I was talking with a friend of mine earlier this week who had used the Perfect Push-up. He liked it. He also made a great comment that really summarizes the use of exercise gadgets- "Hey Chimes, you know what the real perfect push-up is? Actually doing them."
I think that is perfect. Just like the old Nike commercial says- "Just do it!"
Sunday, December 14, 2008
Monday, December 8, 2008
Cushioned running shoes for feet with high arches
The choice of which running shoe a runner should use is largely determined by their foot arch and the type of motion the foot makes through the stance phase (the portion of the running cycle when the foot is in contact with the ground).
There are two common subsets of foot and motion patterns seen in runners. The most common pattern is the overpronator, which is often associated with a flat arch. The second and less common category is the high-arched underpronator, which happens to be the category I belong to.
To understand how these foot mechanics influence choice of footwear, it is important to understand foot pronation. Foot pronation is a natural roll of the foot that occurs during stance phase that serves to help absorb some of the force of impact. When the foot first contact the ground, most people start to roll almost immediately to the outside of their foot (this is why, if you look at the shoes of most people, you see greater wear on the outside of their heel than the inside of the heel). What happens in the middle of stance phase is that weight stays along the outside of the foot arch as the runners body weight is transferred over the middle of the foot.
The main distinction between over- and under- pronators occurs during the end of stance phase. Underpronators start rolling toward the big toe, and keep on going. This pronation is useful, as it helps absorb the force of landing, which is several times bodyweight. The problem with overpronating is that as the foot keeps rolling without control, it drags the rest of the body with it, which causes excessive strain up the kinetic chain (e.g., the excessive pronation can pull the leg bone, the tibia, with it the foot, which can cause strain at the knee). Therefore, runners with excessive pronation are often advised to wear motion control shoes.
The underpronator, like me, has the opposite problem. In their feet, the foot does NOT roll sufficiently toward the big toe. Remember- pronation is an important shock absorbing motion. Therefore, in runners with high arches and underpronation, the general recommendation is to avoid motion control shoes and use running shoes that have extra cushioning (to compensate for the lack of absorbtion from the natural pronation motion).
A recent study from the American Journal of Sports Medicine confirmed the shoe recommendations for high-arched runners.
Caleb Wegener, Joshua Burns, and Stefania Penkala Effect of Neutral-Cushioned Running Shoes on Plantar Pressure Loading and Comfort in Athletes With Cavus Feet: A Crossover Randomized Controlled Trial , Am J Sports Med 2008 36: 2139-2146
In short, this study confirms the recommendations above for the high-arched runner.
For the record, the cushioned shoes that were examined were the Asics Nimbus 6 and Brooks Glycerin 3, and the control shoe that was examined was the Dunlop Volley. This was a well designed study that used a cross-over study design, meaning that each participant started with either a cushioned shoe or the control, and then switched groups. The examiners also assessed both pressure distribution and comfort level of the runners.
Based on this study, the recommendations listed above still apply. Based on my personal anecdotal experience, it is important for runners with high arches and underpronation to look for a shoe that is BOTH heavily cushioned AND not motion control. My experience has been that it is hard to find running shoes that do not have some component of motion control built into the shoe. Since overpronation is the more common foot problem, most shoe manufacturers tend to build some motion control into almost all of their shoes, even their heavily cushioned models.
As a practical matter, this can be a challenge. If you go to many running shoe stores, the clerks sometimes will not know the properties of the individual shoes. My recommendation is to first scout out the shoes you are looking for on a good running shoe site (I tend to use RoadRunnerSports.com), and then look for shoes that fit your category. Once you find a shoe you like, stick with it. Stores that specialize in running shoes (e.g., in Chicago and Pittsburgh, Fleet Feet is a good store) tend to have experienced sales people with good knowledge of what type of shoe is right for you.
There are two common subsets of foot and motion patterns seen in runners. The most common pattern is the overpronator, which is often associated with a flat arch. The second and less common category is the high-arched underpronator, which happens to be the category I belong to.
To understand how these foot mechanics influence choice of footwear, it is important to understand foot pronation. Foot pronation is a natural roll of the foot that occurs during stance phase that serves to help absorb some of the force of impact. When the foot first contact the ground, most people start to roll almost immediately to the outside of their foot (this is why, if you look at the shoes of most people, you see greater wear on the outside of their heel than the inside of the heel). What happens in the middle of stance phase is that weight stays along the outside of the foot arch as the runners body weight is transferred over the middle of the foot.
The main distinction between over- and under- pronators occurs during the end of stance phase. Underpronators start rolling toward the big toe, and keep on going. This pronation is useful, as it helps absorb the force of landing, which is several times bodyweight. The problem with overpronating is that as the foot keeps rolling without control, it drags the rest of the body with it, which causes excessive strain up the kinetic chain (e.g., the excessive pronation can pull the leg bone, the tibia, with it the foot, which can cause strain at the knee). Therefore, runners with excessive pronation are often advised to wear motion control shoes.
The underpronator, like me, has the opposite problem. In their feet, the foot does NOT roll sufficiently toward the big toe. Remember- pronation is an important shock absorbing motion. Therefore, in runners with high arches and underpronation, the general recommendation is to avoid motion control shoes and use running shoes that have extra cushioning (to compensate for the lack of absorbtion from the natural pronation motion).
A recent study from the American Journal of Sports Medicine confirmed the shoe recommendations for high-arched runners.
Caleb Wegener, Joshua Burns, and Stefania Penkala Effect of Neutral-Cushioned Running Shoes on Plantar Pressure Loading and Comfort in Athletes With Cavus Feet: A Crossover Randomized Controlled Trial , Am J Sports Med 2008 36: 2139-2146
In short, this study confirms the recommendations above for the high-arched runner.
For the record, the cushioned shoes that were examined were the Asics Nimbus 6 and Brooks Glycerin 3, and the control shoe that was examined was the Dunlop Volley. This was a well designed study that used a cross-over study design, meaning that each participant started with either a cushioned shoe or the control, and then switched groups. The examiners also assessed both pressure distribution and comfort level of the runners.
Based on this study, the recommendations listed above still apply. Based on my personal anecdotal experience, it is important for runners with high arches and underpronation to look for a shoe that is BOTH heavily cushioned AND not motion control. My experience has been that it is hard to find running shoes that do not have some component of motion control built into the shoe. Since overpronation is the more common foot problem, most shoe manufacturers tend to build some motion control into almost all of their shoes, even their heavily cushioned models.
As a practical matter, this can be a challenge. If you go to many running shoe stores, the clerks sometimes will not know the properties of the individual shoes. My recommendation is to first scout out the shoes you are looking for on a good running shoe site (I tend to use RoadRunnerSports.com), and then look for shoes that fit your category. Once you find a shoe you like, stick with it. Stores that specialize in running shoes (e.g., in Chicago and Pittsburgh, Fleet Feet is a good store) tend to have experienced sales people with good knowledge of what type of shoe is right for you.
Sunday, December 7, 2008
Iron Gym Pull Up Bar
I am doing another product review. One of my readers (that is, one of my grand total of 5 readers) pointed out "for a guy who claims not to be commercial, you sure have a lot of product placements. And while I'm at it, exactly how many mentors do you have?"
Addressing the second question- I have a lot of mentors. I've been very fortunate that many people have cared enough to invest their time in my success. The only payback I can give them is that I try to take their advice to heart and pay it forward to the next group of trainees.
As for the product reviews, let me clarify- I do not take any money or compensation from any sponsor. That may change in the future- I can only hope that I am successful enough that people will pay me for my time. What I can promise is that I will fully disclose any financial relationships I have with any products.
Now, then ...
I am reviewing the Iron Gym Pull Up Bar. Right now, they are selling them for $29.99 at Bed Bath & Beyond.
I will first make a quick plug for Bed Bath & Beyond. You have to love their ubiquitous coupons that never expire, so you never pay list price for anything. Even better, though, is their return policy. I go through blenders fairly quickly- I use mine every day for protein shakes, and occasionally burn out the motor. I used to buy them from other vendors, but because the return policy is so good at BBB, I don't think I will ever buy a home appliance anywhere else. Great customer service goes a long way in building loyalty.
Back to the Iron Gym- it's basically a pull-up bar that can be attached without hardware. It claims to be used for other purposes, but I suspect that 90% of the people who are buying it just for pull-ups.
It does exactly what it says it does- I really like it. I am a big man (well over 200 pounds), so I am skeptical that any bar can really support my weight. But the Iron Gym feels pretty sturdy, and is easily attached to a door in under a minute. I don't see any issues at all with structural integrity of the door, and it has not marred the doorway at all.
Additionally, it allow for multiple grips- I use 2 chin positions, 1 neutral grip (which most bars don't allow for), and 2 pull up positions. I am 6'3", so a concern with some bar designs is that there is not enough clearance, but the bar only extends 5" below my door, so I can easily do pull ups with my knees bent.
So, I am probably the perfect demographic for someone who will benefit from this bar in that:
1. I am able to do a pull up
2. I don't want to permanently install a pull up bar
3. My gym doesn't have a pull up bar, which is a shame, since it's one of the most important resistance exercises one can do
It is perfect for me. On the days when I do upper body weights at the gym, I'll do pull ups on the Iron Gym at home. I usually work for several hours at my computer every day, so I periodically get up anyway for some other reason. When I get up, I make a point of doing as many pull ups as a I can on the bar. Since I, like most people, can't do to many at one time, this is a way to make sure I get in a fair number of repetitions over the course of the day.
There are some people who should avoid this product:
1. If you cannot do a pull up- you should be able to do at least 1 in at least 1 grip position to really benefit from the bar.
2. If you are over 30o pounds- at some point you may damage the door frame. I don't feel like I am approaching that limit, but the product label recommends 300 pounds as a weight limit.
Overall, I think it's a terrific product that fills a real need, and is reasonably priced.
Saturday, December 6, 2008
Medical perspective on Mixed Martial Arts (MMA)
I am a big fan of mixed martial arts, also known as MMA, most commonly associated with the world's largest MMA organization, the UFC (Ultimate Fighting Championship).
Max Kellerman, the great sports commentator and noted boxing fan, frequently notes that fighting is the most intrinsically interesting of all sports. A thought experiment he likes to make is to imagine that you are in the middle of an intersection of two streets with a crowd of people. Imagine that on three of the street corners there is a different sporting event going on- one street corner has a baseball game, another a basketball game, and on the third a football game. The crowd at the intersection would likely have their attention split amongst the basketball, football, and baseball games- none would dominate interest.
Now imagine that on the 4th street corner a fight breaks out. Nearly everybody would stop watching whatever they were watching and turn to watch the fight. It's simply more interesting- fighting is, at it's essence, the most purely interesting of all sports.
Max Kellerman made this argument in defense of boxing, but I think it applies even more to MMA. In recent years, MMA has become the dominant combat sport in America. The stars of the UFC- Brock Lesnar, GSP, Fedor, Forrest Griffen- are now bigger stars than the boxers. UFC fights dominate on pay per view, and the UFC fight cards draw bigger crowds in Las Vegas than do boxing cards.
Senator John McCain famously referred to the early sanctioned MMA fights as "human cockfighting." I have tremendous respect for Senator McCain, and there is some truth in his assessment of early MMA- the rules were not clearly established, and the early cards often seemed to promote the brutality of the exhibitions rather than the elgance and athleticism. It was being marketed as show rather than a sport.
I also think that, at least in part, McCain was speaking as a boxing fan. He loves boxing, and was bothered by a newer sport supplanting boxing. I love boxing too- like most people of my generation, some of my favorite sporting moments as a fan are the great Sugar Ray Leanord/Marvin Hagler/Thomas Hearns/Roberto Duran middleweight bouts, or the Evander Holyfield/Mike Tyson era.
But, I am a much bigger fan of MMA now than boxing, for 3 major reasons:
1. As a sports fan, I think the matches are far more entertaining.
2. As a biomechanists, I think MMA is more elegant. Watching a great multidisciplinary fighter, like Georges St Pierre, is like watching a text book on human movement. It is similar on some level to watching a great dance troupe like Alvin Ailey or great gymnasts like Cirque de Soleil, only with a greater sense of urgency because it is taking place in the context of a fight.
3. As a physician, I think MMA is safer than boxing.
The last point is the major one that inspired me to write this posting.
I don't think it has always been true that MMA is safer than boxing. The early sanctions to clean up the sport, though, have been very successful. There are a few things that make the sport safer now:
1. Most importantly, encouraging a referee to step in quickly when an opponent cannot defend themselves.
2. Rules changes to minimize things like small joint manipulation and kicking an opponent in the head when they are on the ground, that remove some of the most dangerous elements.
3. Creating weight classes, which minimizes the risks of greatly mismatched opponents
4. Moving away from tournaments, which increase the risk of cumultive trauma
5. Increasing popularity, which places an impetus on keeping stars healthy, and creating enough stars that they can alternate on who the headliner is for the card. A top fighter may only have 4 fights in a year
There have been several studies in the past few years that have tried to assess the risk of MMA, both overall, and in comparison to boxing. I don't think the data is conclusive, but my impression is that MMA is safer.
The big difference, in my opinion, is concussion rate. Concussion, or mild TBI (traumatic brain injury), is in my opinion the most serious risk of combat sports. I think the risk of concussion is significantly higher in boxing for several reasons:
1. In MMA, there are many other ways to win, including submissions. In boxing, the main goal of the sport is to give your opponent a concussion and knock them unconscious.
2. The gloves: The thick padded gloves in boxing probably increase the rate of concussion by several mechanisms. I think the most important one is that they protect the hands, so there really isn't much disincentive from punching your opponent in the head. In MMA, the thinner padding of the gloves results in punches hurting the fighter's hands more. This often results in fighters trying alternative approaches, including takedowns and submissions, rather than just punching. Of course, in boxing those options don't even exist. Furthermore, the padding of boxing gloves widely distributes the force, which may minimize the knockout potential of any one punch. This can lead to greater cumultive trauma over the course of a fight.
3. Quick stops. Right now, refs in UFC and most of the other sanctioning organizations are quick to stop fights when fighters cannot defend themselves. Sometimes this is frustrating to viewers, but I think it is one of the most important safety factors for the sport, and it is the one variable that could dramatically change the sport. If UFC wants to continue as a mainstream sport, they MUST continue to protect their fighters.
Enough with medical talk ....
I am very excited about the sport of MMA right now. There are some huge, huge fights on the horizon. UFC has done a tremendous job of promoting their fighters, and I don't know an MMA fan who isn't simply giddy in anticipation of the December 27 card coming up, with 3 fights fully worthy of main event status.
The one major logistical issue that I see right now is that 2 of those most appealing fighters on the planet, Fedor Emelianko and Gina Carano, are not under UFC contracts. I hope that changes. Fedor is, in my opinion, the best fighter who has ever lived, and I want to see him fight all of the best competition available. Gina Carano is a phenomenon in her own right- a legitimately terrific fighter whose marketability is off the charts. A series of fights between her and Cris Cyborg and Tara Larosa would easily be the most heavily anticipated fights in female fighting history. I hope they happen.
Max Kellerman, the great sports commentator and noted boxing fan, frequently notes that fighting is the most intrinsically interesting of all sports. A thought experiment he likes to make is to imagine that you are in the middle of an intersection of two streets with a crowd of people. Imagine that on three of the street corners there is a different sporting event going on- one street corner has a baseball game, another a basketball game, and on the third a football game. The crowd at the intersection would likely have their attention split amongst the basketball, football, and baseball games- none would dominate interest.
Now imagine that on the 4th street corner a fight breaks out. Nearly everybody would stop watching whatever they were watching and turn to watch the fight. It's simply more interesting- fighting is, at it's essence, the most purely interesting of all sports.
Max Kellerman made this argument in defense of boxing, but I think it applies even more to MMA. In recent years, MMA has become the dominant combat sport in America. The stars of the UFC- Brock Lesnar, GSP, Fedor, Forrest Griffen- are now bigger stars than the boxers. UFC fights dominate on pay per view, and the UFC fight cards draw bigger crowds in Las Vegas than do boxing cards.
Senator John McCain famously referred to the early sanctioned MMA fights as "human cockfighting." I have tremendous respect for Senator McCain, and there is some truth in his assessment of early MMA- the rules were not clearly established, and the early cards often seemed to promote the brutality of the exhibitions rather than the elgance and athleticism. It was being marketed as show rather than a sport.
I also think that, at least in part, McCain was speaking as a boxing fan. He loves boxing, and was bothered by a newer sport supplanting boxing. I love boxing too- like most people of my generation, some of my favorite sporting moments as a fan are the great Sugar Ray Leanord/Marvin Hagler/Thomas Hearns/Roberto Duran middleweight bouts, or the Evander Holyfield/Mike Tyson era.
But, I am a much bigger fan of MMA now than boxing, for 3 major reasons:
1. As a sports fan, I think the matches are far more entertaining.
2. As a biomechanists, I think MMA is more elegant. Watching a great multidisciplinary fighter, like Georges St Pierre, is like watching a text book on human movement. It is similar on some level to watching a great dance troupe like Alvin Ailey or great gymnasts like Cirque de Soleil, only with a greater sense of urgency because it is taking place in the context of a fight.
3. As a physician, I think MMA is safer than boxing.
The last point is the major one that inspired me to write this posting.
I don't think it has always been true that MMA is safer than boxing. The early sanctions to clean up the sport, though, have been very successful. There are a few things that make the sport safer now:
1. Most importantly, encouraging a referee to step in quickly when an opponent cannot defend themselves.
2. Rules changes to minimize things like small joint manipulation and kicking an opponent in the head when they are on the ground, that remove some of the most dangerous elements.
3. Creating weight classes, which minimizes the risks of greatly mismatched opponents
4. Moving away from tournaments, which increase the risk of cumultive trauma
5. Increasing popularity, which places an impetus on keeping stars healthy, and creating enough stars that they can alternate on who the headliner is for the card. A top fighter may only have 4 fights in a year
There have been several studies in the past few years that have tried to assess the risk of MMA, both overall, and in comparison to boxing. I don't think the data is conclusive, but my impression is that MMA is safer.
The big difference, in my opinion, is concussion rate. Concussion, or mild TBI (traumatic brain injury), is in my opinion the most serious risk of combat sports. I think the risk of concussion is significantly higher in boxing for several reasons:
1. In MMA, there are many other ways to win, including submissions. In boxing, the main goal of the sport is to give your opponent a concussion and knock them unconscious.
2. The gloves: The thick padded gloves in boxing probably increase the rate of concussion by several mechanisms. I think the most important one is that they protect the hands, so there really isn't much disincentive from punching your opponent in the head. In MMA, the thinner padding of the gloves results in punches hurting the fighter's hands more. This often results in fighters trying alternative approaches, including takedowns and submissions, rather than just punching. Of course, in boxing those options don't even exist. Furthermore, the padding of boxing gloves widely distributes the force, which may minimize the knockout potential of any one punch. This can lead to greater cumultive trauma over the course of a fight.
3. Quick stops. Right now, refs in UFC and most of the other sanctioning organizations are quick to stop fights when fighters cannot defend themselves. Sometimes this is frustrating to viewers, but I think it is one of the most important safety factors for the sport, and it is the one variable that could dramatically change the sport. If UFC wants to continue as a mainstream sport, they MUST continue to protect their fighters.
Enough with medical talk ....
I am very excited about the sport of MMA right now. There are some huge, huge fights on the horizon. UFC has done a tremendous job of promoting their fighters, and I don't know an MMA fan who isn't simply giddy in anticipation of the December 27 card coming up, with 3 fights fully worthy of main event status.
The one major logistical issue that I see right now is that 2 of those most appealing fighters on the planet, Fedor Emelianko and Gina Carano, are not under UFC contracts. I hope that changes. Fedor is, in my opinion, the best fighter who has ever lived, and I want to see him fight all of the best competition available. Gina Carano is a phenomenon in her own right- a legitimately terrific fighter whose marketability is off the charts. A series of fights between her and Cris Cyborg and Tara Larosa would easily be the most heavily anticipated fights in female fighting history. I hope they happen.
Friday, December 5, 2008
Where's the sun?
Now that I've lived in Pittsburgh for a few months, one of the most striking things to me is the absence of sun.
I had heard that Pittsburgh was similar to Seattle in terms of cloud cover. During the summer, it wasn't an issue, and indeed summer in Pittsburgh was beautiful. But once the time change happened, it was striking how little sunlight I saw every day. It is not uncommon for me to see no sunlight the whole day.
I think this has several health implications for the people living in western Pennsylvania. First, people like sun, and the absence of sun makes it less likely for people to be active outside. I am curious which is a bigger deterrent for outdoor activity- weather, or sunlight. Anecdotally from speaking to work colleagues, I think it's sunlight. And this can lead to less exercise.
The second issue is Seasonal Affective Disorder (SAD). I am starting to believe this is much more common than has been commonly realized. In particular, I see many patients with musculoskeletal pain, and I believe there is a high comorbidity with SAD in my patients.
I suspect that one of the changes we will see in the coming decades in the management of musculoskeletal conditions is the realization of the extent to which external environmental factors, including sunlight, contributes to our sense of well being.
I had heard that Pittsburgh was similar to Seattle in terms of cloud cover. During the summer, it wasn't an issue, and indeed summer in Pittsburgh was beautiful. But once the time change happened, it was striking how little sunlight I saw every day. It is not uncommon for me to see no sunlight the whole day.
I think this has several health implications for the people living in western Pennsylvania. First, people like sun, and the absence of sun makes it less likely for people to be active outside. I am curious which is a bigger deterrent for outdoor activity- weather, or sunlight. Anecdotally from speaking to work colleagues, I think it's sunlight. And this can lead to less exercise.
The second issue is Seasonal Affective Disorder (SAD). I am starting to believe this is much more common than has been commonly realized. In particular, I see many patients with musculoskeletal pain, and I believe there is a high comorbidity with SAD in my patients.
I suspect that one of the changes we will see in the coming decades in the management of musculoskeletal conditions is the realization of the extent to which external environmental factors, including sunlight, contributes to our sense of well being.
Sunday, September 28, 2008
fitness gadgets
I don't want to specifically endorse any commercial products. However, I know that most people are familiar with a variety of fitness gadgets on the market- for example, Sunday morning TV is filled with infomercials for all sorts of exercise gadgets.
In general, the best form of exercise is something that you do regularly, so anything that inspires you to exercise more is good. One of my medical school professors liked to say "The best exercise for you is the best exercise for you," meaning that there is no one perfect form of exercise that is universal.
In general, I am not a huge fan of machines that are designed to target one body part, for several reasons. First, it is not possible to spot reduce fat in one region of the body, so machines tha
t market themselves as "hip and butt machines" or the latest and greatest ab machine tend not to be great purchases. Additionally, they tend to be expensive and bulky.
The one targeted machine that I do like is the ab wheel, shown to the left. It's a cheap item (it should certainly be less that $20, and you may be able to get one for as little as $5), small, and does work very well for strengthening the abdominal muscles.
As I discussed in an earlier post, I like anything that makes exercise easy and more convenient. Therefore, little gadgets that allow you to exercise during small windows of time are great. One example is "The Perfect Pushup." It's a $20 item that makes pushups more fun, and probably more effective. The rotation of the handles does place less strain on the wrists, and in my personal testing, I do find that my push-ups seem to be more effective when I use it. I keep mine near the television, which is also a useful reminder for me. When I see them while I am watching TV, it is a useful cue to do some push-ups during the commercial break.
Incidently, a pair of dumbbells serves a similar purpose, and may be an even better choice. The great thing about dumbbells is that they are so versatile- you can do many different exercises with them.
If one were to look into more expensive products that target more total body exercises, there certainly is not a shortage of devices available. Of the large, bulky devices, my personal favorite is the Total Gym, which is an infomercial staple with Chuck Norris and Christie Brinkley. It's a great machine, the main drawback being that you need a large enough space to use one.
Amongst smaller gadgets, one that I really like is the BodyBlade. It's basically a stif
f flat blade, that somewhat resembles a very thin ski. The idea behind the BodyBlade is that by rapidly vibrating the blade in different positions, you can strengthen a variety of muscles through repeated contractions. I wouldn't recommend it for the novice exerciser, for those who are looking for a great way to add variety to their routine, it can be terrific. It is commonly used in physical therapy, so it is ideal for people who are using the BodyBlade in therapy, and want to extend it's use to the home. I like to collect fitness gadgets to play with so that I am familiar with them for my patients, and the BodyBlade is the one that I find myself using the most often. The main downside of the BodyBlade is that it can be quite expensive (usually over $100, depending on which size you get).
Again, my goal of discussing these gadgets is not to endorse any specific product. But I do think that anything that helps cue people to be more active is helpful, and these gadgets can be useful as part of your healthy lifestyle so long as you actually use them.
In general, the best form of exercise is something that you do regularly, so anything that inspires you to exercise more is good. One of my medical school professors liked to say "The best exercise for you is the best exercise for you," meaning that there is no one perfect form of exercise that is universal.
In general, I am not a huge fan of machines that are designed to target one body part, for several reasons. First, it is not possible to spot reduce fat in one region of the body, so machines tha
t market themselves as "hip and butt machines" or the latest and greatest ab machine tend not to be great purchases. Additionally, they tend to be expensive and bulky.The one targeted machine that I do like is the ab wheel, shown to the left. It's a cheap item (it should certainly be less that $20, and you may be able to get one for as little as $5), small, and does work very well for strengthening the abdominal muscles.
As I discussed in an earlier post, I like anything that makes exercise easy and more convenient. Therefore, little gadgets that allow you to exercise during small windows of time are great. One example is "The Perfect Pushup." It's a $20 item that makes pushups more fun, and probably more effective. The rotation of the handles does place less strain on the wrists, and in my personal testing, I do find that my push-ups seem to be more effective when I use it. I keep mine near the television, which is also a useful reminder for me. When I see them while I am watching TV, it is a useful cue to do some push-ups during the commercial break.
Incidently, a pair of dumbbells serves a similar purpose, and may be an even better choice. The great thing about dumbbells is that they are so versatile- you can do many different exercises with them.
If one were to look into more expensive products that target more total body exercises, there certainly is not a shortage of devices available. Of the large, bulky devices, my personal favorite is the Total Gym, which is an infomercial staple with Chuck Norris and Christie Brinkley. It's a great machine, the main drawback being that you need a large enough space to use one.
Amongst smaller gadgets, one that I really like is the BodyBlade. It's basically a stif
f flat blade, that somewhat resembles a very thin ski. The idea behind the BodyBlade is that by rapidly vibrating the blade in different positions, you can strengthen a variety of muscles through repeated contractions. I wouldn't recommend it for the novice exerciser, for those who are looking for a great way to add variety to their routine, it can be terrific. It is commonly used in physical therapy, so it is ideal for people who are using the BodyBlade in therapy, and want to extend it's use to the home. I like to collect fitness gadgets to play with so that I am familiar with them for my patients, and the BodyBlade is the one that I find myself using the most often. The main downside of the BodyBlade is that it can be quite expensive (usually over $100, depending on which size you get).Again, my goal of discussing these gadgets is not to endorse any specific product. But I do think that anything that helps cue people to be more active is helpful, and these gadgets can be useful as part of your healthy lifestyle so long as you actually use them.
Sunday, September 14, 2008
Accidental Exercise, Reversal of Flexion
One of the challenges of most working people is finding sufficient time to exercise. Because of the multiple obligations that most working people have (work itself, family, shopping, paying bills, keeping in touch with friends, etc), exercise is often the first thing that goes, usually with a pledge of "well, I'll fit it in later."
As one of my mentors in NJ used to say, later never comes.
One of the keys, then, is to find ways to sneak exercise into every day life.
One common strategy that has been discussed commonly is to find extra opportunities to walk. For example, you can park far from the entrance to your office, or make a point of using the stairs to work.
Another useful strategy is to turn seemingly mundane activities into exercise. I try not to endorse products, but I am going to make an exception for a book my friend and mentor, Joel Press, called the Couch Potato Workout.
http://www.amazon.com/Couch-Potato-Workout-Exercises-Home/dp/192998815X
In it, he describes some useful exercises that you can use while at home to get in a little bit of extra exercise. I don't want to steal his thunder (and I suppose his profits), but one of my favorites is to stand on one leg while brushing your teeth. This is a particularly effective exercise as the mini-perturbations from brushing stimulate the proprioceptive system to maintain balance at the hip and ankle. It sounds easy, but it's surprisingly challenging at first. Once you get good at it, try it with your eyes closed. For the super advanced toothbrush-exerciser, you can try it with your eyes closed while standing on a towel (to give your foot an unstable platform).
This is just an example of fitting exercise into your day. You can do a simple variation on the toothbrush exercise while shopping. When you are waiting on line, simply stand on one leg. Once you get the hang of that, you can progress by lightly twisting while standing on one leg.
An important time to fit in exercise is when sitting for prolonged periods. Sitting for prolonged periods can put significant strain on the disks in the lower back, especially if you sit with poor posture (which many of us do). It's important to reverse the flexion of sitting periodically. Here are some approaches to reversing that flexion:
1. Stand up. The simplest is to simply stand up and walk for a few minutes. I advise that office workers should (if their bosses will allow it) print all documents to a printer on the other side of the office. This will force you to periodically stand up to walk to the printer.
2. Upward facing dog. If you are in an environment that provides sufficient modesty (e.g., at home, or in an office with a closed door), a great exercise to reverse the flexed position of sitting is the upward facing dog exercise, common in the sun salutations from yoga. An example of this exercise is shown at the following link (http://www.yogajournal.com/poses/474). The upward facing dog exercise is very similar to the Prone Press-Up, which is one of the corner stones of McKenzie Physical Therapy, a form of physical therapy that is particularly effective for low back pain. I recommend doing this exercise at least every 30 minutes if your work environment allows to reverse the flexion of prolonged sitting.
3. Standing back extensions. Another great exercise, which may be able to do logistically, is to stand up and extend your back. It may be easier to place both of your hands in the small of your back as you arch backwards.
4. Push-ups. Another good exercise. In addition to strengthening the chest and shoulder muscles, the posture of the push up (a plank position) requires tightening your innermost abdominal muscles (the transversus abdominus), which is important for maintaining balance across your lower back. Push-ups are great for fitting in periodic exercise throughout your day- crank out a quick 5-10 pushups when you get out of your chair, during commercials while watching TV, or just before sitting to eat dinner.
I hope these exercises serve as useful examples for how you can fit small bits of exercise throughout your day.
As one of my mentors in NJ used to say, later never comes.
One of the keys, then, is to find ways to sneak exercise into every day life.
One common strategy that has been discussed commonly is to find extra opportunities to walk. For example, you can park far from the entrance to your office, or make a point of using the stairs to work.
Another useful strategy is to turn seemingly mundane activities into exercise. I try not to endorse products, but I am going to make an exception for a book my friend and mentor, Joel Press, called the Couch Potato Workout.
http://www.amazon.com/Couch-Potato-Workout-Exercises-Home/dp/192998815X
In it, he describes some useful exercises that you can use while at home to get in a little bit of extra exercise. I don't want to steal his thunder (and I suppose his profits), but one of my favorites is to stand on one leg while brushing your teeth. This is a particularly effective exercise as the mini-perturbations from brushing stimulate the proprioceptive system to maintain balance at the hip and ankle. It sounds easy, but it's surprisingly challenging at first. Once you get good at it, try it with your eyes closed. For the super advanced toothbrush-exerciser, you can try it with your eyes closed while standing on a towel (to give your foot an unstable platform).
This is just an example of fitting exercise into your day. You can do a simple variation on the toothbrush exercise while shopping. When you are waiting on line, simply stand on one leg. Once you get the hang of that, you can progress by lightly twisting while standing on one leg.
An important time to fit in exercise is when sitting for prolonged periods. Sitting for prolonged periods can put significant strain on the disks in the lower back, especially if you sit with poor posture (which many of us do). It's important to reverse the flexion of sitting periodically. Here are some approaches to reversing that flexion:
1. Stand up. The simplest is to simply stand up and walk for a few minutes. I advise that office workers should (if their bosses will allow it) print all documents to a printer on the other side of the office. This will force you to periodically stand up to walk to the printer.
2. Upward facing dog. If you are in an environment that provides sufficient modesty (e.g., at home, or in an office with a closed door), a great exercise to reverse the flexed position of sitting is the upward facing dog exercise, common in the sun salutations from yoga. An example of this exercise is shown at the following link (http://www.yogajournal.com/poses/474). The upward facing dog exercise is very similar to the Prone Press-Up, which is one of the corner stones of McKenzie Physical Therapy, a form of physical therapy that is particularly effective for low back pain. I recommend doing this exercise at least every 30 minutes if your work environment allows to reverse the flexion of prolonged sitting.
3. Standing back extensions. Another great exercise, which may be able to do logistically, is to stand up and extend your back. It may be easier to place both of your hands in the small of your back as you arch backwards.
4. Push-ups. Another good exercise. In addition to strengthening the chest and shoulder muscles, the posture of the push up (a plank position) requires tightening your innermost abdominal muscles (the transversus abdominus), which is important for maintaining balance across your lower back. Push-ups are great for fitting in periodic exercise throughout your day- crank out a quick 5-10 pushups when you get out of your chair, during commercials while watching TV, or just before sitting to eat dinner.
I hope these exercises serve as useful examples for how you can fit small bits of exercise throughout your day.
Wednesday, September 3, 2008
Wii
I try not to officially endorse products, but I was at my brother's this past weekend, and played the Nintendo Wii, so I wanted to give a few comments on it from the perspective of a physician and biomechanist
Overall, I really liked it. I'll list my essentially random observations, just to give some semblance of organization:
1. It's fun. It's entertaining for both adults and young children.
2. It's a better way of doing video games. There has been a trend over the past decade to find new ways to make videogames interactive- for example, the many dance oriented games like Dance Dance Revolution and Guitar Hero. The Wii clearly takes things to a new level- the controller is innovative and worthy of the hype.
3. You can get a great sweat playing. After boxing, playing tennis, or hula hooping on the Wii, my shirt was drenched with sweat. You can get a legitimate workout, if that is your aim, from playing the Wii. My nephews, however, did find ways to move the controllers less aggressively, so I suppose over time the workout may not be as intense as it was for me using it the first time.
4. Good motivator for kids. One of the highlights for me was watching my brother use a boxing game. His youngest son mimicked his dad's movements, and was getting exercise himself. One trend that has been noted in much of the pediatric exercise research is the importance of kids watching their parents be active. We spent a few hours as a family exercising on the Wii, and I think that beyond being fun, it helps establish to the kids that exercise is something that you should do.
5. Real exercise is still preferred. We also took a hike as a family, and that was still a better form of exercise. The Wii is ideally an adjunct to other forms of exercise. If your kids are going to be playing video games, though, it's probably better to do it on the Wii, where they are active, than on other forms of video games.
6. The Wii Fit is pretty awesome. I enjoyed playing the balance, yoga, and exercise games that are part of the Wii fit. I found the additional feedback of the Wii Fit helpful for giving feedback on my balance and stability, and for the most part thought the exercises were well designed and fun. My biggest complaint is that the Wii Fit board is a bit narrow for larger framed individuals like my brother or myself.
7. The Mii are a nice touch. My nephews made an avatar for me (they are called Miis, and they called my avatar Garii). It's amazing how detailed they are- Garii looked disconcertingly like the real me, which was especially concerning when my nephew wacked me in the face when playing the boxing game. It also took a little joy out of beating my nephew in boxing, as Garii knocked out a Mii that looked just like my little nephew.
8. There is some translation from real skills. On games I've never played before, my nephews beat me pretty easily. But I was able to occasionally beat my nephews on some of the activities that I do in real life, like boxing, yoga, tennis, or baseball. If I get a Wii, I think I would probably play the tennis game quite often, since it's certainly easier to turn on the video game system than find a similarly skilled partner.
Overall, I really enjoyed the Wii. For adults in particular, I thought the Wii Fit was great, and could be a enjoyable way to work on balance and strength exercises.
Overall, I really liked it. I'll list my essentially random observations, just to give some semblance of organization:
1. It's fun. It's entertaining for both adults and young children.
2. It's a better way of doing video games. There has been a trend over the past decade to find new ways to make videogames interactive- for example, the many dance oriented games like Dance Dance Revolution and Guitar Hero. The Wii clearly takes things to a new level- the controller is innovative and worthy of the hype.
3. You can get a great sweat playing. After boxing, playing tennis, or hula hooping on the Wii, my shirt was drenched with sweat. You can get a legitimate workout, if that is your aim, from playing the Wii. My nephews, however, did find ways to move the controllers less aggressively, so I suppose over time the workout may not be as intense as it was for me using it the first time.
4. Good motivator for kids. One of the highlights for me was watching my brother use a boxing game. His youngest son mimicked his dad's movements, and was getting exercise himself. One trend that has been noted in much of the pediatric exercise research is the importance of kids watching their parents be active. We spent a few hours as a family exercising on the Wii, and I think that beyond being fun, it helps establish to the kids that exercise is something that you should do.
5. Real exercise is still preferred. We also took a hike as a family, and that was still a better form of exercise. The Wii is ideally an adjunct to other forms of exercise. If your kids are going to be playing video games, though, it's probably better to do it on the Wii, where they are active, than on other forms of video games.
6. The Wii Fit is pretty awesome. I enjoyed playing the balance, yoga, and exercise games that are part of the Wii fit. I found the additional feedback of the Wii Fit helpful for giving feedback on my balance and stability, and for the most part thought the exercises were well designed and fun. My biggest complaint is that the Wii Fit board is a bit narrow for larger framed individuals like my brother or myself.
7. The Mii are a nice touch. My nephews made an avatar for me (they are called Miis, and they called my avatar Garii). It's amazing how detailed they are- Garii looked disconcertingly like the real me, which was especially concerning when my nephew wacked me in the face when playing the boxing game. It also took a little joy out of beating my nephew in boxing, as Garii knocked out a Mii that looked just like my little nephew.
8. There is some translation from real skills. On games I've never played before, my nephews beat me pretty easily. But I was able to occasionally beat my nephews on some of the activities that I do in real life, like boxing, yoga, tennis, or baseball. If I get a Wii, I think I would probably play the tennis game quite often, since it's certainly easier to turn on the video game system than find a similarly skilled partner.
Overall, I really enjoyed the Wii. For adults in particular, I thought the Wii Fit was great, and could be a enjoyable way to work on balance and strength exercises.
Subscribe to:
Posts (Atom)