Can Exercise Really Lower Blood Pressure?

Blood pressure is the pressure exerted by the blood on the arteries and is measured in millimetres of mercury (mm Hg). There are two measures of blood pressure: the systolic blood pressure (SBP) is taken when the heart contracts and the diastolic blood pressure (DBP) is taken when the heart is relaxed. That’s why the systolic pressure is higher than the diastolic pressure. Blood pressure is considered high when it exceeds 140/90mm Hg and optimal blood pressure is 120/80mm Hg. High blood pressure or hypertension, as it’s also known, is a ‘silent killer’. ‘Silent’ because there are no signs unless it’s extremely high and ‘killer’ because it dramatically increases the risk of stroke, heart disease and kidney disease. Alarmingly, over 25% of adults in the UK have hypertension and that figure increases to more than 50% in those older than 60.

I was recently challenged by a client to provide evidence that exercise decreases high blood pressure. I think his exact words were…”where’s the evidence?” At first the question surprised me, but I soon realised he had a valid point. Why embark on a gruelling exercise programme without proof that it will actually fulfill the desired purpose?

So, here’s the evidence:

• Exercise decreases blood pressure in a staggering 75% of people with hypertension. On average, SBP decreases by 11mm Hg and DBP decreases by 8mm Hg. Now, if you’re thinking that those figures aren’t worth the effort…think again! The risks associated with hypertension are continuous. That means that with each 2mm Hg rise in SBP there’s an associated 7% increase in mortality from heart disease and 10% increase in mortality from stroke. So exercise alone can decrease your risks of dying from heart disease by just under 40% and decrease your risks of dying from stroke by 55%! Worth the effort?
• All guidelines (NHS, National Institute for Health and Clinical Excellence, American College of Sports Medicine, Canadian Hypertension Education Program, Mayo Clinic, etc) include exercise as a cornerstone in the prevention, treatment and management of hypertension.

Now that we know exercise works, here are some specific guidelines on how to go about it:

• Exercise should be undertaken on most days of the week and can include activities like gardening, household chores, walking, etc
• Perform primarily endurance exercise supplemented by some resistance work
• It should last 30mins a day (this can be continuous or accumulated over the day)
• The intensity should be 40-60% of reserve heart rate (low to moderate intensity exercise is as, if not more, beneficial as high intensity exercise)

What are you waiting for? Jump on that bike! Actually, before you jump on that bike, make sure you get permission from the owner and check with your GP as well. Next week, even more ways to help decrease blood pressure…

Low Back Pain: When To See Your Doctor?

The BBC News-Health webpage currently links to the BBC Health site. The title of the link is “Back-pain danger signs, Symptoms to take straight to your doctor”. I followed it, read through the information and found it incomplete. In my opinion, a few things could be added to the list, but before adding anything…it’s important to bear in mind that the vast majority of low back pain is trivial and usually disappears after a couple of days or weeks. In a very small minority of cases the low back pain is a sign of something more serious. You should make an appointment to see your doctor if your back pain is associated with:

• Significant trauma (such as RTA or a fall)
• Osteoporosis
• Prolonged use of corticosteroids
• History of cancer
• Unexplained weight loss
• Fevers
• History or high risk of decreased immune response (AIDS or HIV, recreational drug use, steroid or immunosuppressant use)
• Unremitting pain (even when lying down)
• Neurological symptoms (urinary incontinence or retention, fecal incontinence, loss of sensation in the genital region, weakness or loss of sensation in the lower limbs)

Please note that the signs and symptoms listed above don’t automatically mean that something sinister is at hand but simply that further questioning and examination is required. Lastly, remember that the overwhelming majority of low back pain is insignificant…apart from the inconveniencing pain obviously!

Should You Run After A Hip Resurfacing?

Osteoarthritis is the gradual degradation of a joint. It can lead to pain, stiffness and swelling. One of the most common joints to be affected is the hip. In 1940 Dr Austin Moore performed the first total hip replacement (THR) and the technique was later refined by Dr John Charnley. Modern replacements consist of a metal stem and head that is inserted into the top of the femur. It fits into a plastic cup which is cemented into the pelvis. Post surgery, patients usually experience less pain and enjoy greater range of motion. However, several studies have shown that the prosthesis wears and loosens prematurely if excessive running and impact activities are undertaken. This can lead to another operation to revise the THR with the associated risk of complications.

More recently, hip resurfacing was developed by Dr Derek McMinn as an alternative to THRs. It requires less of the femur to be removed. A metal cap is placed over the head of the femur and a metal cup is placed in the socket. The advantages of a hip resurfacing compared to a THR are numerous: bone preservation, less chance of dislocation, less leg length inequality, better lower limb alignment and easier revision to a THR if necessary.

A recent article in Reuters has quoted work done by Dr Julien Girard in France. Hip resurfacings were performed on 40 physically active patients. Their average age was 51 years. After surgery, 90% of the patients returned to running. Three years later 33 out of 40 were still running albeit they had decreased their mileage from 24 miles per week to 16 miles per week. The study didn’t look at the long-term effects of running on the implant.

An article in today’s Medical News Today summarises research presented at the 2012 Annual Meeting of the Academy of Orthopaedic Surgeons.  Over 10 years, 445 patients (average age of 49 years) who had undergone a hip resurfacing were monitored. A correlation between higher activity scores and revision of surgery was found and it was concluded that impact activities such as running and tennis were harmful to long-term success.

In conclusion, although a return to running and impact sports is possible after a hip resurfacing…even to high level competitive sport…it does bear risks…such as the untimely wear and deterioration of the prosthesis. This would require further surgery…and possibly a total hip replacement. With that in mind, my advice for anyone with a hip resurfacing, wondering how much they can or can’t do…would be to stick to non-impact exercise such as cycling, rowing, cross-training, etc. That doesn’t mean that you shouldn’t run at all…I wouldn’t want you to miss that train…but it should remain occasional.

Can Yoga Wreck Your Body?

Can yoga wreck your body? According to a recent article in The New York Times it definitely can! The article mentions a number of serious injuries that are thought to have resulted from yoga. Although it’s slightly dramatic and perhaps a little biased, it may contain a valid lesson…

Surprisingly, it’s a stark contrast to a previous article I posted about the benefits of yoga for back pain. How can yoga be both good for health and hazardous at the same time? By the way, this doesn’t just apply to yoga but can be extended to almost anything in life…and the answer is summed up in one word…moderation! The overwhelming majority of injuries that were cited resulted from forcing the body past its anatomical limits i.e. extreme postures…

If you practice yoga or are thinking about starting…how can you make sure this doesn’t happen to you? There are two parts to this…your teacher…and…you…

Your instructor should:

• be properly qualified and experienced
• have relatively small class sizes to allow for more personalised tuition (particularly for beginners)
• ask students about any existing injuries
• focus on technique and alignment during instruction
• offer a variety of exercise options to allow for differing skill levels
• correct students that are doing movements incorrectly
• not try to push students past their limitations

You should:

• wear clothing to allow free and easy movement
• ask questions if unsure of any posture or movement
• know your limitations…we’re all built differently and have our own strengths and weaknesses
• be cautious with any existing injuries and perhaps even consult your doctor or therapist before starting yoga
• avoid competition with others and with yourself
• take the time to progress from beginner moves to more advanced moves
• listen to your bodies…particularly when it comes to more vulnerable areas like the neck, low back and knees

Lastly, remember to have fun!

Happy New Year 2012!

The New Year is usually synonymous with resolutions…and the resolutions are often linked to health…eating a more healthy diet, exercising more often, losing weight, etc. This may have something to do with the guilt following the hedonistic excesses of the Christmas period! Ask any gym manager, January and February are probably their busiest months of the year. People abounding with good intentions flock into gyms and ardently throw themselves into strenuous exercise routines…only to run out of steam 4 to 6 weeks later upon which they mysteriously disappear…never to be seen again…until the following year of course!

So if you happen to have set yourself some goals this year make sure they’re SMART.

Specific

Measurable

Achievable

Rewarding

Timed

Specific

If you don’t know where you want to go, you’re unlikely to ever get there.

Clearly define what you want to achieve

Eg. “I want to run 30 mins twice a week”.

Measurable

If you can’t measure it, how will you know how close you are to it or even if you’ve reached it?

Use an objective unit of measurement

Eg. “I can time how long I have run”.

Achievable

Setting unattainable goals will decrease your confidence and motivation and setting goals that are too easy will not give any sense of accomplishment.

Set challenging but realistic goals

Eg. “I know I can run 30 mins twice a week if I work hard at it”.

Rewarding

Letting others set your goals or setting yourself uninteresting goals will sap your motivation and enthusiasm.

Set goals that will enhance your life and about which you are passionate

Eg. “Running 30 mins twice a week will help me lose weight and decrease stress”.

Timed

Not setting a deadline is the best way to fall prey to procrastination.

Set a definite starting and ending point

Eg. “I will start today and aim to reach my goal in 3 months time”.

Sometimes, your desires can only be accomplished after a long time. These long-term goals are best broken down into medium and short-term goals. You’ll experience a frequent sense of achievement as you reach your short-term targets and this will be instrumental in elevating your self-confidence and bolstering your motivation. Keep in mind that life is about the journey not just the destination and that health is not a transient goal but a way of life. Good luck!

May 2012 bring you health, vitality and happiness!

Feeling Sad? (Part 2)

Here are some tips to help reduce the winter blues:

• open the blinds and curtains and sit near windows
• take long walks and sit outside during your lunch break
• exercise regularly…it helps relieve stress and anxiety and lifts our mood
• get a light therapy box…it’s effective in 85% of cases when a light source 10x as strong as domestic lighting is used for 1-2 hrs/day…higher intensity light boxes can decrease exposure time to about 30 mins…the treatment can start working in as little as 2-4 days…and is just as effective as antidepressants…why not use it in the morning whilst having breakfast?
• psychotherapy can assist by identifying negative thoughts and behaviours that lower mood…it can also help manage stress
• antidepressants can be prescribed by your doctor if they see fit

I Wouldn’t Sit For That (Part 2)

Here are my tips to help prevent back pain, obesity, heart disease, cancer and death from over sitting:

• Stand whilst on public transport…there’ll be more than enough time to sit when you get to work
• Get up from your desk at least 1-2 times an hour (less than 5 minutes standing and walking around is sufficient)
• Drink more often, you’ll have to get up more frequently…to get a drink…and to go to the toilet
• Rather than send an email, why not walk over and speak to someone? (research has shown that walking at a leisurely pace is enough to reverse the metabolic changes caused by prolonged sitting)
• Don’t have lunch at your desk…go for a short walk…get some fresh air
• Organise your work tasks so that they involve frequent movement
• Here’s a little exercise you can do when you stand (breath in whilst you reach upwards and hold the position for about 5 seconds)…it will help your back

• Don’t use your car when your feet will do just as well

The clear message is that health can be maintained by including frequent short periods of standing and walking in our normal daily activity…little and often is the way forward!

Water Works

Drink 1.6 litres (women) to 2 litres (men) of water a day

Our bodies are 50-60% water. Water is the most essential of all nutrients. It plays an important role in the regulation of blood pressure and body temperature. It is crucial for digestion and it cushions and lubricates the brain and joints.

Two to three litres of water are lost every day through breathing, urinating, defecating and perspiring. Naturally, the quantity of water loss will depend on temperature, humidity, clothing, exercise, etc. A water loss of more than 1% of our body weight is accompanied by a decrease in physical and mental performance. The signs of mild dehydration are: thirst, headache, weakness, dizziness and fatigue. Moderate dehydration leads to a dry mouth, decreased urination, sluggishness, a rapid heartbeat and a lack of skin elasticity.

Although our sensation of thirst usually keeps us normally hydrated, the declining ability to detect thirst with age makes dehydration more common in the elderly. I remember telling my grandfather that he needed to drink more and his response was that he didn’t like it because it made him have to get up…and walk to the toilet! The colour of our urine is one of the best indicators of hydration. Straw coloured urine is ideal. The darker the urine, the more we need to drink.

It is recommended that we take in 2 litres (women) to 2.5 litres (men) of water a day (80% of the replacement water comes from what we drink and the remaining 20% comes from our food). Obviously our intake should be increased if we exercise vigorously.

Most of the information used in this article came from the European Hydration Institute. They are truly a one stop shop on hydration…and they even have a tool that allows you to compare the colour of your urine! Just in case you were wondering…