Tools to help you find your balance

When someone’s fitness level is assessed, we tend to measure strength, endurance and flexibility. In my practice, I also like to look at someone’s functional capacity. My clients are usually with me because a loss of balance and/or stability make it very difficult for them to do things they love, like hitting a golf ball, riding a bike or even just going for a walk.

Losing balance can occur from a number of factors. Diseases like Parkinson’s, MS, stroke and arthritis interfere with the body’s ability to maintain balance and stability due to dysfunction of the muscular and nervous systems. Even in healthy individuals, the cells in the part of the brain that help us to stay upright begin to die off as we age. When this happens, it gets harder to correct the body as it moves through space and has to navigate things like curbs, stones or uneven surfaces. Vision and hearing problems make it difficult to channel information and the use of some medications and/or blood pressure issues can result in dizziness.

Loss of muscle strength, power, co-ordination and reflexes can play a massive role in someone’s ability to balance and stabilize themselves in their everyday lives and in their extracurricular activities. Fortunately, this is the area where we have the most control and where I am most able to help people.

As part of a two-part series on assessing and improving balance, here are my favourite ways to judge the balance and stability of my clients.

1. Single Leg Hold

Stand on one foot and time how long it takes before you touch your opposite foot to the ground. Record your score and repeat with the other foot. If you have serious balance issues, stay near a wall or chair that you can grab in case you wobble.

2. Abdominal Plank

Balance yourself on the floor from your toes and your elbows for as long as you are able to hold, pain free. Do not hold your breath in this position! This is a great measure of core strength and stability.

3. Single Leg Chair Touch

This is a much more advanced version of the Single Leg Hold. Balance on your left foot in front of a chair. Bend at the left knee and touch the chair as many times as you can with your right hand. If you stumble and have to touch the floor with your opposite foot, continue where you left off without restarting the timer and record how many touches you get in 30 seconds.

4. Standing to Lying to Standing

This test should not be performed by people with low blood pressure, back pain or problems with dizziness. Stand in front of an exercise mat and start a timer for 60 seconds. Lie down on the mat on your back and then stand back up. Record how many times you can go from standing to lying to standing in 60 seconds.

5. Modified Standing to Lying to Standing

I came up with a modified version of this test for seniors or others that find it challenging to simply get on the floor. Rather than repeating for 60 seconds, I have the client lie down and stand up only once and then record the time it takes.

6. Timed Up and Go “TUG” Test

This test is very useful for people with conditions like MS, Parkinson’s and Arthritis or post-stroke. The client sits in a straight back chair and a spot is identified 3 metres away. At a signal, the client will rise (using assisting devices if necessary) and walk to the 3 metre mark, turn, return to the chair and sit down. Their time is recorded for retesting later on.

I’ll pick and choose from the tests outlined above depending on a client’s current fitness level and or level of impairment. When I get a score, we’ll use it to compare to a retest every few weeks. Recently, I had a client improve on the Stand to Lie to Stand from 4 to 8 ½ repetitions in just 4 weeks and another client decrease his Modified Stand to Lie to Stand score from 105 seconds to 28 in the first month. These improvements are significant and will have a huge impact on their daily lives.

Next week, I’ll let you in on some of the exercises that my clients use to get the kind of improvements that carry over to their lives in meaningful ways.

I’ve started physiotherapy for my surgically repaired shoulder in the past week. This means that I’m working on strengthening and moving it more these days. I’m a little sore today, but I was able to shovel top soil into the garden on the weekend, play a game of pool and even strummed my guitar for the first time in two months. Slowly, but, surely I’m getting back in the game.

Tweak your workout for life changing results

I’ve been in Collingwood for the past several days with my family for my daughter’s dance competition. We decided to make it a bit of a vacation and take in the scenery at Blue Mountain where the event is being held. The views here are absolutely gorgeous and inspiring.

Our road trip coincided with the fact that I was moving into a new phase of recovery following rotator cuff surgery. Aside from daily mobility stretches, my arm has been completely immobilized for five weeks to allow it to heal properly. While in Collingwood I was able to remove my arm from its sling, so I decided to do my first workout in six weeks in the hotel gym.

My workout started with “body weight only” arm movements before moving on to leg and core exercises and then about 30 minutes of cardiovascular work.

While I was in the gym at the hotel, I got to observe a nice, older gentleman come in for his own workout. He looked to be about 72 years old and looked like he had been sitting, hunched over a desk for at least 40 of those years. His posture was terrible with his head jutting forward, his shoulders rounded and his lower back flattened. Nevertheless, I was impressed that he was making the effort to work out while on vacation!

While I was riding the stationary bike, I watched him go through his routine with great efficiency. He had clearly done this before. As I watched him, it occurred to me that he was doing exactly opposite of what I would have assigned him for a workout if he were my client!

A common mistake that many exercisers make is to only work on the parts of the body that they can “see in the mirror.” This man was doing exactly that. He started by riding the recumbent bicycle for 15 minutes, pushed up close to the handlebars. While the cycling might have elevated his heart rate, it put him in a position that made his postural problems worse and did nothing to warm up his joints and muscles.

After his warmup, he moved on to strength exercises. Chest presses, abdominal crunches, leg extensions and finally bicep curls. Every one of these moves strengthens a muscle group at the front of the body, which in his case was already too tight. He ignored the muscles that he couldn’t see which could help him stand up straighter.

To make matters worse, he performed his entire routine sitting down, slouching forward.

So … to reiterate, I admire this man for going to the workout room and putting in the effort. I feel for him, knowing that his diligence could be moving him in the wrong direction. He’s not just wasting his time; he might actually be making himself worse!

The good news is that his workout routine could be fixed very easily. Here is what I would do if he were my client.

First, I would get him out of his seat! Sitting, slouched over a recumbent cycle is the wrong way for him to warm up. I would have him perform a series of chopping movements with a medicine ball or a light dumbbell, standing up, and emphasizing proper posture and alignment of the spine.

For strength training, he could continue with the exercises that he is comfortable with, but, rather than sitting and resting between sets, he would perform at least two exercises for the back of the body. Rather than doing a set of Chest Presses and then resting, he would do the presses followed immediately by a rowing exercise and then by a back extension. He would rest, standing up, before starting the cycle of three exercises over again. This “superset” method could be applied for each of the exercises he was already doing.

After strength training, he would perform up to 12 minutes of aerobic exercise, on his feet, using the elliptical trainer or the treadmill. Every three minutes, he would speed up for a 20 second burst of effort for the duration of the 12 minute session.

A great way for this gentleman to complete his workout would be with some static stretches, specifically for the tight muscles at the front of his body while he was cooling down.

With just a few tweaks, a disastrous workout can become a routine that can be life changing for an exerciser that is well intentioned and disciplined, but, lacking in direction.

How to keep your joints strong and mobile

When I started writing Fitness Solutions, I introduced readers to the “7 most common conditions that I help people manage with exercise.” It’s important to reinforce that the job of a medical exercise specialist is never to diagnose or to treat a condition. Diagnosis is left to medical doctors and treatment is the domain of physiotherapists. What I do is help people manage their conditions with exercise.

One of the most common problems that I help people overcome are joint disorders related to osteoarthritis (OA).

Osteoarthritis refers to the arthritic changes that happen in a joint due to age, injury, overuse or just daily wear and tear. It involves inflammation and can start in the cartilage before spreading to the opposing bones. Cartilage is the tissue in a joint that provides “shock absorption” so when inflammation happens, the joint loses its integrity and bony surfaces become rough and don’t slide over each other as well as they used to. Pain and instability are common and if the joint affected is for weight-bearing like the knee, ankle or hip, and loss of function can be expected.

If you have arthritis and are starting an exercise program, it is important to go slow, modify your plan through trial and error and develop a balanced program. Balance means doing a combination of strength training, flexibility exercise and endurance activity. Balance also means working at a level that is challenging enough to stimulate the body to get stronger while not so difficult that you can’t recover between sessions. My favourite way to do this is to use several different training modalities. Some workouts are for times when you may not feel your best and others for when you really want to push yourself.

Here are my three favourite workouts for people dealing with joint problems due to osteoarthritis.

1. Aquatic exercise. The thing that I love about working in the water is that it is so adaptable to all fitness levels and is so low impact. If you are sore and tired, just walking and stretching in a warm pool can do wonders for your recovery. On the other hand using things like deep water vests and water dumbbells can allow you to do a workout similar to being in a gym for when you want to really push things.

2. Weight training. For building supportive muscle around an arthritic joint, there is nothing that works as well as weight lifting. Whether you use free weights, machines or rubber resistance bands, the key is to work in a pain-free range of motion and to build muscle equally on all sides of the joint.

3. Static stretching. Joints that are affected by OA become stiff. Stretching the muscles around that joint can help restore proper range of motion and even decrease pain as function is restored. Like weight lifting, you should only ever stretch within a pain-free range of motion. My recommendation is to spend some time warming up, either in a hot shower or by doing some cardiovascular work before doing a stretching routine.

When you do get into a routine of strengthening, stretching and building endurance, it’s important to monitor how you feel. I always tell my clients that it’s OK to feel muscle soreness, but, it is never OK to experience joint pain. OA sufferers may require more time between sessions due to pain, swelling or fatigue and having alternatives to an all out workout is crucial. Arthritis pain shouldn’t be worked “through,” but, it can often be worked “around.”

My own rehabilitation after rotator cuff surgery is entering a new phase this week. The first was to immobilize the joint to allow it to heal. This was done by staying in a sling at all times other than when doing mobility stretches.

On Thursday, I will be out of the sling and will start to use my muscles to lift my arm in several planes of motion against gravity. I’ll also be working with a physiotherapist who will start to actively mobilize my shoulder. Thinking of this, it occurred to me that, other than walking and staying active, for the first time in my life I haven’t actually exercised in 6 weeks!

With summer approaching, I’m really excited to get moving again, with a plan, as my shoulder gets stronger. I’ll work on losing the eight pounds I’ve gained since my operation as well as getting back to mountain biking and then back to men’s hockey in the fall.

Here’s help managing your energy level

When you think of the different pieces of the puzzle that make up someone’s health and fitness, there are three things that jump out at you: Strength, endurance and flexibility. There’s no doubt that these three are critical, but, I would suggest that a fourth might be just as important … if not more so. The fourth key to real, long-term fitness I would suggest we consider is energy.

We live in a world that is increasingly connected and that never shuts down and as a result, we have a population that is tired, stressed and lacking in vitality. The reality is that this isn’t going to change any time soon, so it becomes even more important to learn how to manage your energy levels while you navigate your daily life.

On most days, I have a client that tells me that they are sick and tired of … feeling sick and tired. When they come to me, they’re frustrated because they think they’re doing all of the right things and still not seeing a payoff. The good news is that, with a few tweaks, increasing your energy levels can happen almost overnight.

When I meet someone who says they have “no energy,” I discover they are usually missing out on one of the four key elements that provide the kind of endurance that gets people out of bed in the morning and feeling alert and awake long into the afternoon and evening.

These four key elements are:

• Blood sugar stabilization through nutrition

• Efficient oxygen transportation from fitness training

• Balance and recovery via sleep and stress management

• Mental renewal through hobbies and play

I can think of one client in particular who felt like her whole life was a struggle just to make it to the end of the day and then go home to crash. She thought that she was eating “healthy” and she was walking a couple of times per week. After getting to know her, she handed me her food journal. Her diet was, indeed, quite healthy. Mostly homemade and very few empty calories. What really stood out were the long gaps between meals or snacks. She ate breakfast before going to work and then usually had nothing to eat until dinner 12 to 14 hours later! Her blood sugar levels would drop to nothing and she would be so tired that she sometimes felt dizzy. She started packing a lunch and an afternoon snack that included some protein and, as her blood sugar levels stayed consistent throughout the day, her mid-afternoon slump disappeared.

The walks she was taking were leisurely at best and mostly on weekends. It became a priority for us to design a quick, efficient workout she could do at home three times per week to build her strength and aerobic capacity. While not long, her workouts included higher intensity exercise “bursts” to make her better at moving oxygen rich blood throughout her body.

An interesting thing happened as her vitality increased. Her days became more productive, so she got more done at work and did more at home after work. When it was time for bed, she slept more soundly then she did in years, meaning that she didn’t feel like she was dragging the moment she got up in the morning.

One of the things that she started to do with her new-found energy after work was to get back to her hobbies, which included doing arts and crafts. The importance of this can’t be overstated. Most adults lose the ability to “play” or just do things for the fun of it. Playing and participating in hobbies helps us to relax and brings our stress levels down. The benefits can be similar to those you receive after a vacation. It helps bring perspective back into our lives and even gives us a sense of control when our days might feel like they are controlled by everyone else. It’s the reason your doctor plays golf every Wednesday! For you, it can mean learning guitar in the evening, growing tomatoes in your backyard or colouring in an adult colouring book. When you feel renewed, you are given a new beginning with a full tank.

Last week, I had my surgical followup for my shoulder. I’m happy to say that I seem to be right on schedule. My range of motion is a little bit better than average and I will be adding a fourth set to my stretches during the day. Other than that, I am still in a sling for the next three weeks and learning to live with one arm. My pain level is still extremely low and I haven’t taken a pain pill since the third night after the operation. Basically, my instructions are to protect my shoulder, keep it close to my body and let it heal. Easier said than done!

5 keys to managing back pain

Back pain affects a large segment of our population. For some it pops up occasionally, while others live with it continually. It can affect the upper, middle or low back area and can be caused by a one-time event or by long-term overuse and poor lifestyle behaviours.

When you suffer from back pain, it seems like it’s the only thing you can think about. It saps your energy and makes it hard to focus on anything other than managing it. There are three main reasons that back pain occurs in the general population: disc bulges or herniations, muscle or ligament strains, and arthritis.

Whether the pain comes as a result of a one-time event, like an accident, from long term overuse or from poor lifestyle choices, there are ways to manage it.

After years of working with people who suffer from back pain to different degrees, I have identified 5 keys to managing back pain.

1. Build strength and stability in your core. The muscles of the “core” include the abdominals, the lumbar extensors, the hips and the buttocks. The best strength moves for the core require little or no equipment and include moves such as abdominal crunches, planks, hip bridges, back extensions and resistance band rotation exercises.

2. Decrease, as much as possible, the amount of time that you sit. If you have a desk job, take your breaks standing or walking. If you must be on the phone, use that as a chance to move around and walk during your lunch hour. If possible, consider using a standing desk.

3. Exercise in ways that counteract what you do all day at work. If you are on your feet all day, sit down to exercise using machines. If you sit all day, try circuit training and functional exercise where you are mostly on your feet. In today’s world almost all activities involve being in a flexed forward (hunched over) position. This makes it crucial to spend time focusing on the muscles that hold you upright. These include the muscles that pull your shoulder blades back, hold your head up and help you to sit up straight.

4. Decrease your stress levels. Use tools such as daily check lists to reduce the feelings of being overwhelmed that come from being pulled in too many directions. Working from a list allows you to focus on one task at a time before moving on to the next. People who feel stressed will ignore pain signals and continue working through them. If you feel chronically stressed, try activities like yoga or meditation or simply go for a walk outside.

5. Examine how you sleep and choose the right bed for you. Generally, a firm mattress that provides support will be best for a healthy back. Some people with back pain find relief using body pillows to support their knees, hips and spine in different positions. This is a way to keep your spine in proper alignment while sleeping, which reduces tension on the muscles, ligaments and even on the discs.

If you have back pain that lasts for great lengths of time or causes numbness, tingling or shooting pain into a limb, it’s important to seek attention from a medical doctor, physiotherapist or chiropractor. They will assess you and will help you to plot out the best course of action to find relief.

While medical exercise specialists and personal trainers can help you tremendously to manage your injury, it is outside of their scope of practice to diagnose a problem or to “treat” a problem where these symptoms exist. If you have the symptoms listed above, get to your doctor!

As I write this, I am five days post-op after my shoulder surgery. Two rotator cuffs were sutured, my shoulder joint was cleaned and smoothed and my bicep muscle was reattached to a new location on my upper arm bone. These procedures required drilling, sewing and filing. Incredibly, however, I have no pain. My surgeon insisted that I begin stretching exercises the day after the operation and I think this has made a big difference. I’ll be using my strong arm to move my operated arm three times per day for the next couple of weeks (You can see a video on my YouTube channel demonstrating the moves) and then we’ll assess whether I can move onto strength exercises. Above all, consistency is the key to success and I plan to be diligent with the homework that I’ve been assigned.

The five keys to managing metabolic syndrome

Perhaps the one condition that is most common in clients that I see than any other is metabolic syndrome. It has become more prevalent in our society as rates of obesity have increased, foods have become more refined and lifestyles have become more sedentary. A person with metabolic syndrome is, typically, overweight holding excess abdominal fat and may have problems metabolizing sugar along with having high blood pressure and high LDL (bad) cholesterol and low HDL (good) cholesterol.

Aside from seeking medical intervention for the problems that come with metabolic syndrome, there are a few things that people can do to help manage their condition and even improve their health status. In my practice, I have worked with clients who took measures to get healthier and then were taken off blood pressure medications by their doctors and who also went from being prediabetic to normal.

The five keys I have identified to help manage metabolic syndrome are:

1. Use exercise to build and maintain muscle. One of the main features of metabolic syndrome is having a high body fat level. Fat is burned within muscle cells, meaning that the body’s ability to burn fat is increased as one gains lean muscle tissue.

2. Increase the amount of nutrient dense foods that you eat. Packaged, refined foods are, typically, high in calories and carbohydrates and low in nutrients. To be able to get the nutrition needed from these foods results in high caloric intake which causes weight gain and fat accumulation.

3. Choose foods that promote stable blood sugar levels. Aside from consuming excess calories, another way that the body gains fat is by producing too much insulin. Insulin is a hormone that is produced by the body as a response to high blood sugar levels. Its role is to store sugar within cells for fuel. When it does this, the body stops production of another hormone called glucagon. The role of glucagon is to release stored body fat for fuel. Having erratic blood sugar levels from eating refined, sugary foods interferes with the body’s ability to burn fat.

4. When exercising aerobically, add intervals and high intensity bursts to your workout as opposed to simply maintaining a moderate pace. Evidence has shown that doing interval training workouts will result in lower blood sugar levels and less insulin resistance. Participants in high intensity workouts also have been shown to have greater cardiovascular fitness and greater lung capacity. These are all significant benefits to people with metabolic syndrome. As the intensity of exercise increases, the duration decreases. For larger people, this is meaningful because there will less repetitive strain on the joints.

5. Get adequate sleep and try to keep your stress levels under control. Building and keeping muscle is important for managing metabolic syndrome since it is related to the ability to burn fat. One of the enemies of muscle is having high levels of the stress hormone called “cortisol” which can eat away at muscle. Excessive amounts of cortisol are produced when one is stressed or sleep deprived.

These five keys are intended to build a more effective, efficient metabolism to help combat metabolic syndrome. It isn’t enough to just go for walks and to try to eat “better.” Use a strategic approach to find real improvement. Along with the help of your doctor, you can bring yourself back to health.

As you read this article, I will be recovering from my rotator cuff surgery yesterday. As a medical exercise specialist, I believe in always having a plan. For me, this meant taking one year to continue my sporting and work activities until my function diminished and my pain level was too high. At that point, I would have surgery, then enter a recovery phase for several weeks. I’ve been told that I should be most of the way back in tow to four months and all the way back around six months after surgery. I’ve built a lot of supportive muscle over the last few months, which makes me confident that, although painful, the next part of my plan will be smooth. Stay tuned for the details!

Little Bursts of Speed Have a BIG Impact

There was a time when people thought exercise would only bring you benefit if it was painful. About 20 years ago, the “no pain, no gain” philosophy fell by the wayside and new, gentle approaches to fitness emerged. More recently, however, the pendulum has swung back to hardcore training with offerings like Crossfit, boot camp workouts and the popularity of Mixed Martial Arts.

Currently, the hottest training modality is called High Intensity Interval Training, or HIIT. HIIT workouts are based on alternating brief, intense exercise bursts with a recovery period before going back into another “burst.” The modern history of this type of training goes back to the early 1900s when Olympic runners from Finland experimented with varying intensity levels in their training and then dominated the track and field scene.

Today’s time-crunched fitness consumer values efficiency, adaptability and results over everything. The great thing about HIIT is that the sessions are much briefer than traditional gym based workouts and they can be adapted to all fitness levels. One groundbreaking study at McMaster University even revealed impressive results in workouts that lasted as little as 4 minutes!

As a former professional athlete, I am intimately familiar with the value of interval training. As a Medical Exercise Specialist, I’ve wondered if this training tool could (or should) be adapted for clients who are trying to manage their medical conditions with exercise.

Repetitive strain injuries are a big part of my practice. Reducing the time it takes to see results reduces the repetitive nature of a workout and decreases the risk of injury. Additionally, HIIT workouts are often performed by having exercisers move through a variety of workout stations for set amounts of time. The benefit to this is that stress will be spread throughout the body, reducing overuse.

In reviewing the research on HIIT training, I found three additional benefits to adopting this style of workout. HIIT sessions were found to improve participant’s lung capacity better than regular, steady state workouts and also were shown to have a positive effect on blood vessel function in healthy adults.

For people with cardiovascular disease, research has shown that those who participated in HIIT workouts had double the cardiovascular fitness compared to participants who did moderate intensity continuous training. Lowered insulin resistance and reduced blood sugar levels were also seen as a benefit of this protocol.

There are a couple of ways you can get started doing HIIT. First, you can turn your steady state “cardio” workout into a HIIT session by adding intervals into the mix. Every 2 to 3 minutes, speed up your pace for 20 to 30 seconds before slowing to a recovery speed. Your “burst” should be at a pace that you couldn’t continue for more than 30 seconds.

For strength training, choose 4 to 5 exercises to be arranged into a circuit. I like to choose two for the upper body (one pushing and one pulling), one for the lower body, one for the core and one endurance exercise. Rather than completing a specific number of repetitions, perform each exercise for 30 seconds, followed by 15 seconds of rest before moving to the next station. Once you have completed each of the moves, you’ve completed one round. Decide on a time limit (20 to 30 minutes) and continue with the rounds for the duration of your workout.

As I continue with my rehabilitation after rotator cuff surgery, I’ve come up with my own hybrid HIIT/Rehab workout. Besides strengthening my shoulder, I am trying to lose the weight I’ve gained from being inactive for six weeks, so the higher intensity work is necessary. The circuit that I’ve come up with incorporates low level shoulder mobility drills with leg and abdominal exercises and jogging on a step. My goal is to burn calories and to improve my endurance while restoring full range of motion in my shoulder.

While there are great rewards to using HIIT workouts, there are still risks involved as intensity increases. If you are new to exercise or have any medical concerns, you should always consult your doctor and get input from an expert with experience in this training style to help you plan safely and effectively. It will be well worth the effort.

The 4 Keys to Aging Actively

Some of my most active clients are over 60. They are dedicated, driven and desperate to keep doing the things they love to do. Things like playing golf, cycling, making music, traveling, working or being with their grand kids.

The physical challenges they may face include arthritis, hormonal changes, diabetes, cardiovascular disease and osteoporosis. Fortunately, there is an abundance of evidence showing that exercise has a positive impact on all of these conditions, as well as on depression and Alzheimer’s disease.

I’ve developed a list of three keys to be mastered for someone to age actively and successfully, despite the physical challenges that might appear.

1. Keep your quadriceps strong

Human beings start to lose skeletal muscle in their 30s if they don’t do some type of strength training to maintain it. This muscle loss results in slower metabolism, increased body fat and diminished performance in daily activities. All adults should be doing something to reverse this trend.

To age actively, there is one important muscle group that determines whether someone remains independent or if they become a dependent in later years.

The strength of the thighs (or quadriceps) determines whether someone is able to use stairs, use a toilet, get up from a couch, get into a car, climb a ladder, bend to pick up a golf ball, etc. …

Performing exercises like squats, step ups and lunges is the best way to do this. There are infinite variations of these moves that can be adjusted based on personal ability levels.

2. Use high intensity aerobic interval training

Recent research has shown that even seniors can benefit from adding high intensity intervals to their workouts. Walking hills or adding short speed “bursts” to daily walks can have a positive impact on blood pressure and body composition. Greater health benefits can even be achieved in shorter amounts of time versus longer, steady state aerobic workouts. And an added bonus is that decreasing workout time helps save joints from overuse.

“High intensity” is a relative term so each person should be working at a level that feels challenging to them. I recommend taking your total workout time and adding 20-30 seconds of faster paced “work” every 3 minutes. For a walking workout, the “work” could be faster walking, jogging or hill climbing.

Consulting with your physician is recommended before adding this element to your exercise routine.

3. Protect your joints

While I am advocating overall strength training and high intensity aerobic exercise for older adults, I am not in favour of high-impact workouts that can damage joints. Arthritis is already a fact of life for many, if not most, people over the age of 60.

The best way to keep joints healthy and working pain free is to build supporting muscle around them by doing a variety of strength activities. Alternating between different types of exercise is an effective way to do this without suffering from overuse injuries. In other words, change your routine at least once per month.

4. Stay flexible

Strong muscles will help you perform better, protect your joints and stay leaner. Flexibility will allow you to stand up straighter and move with much more ease.

A daily stretching routine that I’ve developed called The Big 4, is a routine that will stretch the entire body in only four moves. You can watch a demo of the routine by going to my website home page and clicking the You Tube button.

I believe in “under doing” things until an older client has learned proper exercise form and an appropriate intensity level has been established for them. When this happens, they enjoy the benefits of a progressive fitness program like anyone else.

After a year of undergoing MRI exams and managing my pain and injury, my shoulder surgery date is almost upon me. Knowing that I really can’t do anymore long term damage, I’ve increased the training load of my fitness program and for my shoulder specifically. My pain level is a little higher than it has been, but, in an odd way, this gives me comfort knowing that I’ve made the right decision to go through with the procedure.

Medical exercise is all about the numbers

When I get an inquiry from a prospective client, we talk about the process of how to work together. Sometimes it is unclear to them just what “medical exercise” is and I give them a very simple definition. Medical exercise is the development of safe, effective exercise programs to help manage medical conditions. The goal is to achieve measurable functional outcomes.

Medicine is all about numbers. Cholesterol, blood sugar, blood pressure and many other things are measured and assigned a numeric value upon assessment. The hope is that followup assessments will show an improved numerical score.

Medical exercise is the same. After completing an intake interview to get a picture of their health history, lifestyle and some of their challenges, clients will complete a musculoskeletal screening that will point out postural deficiencies, imbalances, tight structures and weak muscles.

From there, clients will go through a functional measures assessment. There are a variety of tools I can use to determine a “baseline number” specific to the health of the shoulders, back, hips, knees and/or ankles as well as for measuring pain, gait and balance. Once I have their “number,” clients will be reassessed periodically to measure their progress and the effectiveness of their program.

Recently, a 30-year-old guitar player was referred to me with problems related to poor posture and overuse injuries. He had burning feelings in his neck and shoulder and his hands were numb and they tingled when he played. His head jutted forward, his shoulders were rounded and his lower back was flat. I would describe him as looking like a big “C”.

It’s important to note that while he is a professional, performing musician, he also has a day job sitting in front of a computer, which contributes to his problems.

As part of his assessment, I used something called a functional shoulder strength scale. This tool has a client lift his arm in several different planes of motion, rotating internally and externally and also lifting a weight. The test assigns a score at the end. His score was 49 out of a possible 120 points. The muscles in his back were overstretched and weak and the muscles to the front of his body are tight and short. He is clearly in need of postural retraining and specific strengthening of the shoulders.

The way that I helped this client to overcome his “weak/ tight” condition was to start a twice daily stretching routine for his chest, anterior shoulders, neck and hip flexors.

He also began a three times per week strength program for the muscles of the upper back, rear shoulders, rotator cuffs and buttocks. Throughout the day, he is encouraged to get up and move around hourly to offset the hours of sitting in front a computer.

After two weeks, he is standing taller, not slouching as much and simply looks “better.” I decided to retest him at this point using the shoulder assessment scale and found that his new number was 79 out of 120. Quite an improvement in just two weeks!

The value of this numeric evidence can’t be overstated. It shows that although he is still having problems with pain, numbness, etc., he is moving in the right direction and he is encouraged to continue. The positive score also makes it reasonable to introduce more challenging exercises with increased resistance.

As this client’s physical condition continues to improve, he’ll be introduced to more of the fitness protocols that healthy people would use. He’ll be tested for standardized fitness measures like strength, muscle endurance, body composition, sub maximal cardiovascular fitness, flexibility, etc., and will be assigned number scores for these results as well.

As I get closer to my own shoulder surgery date, I am focusing my workouts on maintaining my overall fitness level and on strengthening my rotator cuffs using a thin rubber resistance band. The more strength and muscle I have going into the operation, the shorter my recovery will be afterwards.

I’m getting scared, but, excited to get my body fixed!

Ernie Schramayr, CPT, is a Medical Exercise Specialist in Hamilton. He helps his clients manage medical conditions with exercise and you can follow him at

Sitting is Bad for Your Health

You may have seen the news stories recently proclaiming that “Sitting is KILLING You!” or “Sitting is DANGEROUS”.  I think that I’ve seen the articles about sitting and poor health in the papers, on TV, in blogs and I’ve heard it on the radio.  It seems to be everywhere.  The thought occurred to me that, I better find out more about this if I’m going to be able to lead my clients to live healthier, fitter, more productive lives.

Like many active people, I assumed that by exercising frequently every week (5+ hours), I was erasing the effects of an increasingly sedentary modern lifestyle.  Everything is automated these days.  You can change channels, open your garage door and answer the phone without ever getting out of your chair.  Sort of like the people in the movie Wall-E!

If you saw Wall-E… you know the outcome of a life spent in a high tech recliner isn’t good.

I examined the findings of a study conducted by the Sax Institute, who are doing the largest ongoing study of healthy aging in the Western Hemisphere (the Institute is in Australia).  The study was conducted specifically to determine the relationship between sitting and morbidity rates.  They want to find out if people who stand more vs. those who sit more are less likely to die from certain diseases.

After reading over the results, I have to say that the findings are quite shocking!  People who sat 11+ hours per day (at work and then at leisure) are 40% more likely to die in the next 3 years vs. people who sit less than 4 hours per day.  The part that was most shocking to me was that it didn’t matter if the “sitter” was healthy or sick or if they exercised regularly.  Sit longer…. die sooner.  In other words, you can’t “exercise away” a sedentary lifestyle.

I also read the results of a study from the Medical Billing and Coding group who gathered evidence from many sources.  One of their findings was that people who sit more than 6 hours per day are 10% more likely to die within 15 years vs. people who sit less than 3 hours per day.

The evidence cited in the Medical Billing and Coding report is that when you sit, the electrical activity to your legs is cut off immediately and the enzymes that your body produces to break down fat drop by 90%.  Within 2 hours, good cholesterol in your body drops by 20% and within 24 hours, your risk for diabetes increases.  People with sitting jobs are twice as likely to die from Cardiovascular disease according to the report.

Wow.  Heavy stuff.

What we can take from these reports and studies is that the human body is a “movement machine”.  It is designed to work best and last the longest when it is in motion…. upright!  One of the positives from the Sax study was that the one group with the lowest death rates was the group that exercised the most AND sat the least.

What we can do right now.

1-  If you can do an errand by walking 15 minutes or less… do not drive.  Walk.

2-  If you have a desk job, get up every 15 minutes for a few minutes to stretch.  Anytime that you are taking a phone call, as opposed to doing work on your computer screen, stand while you talk.

3-  Turn the TV off and go outside when the weather is nice.  Walk around the block, talk to your neighbours, go for a bike ride.  If you have young kids playing sports, resist the urge to sit for the whole game.  Stand while you watch.

4-  At the gym, switch from the exercise bike to multi-station circuit training or to the treadmill that keeps you on your feet.

5-  Set up your work station to include a “standing desk”.  Surprisingly, this might just save your life!