Saturday, March 12, 2016

Dave Mills, The Optimal Balance

I am happy to have a guest post to Exercise Neuroscience @ UD.  Megan Gilmore is a Senior Exercise Science major at the University of Delaware and the type of student who makes my job more meaningful.  Enjoy.
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This is Dave. Dave was diagnosed with Multiple Sclerosis (MS) in 1973 at just 24 years old. After years of questioning his diagnosis, Dave saw another doctor who concluded that Dave actually has Spinocerebellar Ataxia in 1992. As his condition has progressed since then, he has become 98% dependent on his wheelchair. This hasn’t stopped Dave from getting to the YMCA to swim 3-6 times weekly, covering 1-1.5 miles each session. In order to maintain his physical fitness, Dave needs to display strong aspects of social and mental fitness, while arranging rides through his transportation service and keeping a positive attitude to continue exercising, despite the effort it may take to get there. The majority of us are perfectly capable of walking to a local gym, using the exercise equipment of choice, and getting back to our lives within an hour, yet we choose to let our physical fitness take the back burner. Does it take a debilitating event or disease to appreciate the bodies we are given?


Spinocerebellar Ataxia (SCA) is a condition characterized by progressive problems with movement. People with this condition initially experience problems with coordination and balance (ataxia). People with SCA typically survive 10 to 20 years after symptoms first appear. Today in 2015, Dave has been diagnosed with a condition degenerating his ability to move for over 40 years. Watching Dave swim 54 laps in the pool before 10 am on a Saturday morning was moving to say the least. He refuses to receive help from any person or device to get into or out of the pool and moves from one end to the other using mainly his left arm. After getting out of the pool, he said to me, “My right arm doesn’t move too well does it? But it works enough. Everything has its role.” Dave doesn’t take anything for granted and feels fortunate to have any ability in the arm that is lacking the mobility it once had. Comprehensive fitness can certainly be brought back to Dave’s quote. Social, mental, and physical fitness have to work together, each playing  a role, for a person to embody an overall high level of fitness. He utilizes his body as a unit, where everything has a part to play, big or small.


Dave was hospitalized on two separate occasions this May and June for a serious case of pneumonia, adding up to a total of six weeks in the hospital. In neither of these hospital visits did Dave receive a shower. He watched as his able-bodied roommates got up to take showers daily, but this simple daily function would be considered more of a luxury or a treatment for Dave, as the nurses or aides would have to step in and initiate the process. Dave explained that the staff appeared to be too busy to give him a shower, as they were dealing with more “critical” events with other patients.


It shouldn’t take losing mobility for people to realize that there needs to be change. It is education and awareness that can facilitate change in the attitudes people have towards people with limited mobility. Rather than asking himself, “why me,” Dave maintains a positive attitude as he realizes that his disability is a reality that people face. Hopefully this makes you think. As a 22 year old, I know that I am not guaranteed my health. Maintaining comprehensive fitness is the strongest protective measure to combat challenges and ensure resilience. Any day my body could fail me, and I hope I would choose to live like Dave.

REFERENCE:
“SCA1.” Genetics Home Reference. 30 Nov. 2015.   Web. 1 Dec. 2015.









Friday, February 26, 2016

Q. Why does exercise help Bob's PD?

Because he does it!  The video below shows Bob's legs during one of the high speed bicycling intervals in our SpeedGeezer exercise program. SpeedGeezer is described in this post with training worksheets that you can download, print and use.  Bob overcomes his challenges with PD and does this 30 minute workout 2 times per week.  Listen - when he says '51' he has hit 151 revolutions per minute (RPM).


(See this post about Bob's Comeback.)

An exercise habit or physically active lifestyle is hard to develop and maintain, even for people who do not have the added challenges of Parkinson's disease.  In my research program, we seek the best exercise prescriptions for your health and performance.  But there is a more important issue that often gets in the way of this information becoming useful.  Motivation!

You have to want the benefits of exercise enough to overcome anything that you identify as a reason not to exercise.  And this is a hard thing for me to suggest because I don't have Parkinson's disease and couldn't possibly understand how hard this is.  My perspective might also be different from yours in another meaningful way.  I grew up as a high active and love the feeling I get during and after a good workout.  In fact, when two days pass without a good dose of physical activity, I easily recognize the consequences; physically, mentally and sometimes socially (the three overlapping domains of health).

Below are three links to resources that might help you to get started.  Starting a new exercise program requires more than knowing what exercises to do - it requires you to train your motivation as well.
Exercise only works if you do it so take action now.  Like Wendy above, list reasons why you want to exercise - or why you want to improve your mobility and health.  Then set one really easy goal. Achieve that goal.  Elevate your goal and repeat.  Little by little, grow an exercise habit into your life.  We don't have to re-invent ourselves all at once to make this work.  We just have to keep nudging things in the right direction.  One thing at a time.

Be well.   --ck




Friday, February 19, 2016

Wii Speed Slice: Samurai with PD



The Active Video Game Market has provided many awesome tools for improving your function and fitness. Several games are ideal for fighting Parkinson's disease or age-related slowing (if your partner is a geezer).

I cannot recommend the best game for you without knowing more about you, your symptoms, fitness status and goals but I can explain the features of some of my favorite game options.  Here, I am reviewing a game in the Wii Sports Resort called Speed Slice.

Speed Slice Video: This video shows how to get to the game in Wii and what it looks like.

Precautions:

Fall Risk & Balance Training:  Especially if you have balance impairments, you should make sure that you have created a safe exercise environment.  Remove all tripping hazards from your exercise space and place a stable chair or other piece of furniture nearby so that you can grasp it when needed. You might also consider whether it is best for you to play this game while seated or standing -- or maybe while standing on one leg if you seek Samurai status. Challenging your stability is the way to improve your balance but you need to do so safely.

Shoulder Stability and Getting Carried Away:  I learned this the hard way.  This game is fun and sometimes I get competitive.  The day after I explored this game I had really sore shoulders.  Ease into this game to prevent soreness and injury.

You don't have to walk towards the TV screen to do well:  Some people get so involved that they approach the screen without knowing it.  There are legitimate reasons to attack your television with a sword but this is not one of them.

Why do I recommend this game?  

  1. It is speed based:  This game directly attacks some of the symptoms of Parkinson's disease and age-related slowing.  It is a tool to improve your a) ability to make fast decisions, b) reaction time, c) movement speed.  These abilities are important in driving a car safely, among other things.
  2. It trains your balance:  You can enjoy this game while sitting or standing and you can creatively modify it to challenge your balance.  The slicing movement requires a coordianteed movement  of your arms and trunk and your whole body needs to be prepared for these fast movements to prevent a fall.  Other ways to train these higher level abilities include boxing, partner dancing, throwing/catching, and exercise with battle ropes and other training aids.
Tips:

  1. Ease into this game slowly.  Try it briefly on day one and then increase your vigor as long as you don't experience pain or soreness.
  2. Keep track of your scores using the Wii game system or a notebook and pencil.  Keep it simple.
  3. Study the ways of the Samurai and pursue perfection.  Pay attention to a stable foundation and maintain your best posture.  Work on two- handed slices.  Use the abdominal breathing that you learned in Tai Chi classes.
  4. Put Speed Slice on your calendar with recovery days in between at first.  Consider using the game in the morning and see if it awakens your nervous system.
  5. Don't get discouraged - If this game is too challenging for you, continue to seek ideas from your health care providers and fitness professionals.
Find the Scientific Support Here:  Link to PubMed Search



Thursday, January 14, 2016

Side Effects of Exercise for the Nervous System


My blog is called Exercise Neuroscience @ UD and it is about how older adults and people with Parkinson's disease can use exercise to jumpstart their nervous system and improve their mobility. Even though the exercises I recommend are designed to improve nervous system function, there are meaningful side effects that affect other parts of the body. Fortunately they are good side effects.  And 30 minutes can do a lot of good. My mom endorses this video. 

Thursday, December 17, 2015

Purposeful Fitness


These are the heart rate data from my 5K (3.2 miles) on the treadmill this evening.  It was a 35 minute experience.  It wasn't my typical 5K run.  It was a run-walk-run 5K with a specific purpose.  And the goal of this post is to model the habit of attaching fitness to a purpose.

The purpose of tonight's training was to support personal fitness and family fitness.  In about 12 days my family from Delaware (flat) will be visiting the White Mountains in New Hampshire (not flat). Not too long ago we decided that one of our family goals is to climb all the 4000 footers in the Whites.

Tonight's fitness strategy is informed by experience from last year (Jan. 2015), when the premier hike took us to the summit of Mt. Pierce with a temperature at the summit well below 0.  We have been visiting the Whites for 2-3 days at a time in the summers and winters.  During each visit, our first hike is an easier 'shake-down' hike in which the purpose is to become reacquainted with the temperatures, the terrain, our gear and fitness.

Last year was our first attempt at a Winter 4000 footer.  If you believe in comprehensive fitness, you believe in planning and being prepared.  This list of recommended equipment from the Appalachian Mountain Club will fill a backpack and I haven't hiked with a  full pack in years.  Our shakedown hike was a beautiful hike up Mt. Pemigewasset.  Unfortunately, I wasn't fit for the task and it made me very tired and very sore.  Embarrassingly so.  I bounced back well enough for the larger hikes on the following days but I have absolutely no interest in being unfit again at the wrong time this year, especially with family-welfare at stake.

So this evening's treadmill workout went like this:
  • Run a 9-minute mile.
  • Walk 1.2 miles at 4 mph with the incline set at 14.  
  • Run a 9 minute mile.
This workout was hard for me and it accomplished exactly what I hoped.  It gave me a mild sensation of low-back strain and my tibialis anterior muscles were working very hard.  Both sets of muscles will likely be sore within 24-36 hours (delayed onset muscle soreness).  I will periodically get out of my chair and walk around at work tomorrow. These muscles will recover and if I have a few more workouts like this I will not be sore in New Hampshire due to a task-specific increase in fitness. I'll be better prepared and this elevates the family safety factor - comprehensive fitness.

And yes, my heart rate data probably look weird for someone who knows what they are looking at.  I happen to have a cardiac pacemaker.*  It keeps my heart rate above 55 beats per minute (bpm) and increases it as needed for exercise - as well as modern technology can.  The point of showing you the heart rate data is to demonstrate how much you can increase your cardiovascular demand by walking. Walking can be used sensibly to reduce the impacts that would otherwise occur with running - while still getting great fitness benefits.  Some of my favorite Kinesiology experiments from the 1970s are Scandinavian studies that show substantial increases in VO2 max (the ability to use oxygen for work) due to a program of inclined treadmill walking with ski poles.  Very specific - very purposeful.
  
During my first 9 minute mile of running my HR was around 140 bpm.  When running or cycling, I rarely see my HR at the pacemaker's maximum setting of 160 bpm.  But after the first blue line on the graph, look at how the heart rate goes up with walking at 4 mph on a 14% incline.  It quickly went up to 160 bpm and stayed there as constantly as a machine would (straight lines in natural heart rate data are rare).  And wow, I learned something new about myself.  Once I got my heart rate up to 160 bpm by power walking - it stayed there even after I switched back to the easier 9-minute mile run on the level treadmill.

Bottom line - I am better staying fit when I attach it to a purpose and when the purpose relates to more people than just me.  I hope you can find the higher purpose in your fitness too.

*  The big dips in the HR data are where the monitor strap lost contact with my chest.

Thursday, October 15, 2015

Beetroot Juice Revisited...

Mazzo sets school record in Steeplechase.
This is a guest contribution from a former member of my research team named Melissa Mazzo.  She is smart and fast and currently pursuing Graduate Training in Integrative Physiology at the University of Colorado at Boulder.  Melissa is a high active who adheres to a healthy diet and lifestyle.  To me, that makes her delivery of related scientific information even more credible. - ck

What’s with all the fuss about beetroot juice?

You may have heard about it on the radio, read it in a magazine article, or seen an advertisement for the dark red drink marketed as the next popular “superfood.” But why did a simple root vegetable get so much hype?

With the spreading understanding that cardiovascular disease is the largest single contributor to global mortality, researchers are attempting to learn as much as possible about what factors contribute to heart disease and how cardiovascular health is affected throughout aging. A simple compound called nitric oxide has been found to play a large role in circulatory health, and has been the focus of recent scientific studies in labs around the world. This tiny substance—made up of just one molecule of oxygen and one of nitrogen— is what has the health industry humming about beetroots.

Beets are a plentiful source of nitrate, another small compound that, once ingested, is broken down into nitric oxide. Nitric oxide is then absorbed and circulated in your bloodstream, which is where the potential health benefits of beetroot juice may occur.

Nitric oxide is a substance that is normally produced by healthy, functioning blood vessels. It signals the muscle that surrounds the blood vessels to relax and dilate, which allows for increased blood flow and reduced blood pressure. In populations with hypertension, cardiovascular disease, peripheral arterial disease, and other circulatory health conditions, the blood vessels have become damaged and are unable to produce adequate amounts of nitric oxide.

By consuming foods that are rich in nitrate, the amount of nitric oxide available in the bloodstream can be increased, supplementing the amount of nitric oxide that the blood vessels can produce naturally. Researchers have shown that incorporating high-nitrate foods improves blood vessel dilation (vasodilation) and decreases blood pressure. In these studies, beetroot juice is often the dietary supplement of choice, and does indeed help to increase dilation of the blood vessels. However, beetroot juice is not the only source of nitrate that can help to improve blood vessel health through circulation of nitric oxide.

Beetroot juice is an easily accessible and practical source of nitrate, but many other fruits and vegetables contain substantial amounts of nitrate as well. Dark, leafy greens are excellent sources, and the greens of the beetroot plant even contain a higher concentration of Nitrate than the signature, red bulbous root. Another plant with a red-colored stem, the rhubarb plant, also has high concentrations of nitrate. Arugula, collard greens, spinach, mustard greens, and butter lettuce are all plentiful sources as well.

For anyone who isn’t a fan of drinking earthy-tasting beetroot juice, don’t give up on increased nitrate in your diet just yet—researchers have examined the effects of a simple DASH diet on nitrate intake and nitric oxide concentration in the blood. For those not familiar with the “Dietary Approaches to Stop Hypertension” (DASH) diet, it is a nutritional approach to lowering blood pressure and increasing cardiovascular health without medication.

It’s not a complex diet full of exclusions and banned foods, but instead emphasizes meals rich in fruits and vegetables (especially leafy greens), low-fat or non-fat dairy, lean sources of protein, and a moderate amount of grain products (preferably whole grain). This simple, balanced dietary recommendation has been shown to both increase nitrate consumption and levels of nitric oxide in the blood, showing that you don’t have to supplement with beetroot juice to experience the benefits of nitric oxide.

Even for those without high blood pressure, arterial disease or heart disease, increasing dietary intake of nitrate-rich foods will help to preserve the function of your blood vessels and entire circulatory system. When your circulatory system is healthy and functioning, the rest of the organs, tissues and cells in your body will be healthier as well. Blood vessels are like the lifeline of every cell, providing oxygenated blood and removing metabolic wastes like carbon dioxide from every cell in order to keep them functioning optimally.

Researchers have explored this effect and found that a diet higher in nitrate does indeed have a large impact on improving blood flow in the brain.

Chronic decreased blood flow in the brain tends to occur more naturally as we age, and has been linked to cognitive decline, dementia, and the degradation of brain cells. In contrast, preserving ample blood flow through proper blood vessel dilation helps to ensure the health of brain tissue and to preserve cognitive functioning. Increasing dietary nitrate consumption to increase blood flow allows more oxygen to be transported in the blood and delivered to brain cells to prevent damage that accumulates with age.

This increased availability of oxygen is vitally important in other tissues as well. Increased nitric oxide in the blood has been shown to improve exercise capacity in large part due to the increase in oxygenated blood flow to skeletal muscle. However, increases in exercise capability aren’t quite that simple; nitrate isn’t a “magical” supplement that will cut a minute off your 5k time or allow you to instantly ride for twice as long on your road bicycle. The effect of nitric oxide on exercise performance is seen primarily in populations with sub-optimally functioning blood vessels, like those with heart disease, atherosclerosis, or even anyone leading an exceedingly sedentary life.

In other words, supplementing with nitrate to increase blood-nitric oxide will only improve vasodilation (and therefore blood flow and exercise capacity) in anyone whose blood vessels cannot individually produce enough nitric oxide to suitably vasodilate the blood vessels.

This selective benefit of additional nitric oxide makes sense, as researchers have also studied the correlation between increased fitness and improved ability of blood vessels to produce nitric oxide. Their findings indicate that changes in diet (emphasizing fruits and vegetables high in nitrate; beetroot juice supplementation) are not the only ways to increase blood vessel dilation ability via nitric oxide. As you may now have realized, exercise helps to improve the health and function of blood vessels as well, stimulating the cells in your blood vessels to produce more nitric oxide naturally. Exercise, in addition to improved diet, is another guaranteed way to reduce hypertension and risk of heart disease.

Don’t forget, cardiovascular health is cumulative; the slow-but-steady breakdown of your circulatory system is occurring constantly, so you shouldn’t wait until your arteries are showing signs of damage to start changing your health habits. The earlier a healthy, balanced diet and regular exercise become habitual in your life, the more optimally your circulatory system will function throughout aging, keeping the rest of the organs and tissues in your body in good health as well.

Important points to take away:

Beetroot juice contains a high amount of Nitrate, which can also be found in fruits and vegetables, especially dark leafy greens.

Nitrate breaks down into Nitric Oxide in your body, which your blood vessels naturally produce when they’re healthy.

Increasing the amount of Nitric Oxide circulating in your bloodstream (by eating foods high in Nitrate) can help to…
  • Improve vasodilation and lower blood pressure
  • Improve blood flow to the brain and improve cognitive health
  • Increase exercise tolerance

Exercise improves the ability of your blood vessels to secrete Nitric Oxide themselves, relying less on dietary consumption of Nitrate

 A healthy, balanced diet and habitual physical activity can help to improve and preserve your cardiovascular health, leading to a healthier you all around!

Share your new knowledge with friends and family! 

Tuesday, September 15, 2015

High Intensity Interval Training - Not so fast.

If you follow this blog, you know that we use high speed exercise training  (see SpeedGeezerto jumpstart the nervous system in people who are suffering from slowness (people with Parkinson's Disease and older adults).  This post is to clarify the difference between our speedwork approach and something called High Intensity Interval Training (HIIT), which is quite popular right now in the fitness industry and receiving much attention in physiological research.  I will first provide you with some information about HIIT and then return to the focus of our speed-based exercise strategy.

The American College of Sports Medicine (ACSM) provides a public brochure about HIIT here: https://www.acsm.org/docs/brochures/high-intensity-interval-training.pdf 

The following two bullets are taken directly from the brochure:
  • Definition: High intensity interval training sessions are commonly called HIIT workouts. This type of training involves repeated bouts of high intensity effort followed by varied recovery times.  The intense work periods may range from 5 seconds to 8 minutes long, and are performed at 80% to 95% of a person’s estimated maximal heart rate, the maximum number of times your heart will beat in a minute without overexerting yourself. The recovery periods may last equally as long as the work periods and are usually performed at 40% to 50% of a person’s estimated maximal heart rate. The workout continues with the alternating work and relief periods totaling 20 to 60 minutes.
  • What are the Safety Concerns with HIIT Training?  Persons who have been living rather sedentary lifestyles or periods of physical inactivity may have an increased coronary disease risk to high intensity exercise. Family history, cigarette smoking, hypertension, diabetes (or pre-diabetes), abnormal cholesterol levels and obesity will increase this risk. Medical clearance from a physician may be an appropriate safety measure for anyone with these conditions before staring HIIT or any exercise training. Prior to beginning HIIT training a person is encouraged to establish a foundational level of fitness. This foundation is sometimes referred to as a “base fitness level”. A base fitness level is consistent aerobic training (3 to 5 times a week for 20 to 60 min per session at a somewhat hard intensity) for several weeks that produces muscular adaptations, which improve oxygen transport to the muscles. Establishing appropriate exercise form and muscle strength are important before engaging in regular HIIT to reduce the risk of musculoskeletal injury. 
The members of our research team in the College of Health Sciences would love to see your functional abilities and cardiovascular health improve to the level at which you can safely practice HIIT, but high intensity exercise comes with risk factors that should be considered carefully. Our speedwork program is designed such that high speed movements are are paired with low resistance.  This means low force, light weights and low effort settings on bicycles and other equipment.  We typically set the bicycles on effort levels of "0" or "1".  We use 20-second intervals at high speeds but we watch your heart rate and blood pressure so that we can adjust the recovery time to keep your intensity in a moderate range.  If you wish to someday practice HIIT, a program like SpeedGeezer might be a sensible first step to get the nervous system going.  See the section in the ACSM brochure on HIIT called "The First Step" for more guidance.