Jayme Smithers dominates the peak to valley fitness circuit, beating out Dr.O and many others. Could he be this season’s Saturday fastest?

Monthly Theme:  Flexibility

June’s theme is flexibility.  The high volumes of activity in June will add tension to the body – often in the wrong places.  Joint irritation from overuse and repetitious movements like running and cycling can make your flexibility even worse.

Poor flexibility can lead to increased tension in tendons, which leads to less blood flow, which can lead to poor healing of tissues, which leads to injury.  Poor flexibility also affects your posture, which can cause pain and muscle fatigue over time.  When your joints lack flexibility, the body has to compensate for those inflexibilities by overusing other joints and changing the way that it moves – this often creates pain in other joints for seemingly no reason.  Whenever something starts to hurt and you don’t know why, take a look at the neighboring joints and you may find the cause!

Flexibility becomes exceedingly important as we age; tasks that seemed simple when you were 50 can quickly become difficult at 70.  Maintaining a component of your fitness is always easier then improving it.  “Use it or lose it” is a good rule of thumb for every person as they age.

Notes for all stretches:

Stretches for healthy joints should typically be done at least 3 times per day to get improvements, and at least 2 times per week for maintenance.  Passive stretches should be done after exercise or when the body is warm, and held for 30-60 seconds at a time.  Before exercise, it is better to use active versions of these stretches where you use exercises that naturally stretch these joints while warming up the nerves and muscles at the same time.

Hip flexors:

The hip flexors are a group of muscles in the front of the hip.  They become tight with endurance types of activities like running, biking, or rowing and they also become tight with sitting.  Almost everyone would benefit from stretching his or her hip flexors more often.

When the hip flexors are tight, it puts more compression and torsion through the low back and pelvis while also putting more strain on the lower extremities making injury to the knees, ankles and feet also more likely.

How to do the stretch:

With one knee down and directly underneath you, turn your hips back like you are trying to pour water out the back of your pelvis.  This should create enough of a stretch for you; if not, you can lunge your hips slightly forward.  If you have to lunge far forward, you aren’t using your tummy enough!

Where to feel the stretch:

In the front of your pelvis and upper thigh.

Ankle Extension (Calf/ Achilles Stretch):

Proper ankle extension is essential to maintaining proper form for walking, running and squatting activities.  When they are tight (they are tight very often), it puts additional stress on the foot, knee, hip and pelvis.  Stretching the ankles into extension is a key treatment for many foot and ankle problems, the most common of which is plantar fasciitis.  Proper ankle flexibility can also allow the foot to sit more naturally on the ground and allow for better balance and coordination for sports.

How to do the stretch:

Place your foot onto a ramped surface and then move the knee toward the toe.  Do not let the knee move to the inside or outside, keep it in line, and be sure the arch of the foot does not collapse.   Do the stretch with a bent knee sometimes and with a straight knee sometimes.  This stretch may need to be performed more than other stretches in order to get results, as the ankle can be very stubborn to improvements.

Where to feel the stretch

Deep inside the ankle and in the back of the lower leg.

Shoulder Flexion:

Shoulder flexion is basically reaching the arms over the head.  Loss of shoulder flexion comes primarily from poor posture and not actually doing the motion enough.  Tight chest and back muscles make it even more difficult to do proper shoulder flexion.

The result of poor shoulder flexion is overuse of the neck, back and shoulder joint – which causes painful syndromes in each of these body parts.  It also makes doing overhead tasks at home very tiring; changing a light bulb or building some shelves at home can all of a sudden become an embarrassing activity to perform if you don’t keep up your shoulder flexibility!

How to do the stretch

Point the thumb up in the hitch hiking position, keep the arm perfectly straight, and raise the arm straight in front of you and over your head.  Use a doorway if you are standing or use a chair or Swiss ball in front of you if you are kneeling and add passive overpressure to push the arm back over your head.  Keep your tummy tight so you don’t just bend back in your back instead of the shoulder.

Where to feel the stretch

Different people will feel this stretch in different places, but in general you will feel stretching deep in the shoulder, in the chest, and also in latissimus muscles.

There is a new kind of doctor in Whistler!  Dr Ryan Oughtred will help you take your health to the next level, prevent illness or become a better athlete.  Dr O is a Naturopathic Physician and X – World Cup ski racer; he understands the wants and needs of Whistler residents.

Dr Oughtred offers services suitable for elite athletes to the elderly.  Services offered include:

Health and Fitness Assessments

Manual Therapies

Exercise (High performance and ‘prehab’ type exercise)

Nutritional therapies

Hormonal therapies

Botanical and Chinese Medicine

Come on in Whistler!  See what the doctor can do you for you.

Fish Oil Prevents Aging

A study from the American Journal of Medicine demostrates an association between blood levels of Omega 3 fatty acids and a lower rate of DNA ‘wear and tear’.

Antidepressants work…if you really need them

A new meta-analysis was published in the Journal of the American Medical Association that suggests that antidepressants might only be effect for moderate to severe depression.  The study used only studies that used the Hamilton rating system to determine depression severity.

Platelet Rich Plasma Therapy May Not Work

A popular treatment for tendon injuries is still under question as to whether it works or not.  This latest study compared it to salt water injections – another study that suggests that the injects alone may be what is therapeutic, not the actual agent injected.

MMR Vaccine and Autism – The Lancet takes back the 12 year old paper

The Lancet medical journal had finally taken back its 12-year old paper that suggested links between the MMR vaccine and Autism.  The backlash to this article is significant, with authorities considering legal action against the physician responsible for the article.  The avoidance of the MMR vaccine due to fears of Autism has led to an increased incidence of measles infections worldwide.

Is the Jury Still Out on a Low Sodium Diet?

This NYT article talks about the hot debate over whether ‘anti-salt’ campaigns should be increased or decreased.  Too much salt is probably bad, but too little salt is also bad.  For now, keep checking your blood pressure from time to time and watch your salt intake if your numbers start to climb.

Fitter Students do Better on Exams

A group of researchers showed that students who had better cardiorespiratory fitness also did better academically.  Reportedly, more studies need to be done to prove a causal relationship before schools start to bring back physical education into their curriculum.  In the meantime, more than 1/3 of our children are overweight or obese…but, I guess we need more proof!

Stress EKG’s Help, but Who Wants to Pay for it?

Electrocardiograms can save lives in young athletes by alerting them that they may have an unknown heart condition.  Because these heart conditions are fairly rare, screening is not advocated because it would not be cost effective.  If you perform regular, intense physical activity, the test deserves serious consideration.

Interesting Research Ties Appetite to Your Gut Bacteria

Altering the bacteria in your intestines may lead to better digestion, lower appetite, and weight loss…some day.

A Good Review of Reasons to Exercise

Jane Brody of the NYT reviews the scientific evidence that supports the use of exercise for good health.

Vit D – More Evidence

Every month or two another study comes out to reinforce the importance of having adequate Vit D.  This article highlights the mechanisms through which Vit D may be helping to prevent cancer and autoimmune disease.

PSA – Should it be Used to Screen for Prostate Cancer?

The PSA test is costing the US billions of dollars per year with limited success in fighting prostate cancer.  The author of this NYT article does a good job at reviewing the evidence.   Click here to view some of the follow up from this article.

Breast Cancer Screening Works – Rarely

“Evidence now suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram program, he said, whereas the risk of getting an unnecessary breast cancer diagnosis is 10 times that”.

Following the adjustments to the recommended screening age for mammography in the US (from 40-50 years of age), some are questioning the use of mammography altogether.

Statins Become Preventive Medicine

The FDA has approved the use of Crestor, a medication used to lower cholesterol, for preventive medicine uses.  It has been long been known that statins can act like anti-inflammatories in the body with can theoretically help to prevent a heart attack or a stroke.  Crestor’s main mechanism of action is to block the body’s production of cholesterol, an essential lipid that the body uses to make cell membranes, hormones, and other things in the body.  Time will tell if this drug will do more harm than good in patients with normal cholesterol levels.

Weak Preventive Medical Screening Policies Lead to Debate

Why is there so much debate about cancer screening tests like the PSA and Mammogram?  Because they don’t seem to be very effective.  So what’s the solution?

Hormone Therapy Protects Against Colon Cancer

Another study confirms that hormone replacement therapies can protect against colon cancer.  Long term users experience over a 50% reduction in cancer rates.

Diet Prevents 40% of Alzheimer’s Cases

A diet rich in fruits and vegetables, olive oil, nuts, seeds and fish is shown to lead to less cases of Alzheimer’s disease.

Processed Meats, not Red Meats are Associated with Cancer

A new harvard study had found an association between eating processed and developing cancer.  The same study was not able to show a significant association between those that ate unprocessed meats like beef, pork or lamb and those that developed cancer.

New to 2010 is Dr Oughtred’s annual health assessment: a comprehensive health assessment that includes a medical assessment, a physical therapy type of assessment, and a fitness and lifestyle assessment. Patients will receive a 15 page booklet outlining and explaining their results, and it comes complete with a comprehensive plan that includes dietary recommendations, supplement and medication recommendations, exercise programs and tips, stretching advice, or recommendations for physical therapies or other hands on techniques.

The center piece of your assessment is the summary page, which quickly displays and colour codes your results alongside your recommended goals for the following year. This page gives you a comprehensive, yet simple ‘snapshot’ of your current state of health and fitness, and can act as a great motivator for the future.

For those of you who have extended medical insurance, your coverage will likely cover you for all, if not part of the assessment.

Assessment overview:

• Review and assessment of your current and past health concerns
• Relevant physical examination
• Orthopedic Assessment (Joint Alignment, Range of Motion, Posture, Strength, Stability)
• Fitness Assessment (Everything from grip strength and body fat to cardiorespiratory fitness and lactate threshold testing)
• Nutritional and Lifestyle Assessment
• Disease Risk Assessment (Framingham score, diet, biometrics, other)
• When indicated, referral to other health professionals, physicians or laboratories.

Your assessment acts like an annual membership, and you will be reminded when you are due for follow ups and important preventive medical screening tests and visits.

For fitness enthusiasts, the process involves measurement of lactate thresholds for precise assessment of endurance over time and selection of future training intensities. For those who want to manage their disease risk over time, the assessment gives you a framingham score, estimating your 10 year risk for developing coronary artery disease. This is the perfect annual health screen for someone who is looking for an executive health assessment with a strong focus on fitness, lifestyle, and athletic performance. Together with the advice and medical testing of your family doctor, your assessment will leave you feeling as though no ‘stone is left unturned’ with regard to your health.

Aside from your assessments with your medical doctor, all parts of your annual assessment are performed by Dr Oughtred himself which provides for a 5-star professional experience which you won’t forget. Take the time for your assessment now, and see what new avenues of health open up for you.

Lactate Testing is quickly becoming the preferred test for people that want to assess their aerobic capacity and determine how to make the most of their exercise program. I began to offer lactate testing to all of my patients in 2009 and I have found it effective not only for athletes but also for anyone that wants to take a more precise, deliberate approach to their exercise program.

Testing blood lactates is a relatively new practice in sport that has become popular in the last 10-20 years, especially in sports such as swimming, rowing, speed skating and endurance sports like marathons, triathalons, cycling, etc. At first, even the best trainers in the world were often confused with the use of lactate testing, but over the last 10 years, some consensus seems to have been reached on some topics and experts agree that lactate testing is a superior tool for 3 key purposes:

1 – Measurement of Endurance Performance:

Traditionally the preferred performance test for endurance activities has been the VO2 max test. A drawback to the VO2 max test is that it assesses aerobic power at a maximal intensity over a short period of time – this is not reflective of a true endurance activity which requires a longer duration of activity at a submaximal effort. Other downsides to VO2 max testing is that it can be very expensive (good equipment is very costly) and the devices used to breath in and out of can cause anxiety and discomfort in for the athlete. Aside from the minor discomfort of finger tip blood sampling, lactate testing suffers from none of these drawbacks, and is probably a better performance indicator at submaximal efforts.

2 – Assessment of changes in aerobic fitness over time:

The lactate test measures your lactate levels at many different levels of exertion. As you become more fit, your lactate levels will be lower at each of these individual exertion points; the test demonstrates that you are doing the same amount of work at lower intesities than before. This shift in lactate levels over time is a very sensitive indicator of training adaptation.

3 – A tool to opimize training intensities:

Because lactates can be used to estimate your intensity levels during exercise, it is probably the best method to determine and prescribe future training intensities or ‘training zones’. This is especially useful for fitness professionals so they can avoid overtraining or undertraining an athlete. Learning your ‘Lactate Thresholds’ can essentially make your training more specific to your goals. Whatever your goals, lactates can be used to help get reach them quicker; you can more precisely improve your endurance, your V02 max, your ability to heal and recover, or your ability to burn fat during a workout.

In his book, “The Science of Winning”, Jan Olbrecht talks about how he uses the lactate tests with elite athletes prior to big events in order to properly balance their aerobic and anaerobic systems. Although this use is less popular, it is very enticing; it is hard to argue with the 40 olympic medals that Olbrecht was part of in the Athens Olympics!

Understanding Blood Lactate

Lactate is a byproduct of glucose, or ‘sugar’ in your body. As lactate accumulates during exercise, we can assume that you are using glucose as an energy source. As the intensity of an activity increases, the percentage of energy that comes from glucose will increase, and you will produce more lactate, which can be measured in the blood. At low intensities of exercise, your body uses its aerobic energy systems (using oxygen for energy) which spares glucose and keeps lactate levels low. The more aerobically fit you are, the harder you can push yourself without accumulating lactate. Over time, as you become more aerobically fit, you will be able to achieve higher levels of intensity and keep your lactate levels the same. If we graphed this over time, your lactate curve would shift downwards, and to the right.

As you increase your intensity during exercise, you will eventually overwhelm your body’s ability to recycle or remove lactate from the blood. The highest intensity at which you can create lactate in the body and still remove it from your blood is called your lactate balance point. This is an important intensity to learn, and it has many other names; ‘anaerobic threshold’, ‘lactate threshold’, or just ‘threshold’ are the other most common names used. As you push yourself beyond this intensity, your body’s energy systems will actually become inhibited and your performance will suffer if you hope to perform much longer than 5-8 minutes. Getting to know this balance point is critical for everyone, not just athletes, exceeding your balance point in training could have negative effects to your health, your performance or even your ability to lose body fat.

How Lactate Testing is Done

So what does a blood lactate test look like? The most widely used method involves an endurance test that has incremental increases in intensity. Each stage can be anywhere from 2-5 minutes, and at the end of each stage a small blood sample is taken by a fingerprick and placed into an analyzer. The total test length can vary anywhere from 20-60 minutes, depending on the fitness of the athlete and the length or increments of the stages. Testing is usually performed on a bicycle ergometer or a treadmill.  As stated previously, the test is approximating intensity at all stages, and so it does not require the participant to go ‘all out’, but it does require the participant to go up to at least an 8 or a 9/10 on the exertion scale.

Becoming more popular is the FACT method, which involves an initial staged performance test as outlined above and then follows that up with a another staged approach that is thought to better isolate the balance point between lactate production and removal from the body. I utilize both methods, as I find the traditional method effectively demonstrates fitness adaptations over time and the FACT method is excellent for determining future training intensities or ‘training zones’.

Set Your Targets and Optimize Your Training Time

After your lactate test, you will have objective information from which you can set future targets for improvements. You will also have an outline of your individualized training zones that you can use to effectively target your weaknesses and make the most of your limited training time.

Fish Oils Prevent Vision Loss

Ensuring that you get small amounts of fish oil on a regular basis can decrease your chances of getting age related macular degeneration, according a recent study.

My recommendation for everyone is to take 1-2 tsp of fish oil per day in order to decrease total body inflammation and prevent chronic disease.  Individuals who consume more than 3 servings of fatty, cold water fish per week, probably don’t need to take fish oils.

Its Not Just About Cholesterol

This article discusses another type of blood marker that is used to measure your heart disease risk.

Knowing your risk for heart disease or stroke is about much more than just measuring your cholesterol.  Other significant factors include your blood pressure, blood sugar levels, your waistline and overall body shape, your family history, your physical activity levels, your diet, and your avoidance of risky behaviors like smoking or drinking excessive amounts of alcohol.

More Reasons to Screen for Thyroid

This article talks about the association between longer labors and lower levels or circulating thyroid hormones in women.

Thyroid problems are quite common, they can have many different symptoms depending on the patient, and they often go undiagnosed.

Low Acid Diet for Bone Health

Jane Brody writes an excellent article about the theories and evidence behind eating a low acid diet for healthy bones.  The short version: eat more vegetables, eat less garbage.

Treating Depression Balances Blood Sugar?  Huh?

Diabetic patients treated with antidepressants experienced a 2% drop in HgA1c levels – this is a big drop.  I would take this as a reminder that mental health is very much connected our physical health.

Happiness of your friends, your friend’s friends, and your friend’s friend’s friends can make you happier

A Harvard team was able to demonstrate that when the happiness of your friend increases, it can directly increase your happiness, and in turn improve your overall health.  Not only that, but people you don’t even know that are indirectly associated with you via other people can also affect your state of happiness.  This BBC link has an audio interview with the lead author.

Acupuncture Reported Better than Aspirin for Headaches

A recent study with chronic headaches found that those using acupuncture reported improvement in 65% of patients vs. 40% of those who were taking aspirin.

Television and Video Games Linked to Poor Health in Children

A meta-analysis of over 170 studies publised since 1980 found strong correlations between increased media exposure through television and video games, and obesity, early sexual activity, teen pregnancy, drug use, smoking, and poor academic performance.

During my athletic career, I was impressed by the knowledge and understanding of the physical therapists that helped me.  Unfortunately, I almost always had to be injured before I would benefit from their expertise.  It made no sense to me to wait until I was hurt before addressing my physical weaknesses ; I wanted something more pro-active.  Prehabilitation (prehab) is the act of applying rehab principles to healthy individuals in order to prevent injury and enhance physical performance.

Rehabilitative principles are applied in a step-by-step fashion, to ensure that the body is not forced to do anything that it is not ready for.  I will outline some of these steps, and give you examples of why each could be important to you:

Reduce Pain and Inflammation

Pain or inflammation in a joint causes key muscles to be deactivated, as well leads to patterns of avoidance.  Running with a sore back for instance can train key stabilizing muscles not to work, leading to instability of the back long term, and can cause you to adopt habits that could make you a slower runner in the long term.

Ensure Proper Joint Motion and Stability

Tight ankles, especially one sided, can cause rotation through the entire body, cause unequal wear and tear of joints, overuse of other joints, and poor balance.  Weak hamstring muscles can increase your likelihood of tearing ligaments in your knee.

Efficient Movement and Posture

Your technique when you exercise determines which muscles get strong, which ones stay long and supple, which joints get stressed, and how tired you get.  Anti-inflammatory herbs or medications may help for your knee pain, but if the cause of the knee pain is the way you walk or run, then your pain will always recur.

Notice that none of the above steps have much to do with general fitness; someone can be very strong or fit, and still fail some of these steps.  Every day, people are exercising or performing simple daily tasks with limitations in the above categories, and those seemingly healthy activities can be making them unhealthy.  Don’t wait until you are unsatisfied with your physical health; learn about your physical limitations and what you can do about them right now.

Take a look at this clip which highlights some of the exercises that Mike did during his recent visit with Dr Oughtred, in Vancouver, BC.