to conserve energy (i.e. lowers the metabolic rate) in order to make it for the long haul. When there is a pattern of sustained partial-day fasts combined with calorie restriction this effect can become pronounced hindering weight loss or maintenance.

In contrast individuals who routinely eat breakfast can consume somewhat higher total caloric intakes without weight gain. Skipping breakfast is linked to higher levels of hunger hormones and greater cravings. Eating breakfast is associated with improved strength and endurance performance and improved mood and concentration. But what you eat also matters; breakfasts with high complex carbohydrate loads (whole grains, oats, rye) and with low fat and low cholesterol are associated with greater reduction in BMI and with better blood sugar and lipid control. Breakfast high in fat (whole milk, full-fat cheese, bacon, fried eggs, sausage and gravy) are inferior to mixed meals of complex carbs and lean protein and associated with similar risk of obesity. Toast only or breakfast snack foods like fruit-filled pastries or sugared cereals that are not high fiber, are of intermediate value. Better than nothing but not by much, since their overall contribution to total daily calories is not of the highest quality.

When you breakfast is negotiable. If your workout is in the early morning, coffee and a mini-pack of raisins may hold you through an aerobic session (running, stairmaster or arc trainer) with maximal capacity to use fat as an energy source. In essence you are purposefully continuing your fasting state. However you must carefully assess whether you trade-off fat-burning for less endurance and a less intense session. If you are strength training, it’s important to remember that muscle uses glucose as fuel, muscle stores are relatively depleted overnight, and performance can be sacrificed if you skimp on breakfast. Eat complex carbohydrates (quick sources in fruit and slower sources in grains), lean protein (eggs fried without fats, egg whites, string cheese, turkey), or mixed sources (low-fat Greek yogurt). The faster carbs will arrive in time to support your work out, and the protein will kick in at about 60 minutes from consumption covering initial muscle needs. In either plan you can lay in the balance of your calories as “breakfast” in the form of a smoothie or meal selected for the type of exertion (more protein/essential aminos acids if big demands on muscle) with an overall balance towards complex carbohydrates and protein with low fat.

As a parting note, the National Weight Control Registry provides the final evidence. Among registry members who have lost an average of 66 pounds, with all having maintained at minimum a 30 pound loss for five years, 96% are breakfast eaters. Enough said.

References:

Megan McCrory and Wayne Campbell. Effects of eating frequency, snacking, and breakfast skipping on energy regulation: symposium overview. Journal of Nutrition 2011;141:144-7. [This symposium was videotaped and is available at www.nutrition.org.]

David Schlundt and colleagues. The role of breakfast in the treatment of obesity: a randomized clinical trial.  American Journal of Nutrition 1992;55:645-51.

Greenwood and colleagues. Preventing or improving obesity by addressing specific eating patterns. Journal of the American Board of Family Medicine 2008;21:135-40.

Mark Pereira and colleagues. Breakfast frequency and quality may affect glycemia and appetite in adults and children. Journal of Nutrition 2010;141:163s-68s.

Rena Wing and colleagues. Long-term weight loss and maintenance. American Journal of Clinical Nutrition 2005;82:222s-5s.

K. Hartmann, MD, PhD

khartmann@thedelta.com

Posted in Aerobic activity, Calorie Restriction, Diet, Energy, Fitness, Metabolism, Nutrition, Research Evidence, Weight Loss, Weight Maintenance | Leave a comment

Is Fructose the Root of All Dietary Evil?

Posted on January 26, 2012 by Dr. Katherine Hartmann

Sugar the Bitter Truth is Dr. Robert Lustig’s 1.9 million hit YouTube video of a University of California San Francisco mini-medical school lecture. Mini-medical school topics are presentations of research hot topics for a lay audience. Lustig is a pediatric researcher who studies and treats childhood obesity. In about an hour he covers the politics and perils of fructose in the American diet, arguing that increased consumption (in multiple forms including juices, high fructose corn syrup, and sodas) drives obesity in modern western cultures. He also explores the corollary that decreasing fructose consumption is a primary pillar of weight management at all ages.

His biochemistry comparison of the fate of 120 calories of glucose, 120 calories of ethanol, and 120 calories of fructose is what drove this video to cult status in the online fitness community. His take home point is that fructose is a dietary toxin that demands increased awareness.

Want the abridged version? Sean Croxton, nutritionist, trainer, kineseologist, and founder of UndergroundWellness.com, delivers a fabulous 11 minute Cliff Notes version that keeps all the facts straight.

Less sugar is good and less fructose may be even better.  Check out the carbs and calories Delta Blogs; this biomedical evidence all fits the bigger picture goal of flying below the insulin radar, increasing complex carbs, minimizing simple sugars, as well as increasing lean protein sources, and healthy fats as the foundation of a healthy eating pattern.

Get RealFit – Katherine E. Hartmann, MD, PhD

khartmann@thedelta.com

Please make health decisions in personal consultation with a professional. Personalized decisions about diet and nutrition are important. This material is not intended to replace or guide care.

Posted in Calorie Restriction, Diet, Energy, Health, Metabolism, Nutrition, Research Evidence, Weight Loss, Weight Maintenance, Well-being | Tagged , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Rock Your Bench Press

Posted on January 21, 2012 by Dr. Katherine Hartmann

Banish bad technique. Optimal bench press performance demands the whole body. Delta trainer Joel Paavola recently pointed the 6am crew to the blog of John Gaglione at Testosterone Nation. Gaglione, owner and head trainer at Gaglione Strength in Long Island, breaks down the keys to great technique with a strong collection of videos. The first documents how to maximally engage muscle groups during the press using correct form:

Gaglione’s post  breaks it down to these 8 key elements:

  1. Get your entire body super tight to create a stable platform.
  2. Use your lats to pull the bar out of the rack to make sure your shoulders are in good position.
  3. Push your belly up and drive your shoulders into the bench and imagine that you’re moving your body to the bar.
  4. As you tuck your elbows and lower the weight, try to bend the bar and pull it apart.
  5. Keep a tight arch in your back tight the entire set (since the back is not bearing a vertical load this can be safely accomplished)
  6. Aim to keep triceps thick and strong, allowing for a strong, smooth, lockout.
  7. Keep upper back and lats thick, allowing for a more stable press.
  8. Use leg drive to start the lift after the press call and keeps your glutes tight throughout the set.

More brief videos at the site feature additional training tools to help you accomplish the 8 keys to a great bench press. Watch and learn – we’ll know who you are when we see integrated lats, full back, chest, and legs at work along with the arms and pecs. And when your old personal best quickly becomes a relic.

Get RealFit -  K. Hartmann, MD, PhD

khartmann@thedelta.com

 

Posted in Core Training, Fitness, Muscle, Strength Training | Tagged , , , , , , , , , | 1 Comment

Performance Buzz

Posted on January 13, 2012 by Dr. Katherine Hartmann

Enjoying the extra coffee during member appreciation week? Seems like a good time to update where caffeine fits into exercise. Claims about caffeine’s links to strength and endurance reach across centuries and cultures.

Laboratory evidence supports biological roles relevant to exercise. At a cellular level caffeine influences calcium channels which are responsible for nerve impulses and muscle contraction. In tissue caffeine increases use of free fatty acids as an energy source, in theory reducing demand on glycogen stores making more fuel available for longer endurance.  In the brain, caffeine acts on a key neurotransmitter masking awareness of fatigue from exertion and increasing enjoyment of exercise. In aerobic exercise, the both mechanism – making us less aware of fatigue and having a positive experience – have been shown experimentally in both elite athletes and others to be the primary contribution to performance improvements. Across nearly two dozen studies, caffeine consistently extends the time before physical exhaustion from exertion sets in.

Improvement in endurance is distinct from other factors like glucose and electrolyte replacement. If a length of exertion is set, for instance 30 minutes of rowing or cycling, research subjects dosed with caffeine have an average of a 4.3 percent increase in the maximum amount of energy they can expend during a fixed timeframe. Some studies show up to 17 percent increases. The broad range of improvements in performance likely reflects differences in caffeine tolerance with greater increases among those who abstain from caffeine prior to events like marathoning or team sports like soccer.

In strength training, caffeine is most effective at increasing the number of repetitions and sets, improving total perfomance by an average of 9.4 percent while simultaneously decreasing perceived exertion. But caffeine has little effect on the maximum amount that can be lifted in a single attempt. This suggests caffeine is not enhancing the strength of the muscle per se rather acting on our body’s awareness of and willingness to continue exertion. Caffeine is also on the short list of natural ingredients described as thermogenic, meaning they increase your energy expenditure whether or not you are exercising.

Enthusiasm for tea extracts and caffeine supplements follows evidence that weight loss and maintenance may be enhanced by caffeine.  Since every shelf of sports drinks and supplements features “fat burners” and “performance mixes”, what is the evidence about how much caffeine is enough (and too much)? The beneficial effects on endurance and resistance training occur in the ranges of 3mg to 6mg per kg of body weight. No appreciable benefit comes form doses at 9mg and above – more is not better. Around 9mg/kg is the range that side effects such as headaches and nausea kick in. Typically, plain brewed coffee has about 95mg per 8 ounces; with a Star Bucks Grande sporting a total of 330mg. To get performance effects consume caffeine – fancy tablets and gums are not better than other sources – 30 to not more than 60 minutes before your work-out. If the event is longer than a hour better results come with continued consumption during the activity.  Keeping caffeine consumption below 50 mg total in a day (near complete abstinence) for at least 2 to 4 days and optimally 7 days before an event will also help assure you get the kick you want if race times or extended endurance are your goals. Source does not appear to be important. Your body will get the same “caffeine” effect whether or not you consume it with water, as tea, coffee, or part of an energy drink.

Is caffeine harmful? You body does build tolerance and at high levels of consumption throughout the day can result in swings of energy and concentration and in caffeine deprivation symptoms – headaches and lethargy. People who regularly consume caffeine experience negligible effects on blood pressure and may experience beneficial effects on metabolism and weight. Sudden and large increases in consumption can cause the sensation of heart racing and create spikes in blood pressue; so don’t ramp up intake to enhance performance unless you know you’re fit or check in with your health care provider.

It is a myth that caffeine causes dehydration. The diuretic effect of increasing urine production ceases when the body needs to retain fluids. Following your thirst during training and usual replacement plans during endurance events is the key. In summary, research increasingly supports the buzz that caffeine enhances effort and endurance. Keeping in mind that we are talking about 4 to 9 percent average increases in performance, it’s a personal question of intensity of training and desire for a competitive edge whether or not to build caffeine into your fitness and competition regimens.

REFERENCES

S.H. Backhouse and colleagues. Caffeine ingestion, affect and perceived exertion during prolonged cycling. Appetite 2011 Aug; 57(1):247-52. PMID 21605608

T.A. Astorino and D.W. Roberson. Efficacy of acute caffeine ingestion for short-term, high-intensity exercise performance: a systematic review. Journal of Strength and Conditioning 2010;24(1):257-65. PMID 19924012

M.S. Ganio and colleagues. Effect of caffeine on sport specific endurance. Journal of Strength and Conditioning Research 2009;23(1):315-24. PMID19077738

R Hursl and M.S. Westerterp-Plantenga. Thermogenic ingredients and body weight regulation. International Journal of Obesity 2010;34:659-69. PMID 20142827

K. Hartmann, MD, PhD

khartmann@thedelta.com

Posted in Energy, Fitness, Metabolism, Running, Strength Training | Tagged , , , , , , , , , | Leave a comment

Video Bookmark: Are Our Models of the Causes of Obesity Making Us Fat?

Posted on January 10, 2012 by Dr. Katherine Hartmann

Online scientific presentations for sophisticated lay audiences are moving front and center in explaining the core arguments in debates about how we should eat. In Video Bookmarks, I’ll pass along notes and links to well-documented thought pieces on topics that provoke endless spin in the health media. The next few book marks are about calorie intake, the root causes of overweight and obesity, and carbohydrates in the diet.


In this video of a 2011 presentation at Ohio State University Medical Center, Gary Taubes tackles the persistence of outdated ideas about energy balance and carbohydrate consumption. Taubes, author of Why We Get Fat and Good Calories, Bad Calories, is a science journalist whose passion is exploring how theories get traction and how accepted theories are overthrown by newer, better evidence. His work on contemporary nutrition recommendations harnesses deep knowledge of the scientific and popular nutrition and weight loss literature.

He highlights why the scientific especially public health establishment is reluctant to let go of over-simplified calories-in-calories out models and the low-fat/high carbohydrate paradigm adopted in the 1970s and 1980s despite newer persuasive evidence. Highlights include his rapid take on why the Adkins diet and low carb approaches in general deserve careful attention.

Bookmark this for when you have time to relax into exploring these concepts in a lecture format (skip the first 5 minutes if you want to forgo the formal introductions). Provocative and carefully documented ideas make the investment well-worth it for gaining crucial new information.

K. Hartmann, MD, PhD

khartmann@thedelta.com

This blog is not intended to guide individual medical care or health decisions; it cannot substitute for professional consultation and guidance or supplant recommended treatments, prescriptions or plans of care.

 

Posted in Uncategorized | Leave a comment

Ideas for 2012

Posted on January 1, 2012 by Dr. Katherine Hartmann

Health ideas I’ll be preaching to myself this year include:

Fly below the insulin radar more consistently.

Enjoy being in my body and not my head.

Dwell on function and form.

Mix it up more.

For each idea I’ve include a rational and potential strategies below. Accountability is a terrific way to launch into a new year. Consider your goals and share them soon. 

1.) Fly below the insulin radar more consistently

Why: Insulin drives storage of excess carbohydrate as fat. Eating more protein, healthy fat, and slow, unprocessed carbs allows us to preserve calorie intake and feel full while provoking less fat storage.

Exploit muscle in this goal. Muscle is studded with insulin receptors that facilitate transport of glucose into muscle cells for use as fuel. More muscle means more efficient use of fuel during and after exercise.

How:

  • Protect and build muscle. With too few calories the body looks to protein in muscle for fuel. Eat well.
  • Reduce total carbohydrate consumption. Eat slowly digested carbohydrates with low glycemic indices; carve out simple sugars and juice except as treats.
  • My first specific goal is to cut back on fructose sources.

2) Enjoy being in my body and not my head.

Why:  Exercise is energizing. It can alleviate stress, improve decisional making, drive optimism, enhance quality of sleep, help prevent depression, and improve your sex life. Exercise is also linked with creative energy and overall quality of life. Remember it should be play.  Focusing more on enjoyment makes using your body a rewarding habit rather than a duty.

How:

  • Concentrate on being in your body.
  • Feel what it is like to move the weight, to push on for another 10 minutes, to stretch in a new way, to enjoy hard-earned flexibility, to breath deeper, and to stand straighter, taller, and more grounded.
  • Don’t ignore message like pain and fatigue. Listen and adapt.
  • Make a timeline of real improvements – recall when you couldn’t look over your shoulder to see out the back of the car; note when it was that you couldn’t take the stairs at work; when you hit a weight lifting or distance ceiling, and when those things changed. Record plateaus and close that part of the log – look back in 3 to 6 months.
  • Celebrate.

3.) Dwell more on function and form.

Why: We all let technique slip without even recognizing the changes – it’s easy to assume less difficulty is resulting from greater strength or familiarity or adaptation. Whether running, swimming, lifting, golfing, or pursuing any specific activity, performance can stagnate and will benefit from objective assessment and renewed training focus.

How:

  • Ask your trainer to help you take it up a notch. They may not know you want to aim higher and have some hesitation about appearing to offer unsolicited critique. Pick a few new targets to achieve with better form.
  • Evaluate elements of function fitness. Consider formal assessment with a functional movement screen.
  • My focus this year is improved integration of back extension and upper back strength during whole body moves that translate to better posture every day.

4.) Mix it up more.

Why: Boredom undermines both enjoyment and concentration on form and function. Likewise the body habituates to anything we do with grinding regularity. The same circuit, the same class, the same run, the same stair master session, will give us less reward with time, both in terms of calorie burn and conditioning. Making new demands on the body recruits new neural circuits and promotes functional integration that we experience as greater well-being and fitness.

How:

  • Look for new things:  getting comfortable on the treadmill? – move it outside. Always exercise in the morning? – fit in a midday session. Most often looking for a new personal best? – regroup and work on form for a couple months.
  • Reward yourself for gains by refocusing. Made big improvements in strength but not so much in flexibility? – trade out a resistance session for yoga.
  • Change up intensity, schedule, and content of exercise. Build in more “active recovery days” hiking, biking, etc.
  • Make it social: Find a group with common interests on sites like meetup.org. Join a masters’ athletics group. Running and swimming options are robust in the greater Nashville area. Indoor rock climbing and bouldering are nearby.
  • My goal this year: connect more consistently with others outside competitions – add new ways to play by learning from their training programs.

Best wishes for a life and body shaped by joy, energy, play, and peak performance in 2012.

K. Hartmann, MD,  PhD

Khartmann@thedelta.com

Posted in Core Training, Energy, Fitness, Flexibility, Health, Metabolism, Muscle, Nutrition, Strength Training, Weight Maintenance, Well-being | Tagged , , , , , , | Leave a comment

Can Brown (Good) Fat Be Induced?

Posted on December 28, 2011 by Dr. Katherine Hartmann

Brown fat has been termed ”good body fat” and inducing brown fat to burn calories has been a recent source of buzz in the fitness world. Brown fat is the furnace that warms our bodies when we are challenged by cold temperatures and also kicks in during fight or flight responses. Relatively small nests of brown adipose tissue located along the neck, spine, collar bone, deep in the chest, and above the kidneys achieve extraordinary levels of energy consumption and blood flow when activated. They extract glucose and other fuels at disproportionately high levels, modify how cells produce energy to instead produce heat, and literally warm the blood as it flows into and out of the region of the brown fat.

Brown fat protects animals in the winter months by allowing them to literally heat themselves from the inside in order to tolerate extreme weather conditions. Until the last decade brown fat was believed to be largely absent after infancy in humans.

Brown fat was discovered to be present and able to be activated in adults as a serendipitous finding of advanced biomedical imaging techniques. Researchers seeking new tools to identify tumors and metastases designed imaging protocols to take advantage of key characteristics of cancer cells. Tumor cells are highly metabolically active and take up glucose at markedly high levels. Using MRI techniques that rely on uptake of labelled glucose, researchers found they were increasingly identifying symmetric non-cancer “hot spots” that were similarly very metabolically active.

Tissue biopsies with exacting classification of the cell types and function overturned the dogma about adults lacking brown fat and confirmed the hypothesis that the metabolic hot spots interfering with tumor imaging were brown fat. Imaging researchers intrigued with the metabolic implications began to design studies specifically to investigate the properties and activation of brown fat in healthy adults. The conditions in which brown fat is best identified were shown to include cool settings – individuals imaged in a room at 68 degrees expressed activity while the same individuals in a warmer environment did not. Greater activation is seen at 60 degrees (lower temperatures

Experiments in animals duplicating conditions of induction of brown fat activity and showing longterm metabolic changes associate with activation of brown fat. These studies suggest that brown fat can be adventageous in weight maintenance by increasing overall metabolic response – simply put animals with active brown fat burn more calories. Animal research also demonstrated that brown fat was under the control of the sympathetic nervous system. Demands that release norepinephrine and ephinephrine (adrenaline) may also increase brown fat activity. In humans exercise is associated with increased sympathetic drive (norepinephrine levels) related to the intensity of exercise. Human experiments took the opposite approach from animal studies to understand brown fat and sympathetic control. They blocked the ability of subjects to respond to their own sympathetic drive and showed that the experimental maneuvers could shut down brown fat activity in the same participants previously shown to have brown fat by MRI.

From this jumping off point there has been speculation that humans can purposefully take advantage of brown fat through cold activation (e.g. walking or running in outdoors in winter; cold showers) and regular exercise, perhaps even modest levels of walking.

But the question is unanswered in humans. All the current data is correlational – leaner individuals and younger individuals have more brown fat. And women have more than men. People who exercise in the cold have more brown fat – but they may also be the same young, lean individuals who have more brown fat to begin with. Ideal evidence of effectiveness would come from randomized trials showing that brown fat can be induced long term (by nutritonal factors, cold, exercise, or both) and that inducing brown fat activity positively influences calorie burn on an ongoing basis. The “dose” of cold or exercise required to increase the presence and activity of brown fat is unknown. It is conceivable, given the feedback loops in play, that brown fat activation is temporary and can habituate (more exposure does may not promote more activation) and that activation may increase appetite and neutralize any metbolic benefits.

So while Dr. Lyons of the Brown Fat Diet posts YouTube videos doing resistance band training in the snow, many question remain open. Harmful to give it a whirl?* Extreme cold exposure can weaken upper respiratory tract resistance to the common cold, so keep your face warm. And of course don’t tempt hypothermia. But otherwise for those in good health (and remembering you don’t need to freeze to get effects) it’s a interesting concept awaiting proof.

K. Hartmann, MD, PhD

khartmann@thedelta.com

*Please make health decisions, including those about form and intensity of exercise, in personal consultation with a professional. This material is not intended to replace or guide care.

REFERENCES

Cypess, AM and colleagues. Identification and importance of brown adipose tissue in adult humans. New England Journal of Medicine, 2009 Apr 9;360(15):1509-17. PMID 19357605

van Marken Lichtenbelt WD and colleagues. Cold-activated brown adipose tissue in healthy men. New England Journal of Medicine, 2009 Apr 9;360(15):1500-8. PMID 19357405

Yoneshiro T and colleagues. Brown adipose tissue, whole-body energy expenditure, and thermogenesis in healthy adult men. Obesity, 2011 Jan;19(1):13-6.  PMID 20448535

Posted in Diet, Energy, Metabolism, Research Evidence, Weight Loss, Weight Maintenance, Well-being | Tagged , , , , , , , , , , , | Leave a comment

Light up the Winter*

Posted on December 18, 2011 by Dr. Katherine Hartmann

December 21, the winter solstice, has the fewest hours of daylight of any day of the year in the northern hemisphere. It’s a good cue to check in with yourself about quality of life. Early sunsets and waking in darkness can sap energy and disrupt sleep cycles. Given “hibernation” tendencies to get less physical activity and eat more calorie dense foods along with the demands of the holidays and travel, winter is a set up for the blahs or the outright blues. Exercise, balanced diet, good sleep, and light exposure are integrally tied to mood. Deficits in one area can tip over the others and compound negative influence on mood and sense of well-being.

Regular exposure to light helps reset brain chemistry within multiple “control” systems. Research evidence from randomized trials finds light exposure, often termed phototherapy, is effective for resolving seasonal affective disorder which is depressed mood during the winter months. Broader research also suggests light box treatment can prevent or relieve depressed mood, in some cases as well as medication. If you have a history of clinical depression or aren’t certain, don’t go it alone. Talk with a qualified physician or psychologist – light therapy may well be part of the fix.

If you just dread the sluggish, tired and increasingly flat feeling that sneaks up on you in winter, talk with your care provider about using a light box. Or if you want to head off minor doldrums that seem to catch you by winter’s end it may also be worth consideration. Athletes in winter training also make us of light therapy for logical reasons related to enhancing performance by maintaining good energy, mood, and sleep, but with little organized data to formally support the idea.

Multiple online merchants sell light boxes. Compared to their earlier cousins that looked more suited to a greenhouse, newer models are small and more moderately priced. They range from compact portable models that pack well for trips to more elaborate models that can mimic natural sunrise and replace a jarring alarm clock –with prices in the range of $99 to $500.

The best studied light exposure shown to be effective is 10,000 lux in the morning. Standard exposure is 30 minutes, ideally soon after awakening. More is not better. Longer exposure time does not offer increased benefit and may have risks (and should be avoided by those with cataracts). Daily use produces the best results and is mostly a matter of working it into your winter routine. Optimal timing is first thing in the morning:  read in bed for the first minutes of the day, have your coffee and check on the morning news, or mediate (eyes open) literally in the light. When life is more tightly schedule, creative options can kick:  use on a spin bike or treadmill, during carpooling, first thing at your desk while you return emails and get the day organized, during the first break of the morning, or while returning call. If your time must shift back into the day, aim for consistency within the first half of the day.

After several weeks, set aside time to evaluate benefit. Maximal gains should be reached by 6 to 8 weeks. If you’re a light box user, chime in about your experience with lighting up the winter months. How does it relate to endurance? Training results? Weight maintenance? And overall wellbeing?

Check in with your care provider. It’s not too late to add light for the winter months to your holiday wish list.

Katherine E. Hartmann, MD, PhD

khartmann@thedelta.com

*Please make health decisions in personal consultation with a professional. Proper screening, diagnosis, and therapy for all health conditions including depression is crucial. This material is not intended to replace or guide care.

Resources

Mayo Clinic. Seasonal Affective Disorder: Choosing a Lightbox To read more about picking a safe and appropriate lightbox.

Pail, G et al. Bright Light Therapy in the Treatment of Mood Disorders in Neuropsychobiology, 2011; 64(3):152-62. EPub July 2011.

 

 

 

Posted in Energy, Mental Health, Research Evidence, Sleep, Well-being | Tagged , , , , , , , , , , | Leave a comment