Given the times we live in, where social contact is limited, the promotion of online services in all professional areas proliferates. In fitness, it seems that it has suddenly been discovered that you can (and should) train every day and that you can train at home and/or on your own. It is incredible the explosion of posts on social media by personal trainers offering sequences of exercises for people to perform at home. We know that, for better health and resilience, it is essential to exercise every day, just as it is essential to eat well and maintain personal hygiene, but this has always been so and, therefore, it is not only a necessity of current times.
For this reason, posting an exercise line-up for everyone to perform is as valuable as posting a photo of a meal or of someone brushing their teeth. It serves as much to remind you that these activities are important, but the content is not, to a large extent, applicable to you reading this text. Much less when it comes to exercise. In fact, picking up the fork and knife to eat, or the act of brushing your teeth are less complex activities than performing most of the physical exercises that we often see proposed, let alone organizing them in a training session.
The health and resilience resulting from training is even more relevant in times of crisis such as the one we are experiencing now, but that health and resilience was mainly built months and years prior to this moment. Notably during those months and years that you consistently went to the gym to do your workout, often with personal sacrifice. It is hard to organize oneself in order to be able to train! We have family and work and it is sometimes difficult to reconcile all social and professional obligations with the time we choose to invest in our health and well-being, like in the case of training. Notice that now I’m using the term training.
Because many of you who are reading these lines have long understood the difference between “exercising” and training. Many of you have realized that “exercising” is better than nothing, but that training is at a higher level. Training is a process that requires the organization and management of a range of variables over time. It requires making a careful assessment of the initial condition, selecting specific exercises and the ways to perform them, observing and evaluating movement, and making the necessary adjustments (e.g. load, type and form of exercise execution) in order to ensure constant progression along the path towards health, performance and resilience. Training is not the same as ‘’doing exercises” always varied and without criteria just to maintain some physical activity. And because some of you understand this difference, you have come over the months and years that preceded today’s turbulent times to make organizational sacrifices in order to train. And you chose to invest a little more of your time and money, and regularly went to a gym to get a training service. A service in which a program is followed, the exercises are not chosen at random, and in which the progression in the loads used as well as the execution of the exercises is closely monitored by a coach.
All the benefits of personalized training are possible to obtain remotely via online. I believe that the in-person format will always be superior, but with good organization and commitment from both the coach and student, constant progression is possible, and this difference can be mitigated. How do we know this at The Strength Clinic? Because we’ve been doing it for years! In addition, personalized training followed online may even have some advantages over the face-to-face format, such as:
- Not having to go to the gym at any given time. This can be a great advantage for some people. If the self-discipline of following your training program is guaranteed, travel time and what it implies in organizational terms is saved. In addition, you can choose a training time slot that best fits your schedule without being conditioned by the availability of your coach;
- Greater consistency and commitment doing the exercises in your program. Since you can choose the time slot of your training session, you are less likely to miss it, as you will have more flexibility in adjusting the schedule if needed. This way, it is more likely that you reach the weekly training frequency that is desirable. In addition, as we recommend that you document on video a summary of each workout on an online platform so that your coach can observe, this also adds an additional sense of commitment to the session and the proper execution of the exercises;
- Better cost benefit. In fact, you will be able to enjoy almost all the benefits of having a personal trainer for a lower price because you will not have to pay for the running costs of the facility and its equipment usage where the in-person training session would take place;
- Train directly with your favorite coach. If the coach you would like to work with is not available in-person or his/her in-person rate is beyond your means, the online option will allow you to work directly with him for a lower price.
The message “don’t stop training even if you are at home or on your own” in the context of the crisis we are experiencing today is correct! However, this need did not arise today. It is something that should be part of our lives if we want to remain getting stronger and healthier forever. For this purpose, training is much better than just “exercising”, especially if you follow workouts taken from social media that do not take into account your specific profile, your body awareness and do not follow any criteria for exercise selection and future programming. It only serves the purpose of “moving the body” and getting tired in that moment or day, but it will not accomplish much more than that. Because training implies a process that is based on your goals and individual characteristics. In a training session, what you do today was based on what you did yesterday and what you are going to do in the future. And it is possible to continue to train online and reap all the benefits of personalized training, even at a distance. It requires a mutual commitment of the student and coach in a process that is joint. Your optimized personal development will always be our commitment at The Strength Clinic. We are here to guide you through this process rather that offering “one size fits all” workouts for everyone!
In order to maintain physical function, recover better from injury, maintain lean mass and stay healthier overall, older individuals need a higher protein intake than younger individuals. Higher protein intake contributes for attenuating inflammatory and catabolic processes, as well as ameliorating the decreased efficiency in protein metabolism associated with age.
According to the recommendations advanced by the PROT-AGE Study Group (2013) (reference below), older individuals should:
– eat at least 1 to 1.2g/kg body weight of protein per day;
– eat MORE protein if suffering from acute or chronic illness, between 1.2-1.5g/kg body weight of protein per day;
– ingest EVEN MORE if malnourished and / or suffering from severe illness or injury, ~2g/kg body weight of protein per day;
– limit protein intake if suffering from SEVERE KIDNEY DISEASE and NOT following hemodialysis. These individuals are therefore an EXCEPTION concerning protein intake;
– use supplementation to the achieve desired protein intake levels;
– and, of course, DO the type of exercise that most effectively promotes the maintenance or increases in lean mass, which is strength training.
And no, kidney disease is NOT caused by protein intake. In a one-year follow-up study with resistance-trained men consuming ~2.51-3.32 g/kg of body weight per day for one year, there were no harmful effects on measures of blood lipids as well as liver and kidney function (Antonio et al, 2016).
Maintaining strength and lean mass (including muscle mass, bone and connective tissue mass) are identified as the first and most relevant biomarkers of health and longevity. Improving these markers produces a positive and powerful “domino effect” on most (probably all) of the other health markers. Proper protein intake and strength training is essential for building lean mass. And even more crucial as we age in order to counteract the inevitable progressive loss of efficiency in our metabolism.
Do not fear protein nor strength training. These are probably two of your best allies to live better and longer.
Don’t forget the protein at your next meal!
Bauer, J. et al., 2013. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the prot-age study group. Journal of the American Medical Directors Association, 14(8), pp.542–559.
Antonio, J., Ellerbroek, A., Silver, T., Vargas, L., Tamayo, A., Buehn, R., & Peacock, C. A. (2016). A High Protein Diet Has No Harmful Effects: A One-Year Crossover Study in Resistance-Trained Males. Journal of nutrition and metabolism, 2016, 9104792.
In previous articles (check Part 1 and Part 2) we discussed the fact that while all golfers will do everything possible to change their game (buying new clubs and new balls), many overlook one of the most decisive factors for their physical and mental success – their nutrition; we have identified some of the main reasons why golfers never change and, finally, we have pointed out five important links between golf and proper nutrition. In this article, I will share with you my concerns about the so called “normal diet” and the five most important habits you should create to start nourishing your body better.
The Western Diet
The western diet is generally used to describe popular eating habits in the USA. As these eating habits are still very popular in Europe and other parts of the non-Western world, it will probably be necessary to find a new name for this type of “diet” in the coming years (perhaps the killer diet is a good name!).
But what is the “western diet?” Well, this “diet” can be briefly characterized by a high intake of processed foods, refined carbohydrates, sugar and hydrogenated fats; and a low intake of healthy fruits, vegetables and fats. It is this “western diet” that has been associated with most western diseases or diseases of civilization (examples: cardiovascular disease, obesity, diabetes, cancer, Alzheimer, Parkinson). Interestingly, this diet may also be responsible for increased violence and decreased cognitive test scores in school-age children (attention deficit disorder) and adults. Finally, this “western diet” has also been linked to bone loss (osteoporosis) and muscle wasting (sarcopenia) in adult individuals.
Let’s look at an example of a “normal athlete” daily menu before working with me.
Breakfast: Bowl of cereals and milk + Natural orange juice + Coffee with sugar
Snack 1: Mixed toast + Chocolate milk
Lunch: Chicken salad with mayonnaise and ketchup sauce + soda + ice cream
Snack 2: Slice of cake + Juice
Dinner: Grilled fish with vegetables + Baked potatoes + Glass of red wine + Dessert
For most people, this may even be considered a good day (and indeed there are some good things in this menu), but in the long run this type of eating will greatly compromise your health and performance. For this reason, we have to discuss this situation with the person and meet their real physiological and functional needs.
The Habits you must create
Before changing their diet, it is important that people start with a firm and solid foundation, and then make the necessary changes to optimize their health and performance. Most people (athletes included) want to start building a house from the roof down or building walls without paying attention to the quality of the soil. Any of these habits are simple enough, but just like any habit you want to create, it takes time to practice to assimilate the foundations of proper nutrition.
Habit 1 – Drink more water
Sometimes we talk about so much about food and forget about water, the most important element our bodies need to function properly. It is water that regulates all the functions of our body, including the activity of all solutes (the solid materials) dissolved in it. It is water that will actually allow the nutrients we consume to reach our cells and our organs. Aim to consume 1-2 glasses of water after waking up and to drink about 2 liters / day.
Habit 2 – Eat a protein source at every meal
Eating protein at every meal is critical. Of course, some “experts” will make you believe otherwise, suggesting that protein is somehow harmful to the kidneys, unnecessary, etc. However, I want to highlight the fact that what I am looking for my clients / athletes is the best of these three worlds: better health, better body and better performance – it will be very difficult to achieve these three with a suboptimal protein intake. Some examples include: eggs, meat, fish, chicken, turkey and shellfish.
Habit 3 – Eat vegetables at every meal
Your parents and / or grandparents are right – you need to eat vegetables to prevent disease! Evidence has shown that in addition to the micronutrients (vitamins and minerals) contained in vegetables, there are also phytochemicals that are essential for optimal physiological functioning. Vegetables will help improve the acid-base balance in the body, so my advice is eating all the vegetables you can!
Habit 4 – Eat a healthy fat sources at every meal
Fat (such as protein) is an essential macronutrient and so we have to ensure proper intake every day through our diet. There has been a lot of misconception about the effects of fat on diet but the truth is that fat can be our best friend when the goal is to lose fat mass, optimize the body’s physiological response and our health. Some examples of healthy fats include: fatty fish, nuts, seeds, extra virgin olive oil, coconut and avocado.
Habit 5 – Eat more vegetables with main meals and leave the other carbohydrates to the post workout window
Another way of saying this is: if you have fat to lose, you have to earn the right to eat carbohydrates by doing vigorous exercise in the first place! Do you want to keep eating bread, pasta, rice, potatoes, crackers, sugary foods, pizzas, sweets, etc.? You can even eat them – just make sure you do it in the post workout window (1-2 hours after training) because this is the time when your body is most sensitive to insulin. As for the quality of carbohydrates, you will have more benefits if you choose gluten-free foods (rice, quinoa, chestnuts, sweet potatoes, yams, potatoes) than highly processed foods or gluten-free junk foods. Also, don’t use exercise as an excuse to treat your body like the garbage truck!
Ever wonder why most people eat so much alike? Milk and cereals for breakfast, a soup and a sandwich at lunchtime, and, with luck, a slightly more balanced dinner of meat or fish, rice and some vegetables? What about those mid-morning and/or afternoon coffee and toast snacks? Crackers? Cakes and sodas? Cereal bars? Do you think this is a coincidence? Of course not, this is no coincidence!
This only happens this way because that is how you were taught to eat. Maybe this is the way your parents eat. Perhaps this is the way your wife, husband or partner eats. Maybe this is the way your friends and/or co-workers eat. Maybe this is the way your teammates eat. In fact, people do not even realize if what they are eating is appropriate or not for our physiology and genetics, if it improves or worsens health, if it improves or worsens performance, they eat this way because this is the eating pattern that they have been following for many years, and these were the habits they have ingrained.
In the last article we covered several reasons why golfers neglect nutrition, one of the aspects that can most influence their performance on the golf course. Interestingly, most golfers are more concerned with top-of-the-range clubs and new accessories than the foods they eat. And that is why today I will present five reasons for you to improve your diet.
Think about this for a while. If you knew that eating and/or supplementing in a certain way would: 1) reduce your fat mass; 2) increase your muscle strength; 3) improve your bone health; 4) enable a faster recovery; 5) increase your distance from the tee; 6) improve your mood; 7) reduce feelings of anxiety and anger; 8) improve your concentration and creativity; 9) improve virtually any known health marker and 10) improve your performance in training sessions and/or competition, would you be willing to eat that way? Given this short list of benefits I think it would be worth a try. Stay with me.
- Eating well will improve your body composition
Your total body weight is the sum of your lean mass and your fat mass. Lean mass consists of muscle mass, organs, bones, blood and skin. Your fat mass is basically all the fat that has accumulated in the body. For an individual to be considered athletic, he or she needs to maintain a good ratio between lean mass and fat mass. And golfers should be no exception. By this I do not mean that all golfers need to have Cristiano Ronaldo’s abs, what I mean is that under normal circumstances excess body fat has no benefits (unless you are a sumo wrestler in the spare time). Excess body fat will affect the efficiency of your swing, your mobility and your rotational power, meaning that you will have greater difficulty moving your body when you carry excess fat. The more fat you have, the more energy you have to use to move your body – the fat will “steal” power from your swing. So, it’s not the fat tissue that will give you power, it’s your muscle tissue!
- Eating well will improve recovery
If you are seriously committed to improving your game, you know you need to practice (and a lot!). According to experts, some professional golfers can hit 600 balls a day including chips and putts. And to perform all these swings you need muscle strength and power, meaning you need to do some kind of work in the gym! If the body is not prepared to cope with this type of stress in a regular basis, injuries and pain will begin to rise. If you often end your golf training sessions sore, if you notice fluctuations in motivation, if you can no longer hit balls in a coordinated manner, if you notice reductions in appetite, and if you are awake at night despite training a lot, it is very likely that your recovery is not being optimized. Muscle damage, Central Nervous System fatigue, and over-reaching are all common symptoms of many sports, but golfers tend to ignore these things. Although golf is not as physically demanding as other sports, the fact is that the daily training volume to which the body is subjected is large and this will make nutrition a key part of recovery.
- Eating well will improve mood, concentration and focus
Any professional golfer on the PGA Tour and/or the European Tour is capable of winning any major event. But why do some stand out more consistently than others? Because, according to experts, those who excel are mentally unshakable. That is, their ability to turn off negative internal dialogue, to consciously relax the brain and to focus with unflappable concentration is impressive. Some consider this to be an innate skill. And it is indeed. But it can be trained! However, there is also a biochemical basis for this mental prowess. You should know that by providing the right nutrients, including nutritional supplements, at the right times, the physiological link between the brain and muscles can be strengthened. Such as focus and concentration. For example, by controlling your blood glucose levels with frequent meals and less dietary sugar, mood fluctuations and that feeling of low energy after lunch can be eliminated. Therefore, in addition to body composition and recovery, nutrition can strongly affect your mental game. With the right nutrients, concentration, neuromuscular efficiency and mood can be significantly improved. On the contrary, if you do not ingest good nutrients, fatigue will appear earlier and you will no longer be able to concentrate in the same way.
- Eating well will improve your health
When I am talking about health, I am not just referring to the absence of pain and/or illness, I mean a feeling of physical, emotional and mental well-being. To perform at the highest level, health needs to be optimized, so the definition of health I share with my clients/athletes includes: 1) a resilient immune system; 2) strong antioxidant systems that protect against free radicals; 3) good detoxification systems; 4) a good balance of bacteria in the gut; 5) a good balance of basic and acid foods; 6) low levels of inflammation in the body; 7) an ideal balance between fat mass and lean mass; 8) a good balance of fatty acids; 9) good insulin sensitivity; 10) high energy levels and 11) the ability to maximize mental and physical performance at any age. All of these health markers can be influenced by the foods we eat every day! Therefore, these nutritional strategies will not only help you prevent disease but also optimize your body function and perform at the highest level.
- Eating well will improve your performance in training and competition
It is not surprising to most of you to find that most nutrition on the golf course is poor, ranging from mixed sandwiches and beer, to sports drinks and “energy bars” (note: most of which are basically full of sugar and bad fats) with a seemingly healthy label. These foods are certainly not preparing you for noteworthy performances, I would even say that these foods will compromise your performance. For example, beer is a central nervous system depressant, reducing concentration and motor control. Sports drinks (e.g. Powerade), sandwiches (even wholegrain!) and “energy bars” will raise blood sugar levels, which is-apparently good because it leads to a quick energy rise, but it turns out to be bad because then we’ll also watch a rapid energy drop 45-60 minutes later. When blood sugar levels drop to a peak, mood worsens, focus and concentration decrease – and of course performance worsens!
To optimize your performance in training and competition, there are at least three things that are required. First, you must maintain good hydration, especially in hot and humid climates. Even a slight dehydration can reduce coordination and motor control. Secondly, you must control your blood sugar levels. This means that you should not eat sugar-rich foods, but foods that help keep your blood glucose levels stable. Third, you should resort to some nutritional strategies and/or supplements that help you increase focus and concentration. In short, don’t continue to depend on what they offer you in the golf course bar carts – probably the only healthy thing they have there is water!
All golfers have one thing in common: they will invest a lot of time and money to improve their game! They will hire the best coaches to perfect your golf swing. They will buy the best equipment available to get more accuracy and to gain distance. Those who have already realized the importance of fitness in this sport will hire the best professionals to help them gain mobility, become stronger and more resilient. Some will turn to sports psychologists to learn how to maintain a good attitude in the field, focus and concentration. They do all this in order to make more birdies. But aren’t they forgetting something?
In fact, there is something that most golfers forget to change: their low-quality diet. Most golfers have no idea how diet can influence performance. For starters, they forget that eating poorly will compromise increased muscle strength and will lead to body fat accumulation. And if you still think that having weak muscles and excess body fat is the way to go to become a top-level golfer, it’s not worth reading any further. This article is not for you.
In addition to the deleterious effects on body composition and muscle strength it must be borne in mind that eating poorly will limit focus and concentration, will lead to mood swings and may lead to poor immune function, increased chronic inflammation and general health problems. Try playing several rounds for days at a time when you are in a bad mood, in bad shape, and unable to concentrate. Poor nutrition will have a direct impact on training and competition. Lack of focus, concentration and early tiredness, especially during training and / or competitions, are signs that your nutrition is compromising your performance.
No doubt, you can be very skillful with your golf clubs, do some Ballesteros shots and do some exceptional rounds from time to time, but if you’re looking for consistency in results and longevity as a golfer, there’s no better substitute than the foods you eat every day. None!
So why do golfers never change?
There are several reasons why golfers never change and prefer to continue eating the club sandwiches, the chips and the pasta served in every clubhouse menu in the world. Let’s go through some of those reasons.
1) The myth of the pre-competition meal.
Many golfers (especially beginners) make the mistake of thinking that it is only the food eaten before and during practice and competition that can affect their game. While this may make sense at a first glance, this is not physiologically what happens – most of the energy you are using today depends on the nutrients you have eaten (and absorbed) in the last 72 hours!
Please note, I am not saying that what you eat before and after practice / competition makes no difference. Of course it does! However, these meals are not necessarily the most important. Each meal will have a certain impact on your body regardless of the time frame in which it is consumed. It is the cumulative effect of these meals that will lead to an improvement (or decrease) in performance.
In other words, in golf, there is no pre-competition or intra-competition magic meal. If you’ve waited until the day before a big competition to start eating well, it’s probably too late. I am sorry to inform you but there are no miraculous solutions, you really need to eat consistently well!
2) Golfers cannot see the link between nutrition and performance.
Most golfers do not realize the connection between nutrition and performance. And that’s because they are not aware of how diet will influence their muscle function and brain biochemistry.
In the case of golf, as this is a sport that does not involve too much energy expenditure and does not require athletes to maintain a certain body weight (as with wrestlers, gymnasts, swimmers, endurance athletes or athletes from other sports), it is thought that the need to eat well is not that important. In fact, this relationship might not seem so obvious.
But that’s not the point, golfers don’t need to be muscular and low body fat individuals as you see in fitness magazines. What they need is to develop their athletic potential so that this is not a factor that could hinder their performance on the golf course. Golf is not a very energy-intensive sport so a golfer’s nutritional needs cannot match those of a fighter or an endurance athlete. But different does not mean less important – as we saw above it is not just body composition that will be influenced by diet.
Although the link between golf and nutrition is a little less visible than in other sports, it exists. Maintaining and / or increasing muscle mass, mobility, reducing inflammation of muscles and joints, maintaining focus and concentration, preventing injuries, can all be influenced by nutrition. But only those who put the best nutritional strategies into practice will have competitive advantages (obviously this does not include Big Macs!).
3) The difficulty in changing eating habits.
Probably the most difficult hurdle for most people is overcoming the eating habits they have. Our eating patterns have been around for a long time and few people are willing to change them if there is not a strong reason (as in the case of a serious health problem). And why does this happen? Because we have not been taught to think that food is information for our cells. We have not been taught to think that food will influence the expression of our genes. We have not been taught to think that it is the everyday foods we consume from our environment that can trigger health improvement or health deterioration.
Of course there are many other reasons why golfers are reluctant to change their eating habits and why you don’t change yours. And that’s why in the next article I will continue to address this topic so you can understand why you need to change your eating habits quickly to live healthier and to take your game to the next level.
There is currently sufficient scientific evidence to assert that strength training is an effective method for preventing, treating and potentially reversing various chronic diseases. Indeed, adherence to a properly designed strength training program can significantly increase the physical and mental health of the population.
The importance is such that several world-renowned organizations (World Health Organization, Centers for Disease Control and Prevention, American Heart Association, American Association for Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine) recommend this form of training for maintain health.
However, despite this evidence, most of exercise recommendations are still for aerobic training, and few physicians (and health professionals in general) recommend strength training. This article aims to alert for the relevance and valuable impact of strength training on health.
About 100% of our biological existence has been dominated by outdoor activity. Hunting and searching for food has been a condition of human life for millions of years1. That is, if in the past it took effort (i.e. physical activity) to find food, nowadays food comes to us without having to make any effort. Therefore, we have moved from a very active lifestyle to a highly sedentary lifestyle. With serious consequences for public health. If in the past all people had to engage in some sort of physical exertion to carry out their daily tasks, today most of them do not have those needs. The environment has changed and so have people. They are weaker, sicker, have more chronic pain and are increasingly dependent on medicines. But the message still going on in our society (and passed on in medical appointments) is “make no physical efforts and follow your normal life”. And I believe this is the worst advice people can get! Normal life? But what kind of advice is this? How can normal be good? You must be completely alienated from reality in order to make such recommendations.
Today we have more opportunities than ever to build a healthy and strong phenotype. The phenotype is the expression of our organism, and it depends largely on the choices we make every day. Two organisms can have the same genotype, the same DNA, but different phenotypes – based on their experiences and the environment. Admittedly, there are things we cannot control such as our genetic heritage, the place of the world where we were born / lived, overall luck and the general environment to some extent. But there are many things that we can control that depend solely on our priorities in life and our daily choices (examples: exercise habits, eating, sleeping, stress management, smoking, alcohol, exposure to polluted environments). And I believe that exercise in general (and strength training in particular) is the most important factor of all. It is the most potent, it’s quantifiable and acts quickly on all systems and organs of the human body.
The reality is this: the population is aging and with more chronic / noncommunicable diseases. The main noncommunicable diseases are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. These four disease groups alone account for over 80% of the 41 million deaths in the world2! According to the first report on healthy aging by the World Health Organization (WHO), the number of people over 60 is expected to double by 20503, and it is in this context that we need to urgently intervene to promote motor autonomy and improve people’s functional capacity. Traditional recommendations for walking, swimming, Pilates, and “doing low effort activities” or “no physical effort” probably need to be reconsidered and properly contextualized.
It is in this context that strength training and athletic training play a key role. All people (athletes and non-athletes) need to train their physical qualities to live with quality and independently. After age 30, adults lose 3-8% of their muscle mass per decade. Over time, the loss of lean mass contributes to a decrease in muscle strength and power, which are important predictors of balance, falls and mortality4. In the case of the elderly, it is important to note that falls are the main cause of accidental death after age 65 and hip fractures are those that most affect their independence5.
When I speak of strength I mean the basis for interacting with the environment around us, the foundation for the development of other physical qualities (mobility, power, speed, agility, muscle endurance), the ability to produce strength against external resistance (it can be the floor or any other object) through muscle contractions. This is probably the most trainable capacity we have and the one that could have the greatest impact on improving our function, independence and functional longevity. Tasks such as brisk walking, sitting and rising from a chair, climbing stairs, maintaining balance, carrying luggage, or playing with children / grandchildren are examples of activities in our daily lives that require a minimal component of various manifestations of strength (maximum strength, power and strength endurance). Therefore, both strength and muscle (quality rather than quantity) are physical function related parameters that need to be taken care of in the quest for achieving a healthy aging phenotype.
These issues are even more important when we note that as of 1st of October 2016, in the tenth revision of the International Classification of Diseases (ICD-10), sarcopenia has been classified as a disease by WHO and has its own code (M62.84). This should lead to increased availability of diagnostic tools and increased enthusiasm for the pharmaceutical industry to develop drugs to combat sarcopenia6. But in my opinion, this also represents a great opportunity for exercise professionals to be able to help fighting this disease, as strength training (properly oriented of course) will be the most potent stimulus in its prevention and treatment.
- Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology. 2012;2(2):1143-1211. doi:10.1002/cphy.c110025.
- GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016; 388(10053):1659-1724.
- Beard JR, Officer A, de Carvalho IA, et al. The world report on ageing and health: A policy framework for healthy ageing. Lancet 2016;387:2145e2154.
- English KL, Paddon-Jones D. Protecting muscle mass and function in older adults during bed rest. Current Opinion in Clinical Nutrition and Metabolic Care. 2010;13(1):34-39. doi:10.1097/MCO.0b013e328333aa66.
- National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs 2nd edition. Atlanta: 2015.
- Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle. 2016 Dec;7(5):512-514. Epub 2016 Oct 17. PubMed PMID: 27891296; PubMed Central PMCID: PMC5114626.
We often hear reports from people who spend hours and hours in the gym and remain the same. They do not lose fat, do not gain lean mass, do not gain strength, nor improve their functional capacity. They simply do not evolve. We also have those who rely only on the traditional weight training component to lose weight and yet not always have results, regardless of the diet they follow.
So, what is the secret for having results? Program design and professional supervision may be more important than you think.
In a study conducted by Bea et al. (2010), the authors investigated the association of exercise frequency and volume (total weight lifted on the military press and squat exercises) with changes in body composition in postmenopausal women who participated in a progressive strength training program for six years.
The women were divided into three groups: one group did strength training during this period, one started strength training after one year and the third (control group) did nothing. The training programs were supervised by professionals and involved motivational strategies to increase adherence. The training program consisted of eight exercises (based on free weights and machines) and was done three times a week, progressively.
The results showed that the group that did nothing (control group) gained weight and fat over the six years, suggesting something that everyone should already know: if nothing is done, we will get fatter and weaker with each passing day.
But there is something more interesting to highlight. The authors analyzed the relationship between body fat and increased squat load and found that the women who gained the most strength had better control of their weight and body composition over time! This means that if you are always doing the same program without managing training variables and principles, stagnation is what will happen.
So, what we have to tell you is that if you are part of that package that spends hours in the gym, between exercise machines, selfies and talking to your partner, then you are certainly not on your way to good results. We know that the socialization part is important and should not be ignored, we simply believe that it must be well managed! The key is knowing how to clearly distinguish what is training and what is ‘’going to the gym’’. And more training time is merely a quantitative indicator, not a quality indicator.
Enjoy your training!
Bea JW, Cussler EC, Going SB, Blew RM, Metcalfe LL, Lohman TG. Resistance Training Predicts Six-Year Body Composition Change in Postmenopausal Women. Medicine and science in sports and exercise. 2010;42(7):1286-1295. doi:10.1249/MSS.0b013e3181ca8115.
Implications and practical applications of calorie restriction and intermittent fasting
And now … can the practice of calorie restriction (CR) or fasting have therapeutic value in humans? As noted earlier (Part 1), randomized controlled trials in humans studying the effects of CR and fasting in humans are scarcer. It is not easy to find volunteers to subject themselves to the “discomfort” of eating less food.
Just an aside …
Changing something in someone’s diet can be a daunting task! In fact, and based on my experience, people are generally highly resistant to changing whatever their eating patterns are and tend to defend them tooth and nail! They elaborate the most varied rationales (and very sophisticated sometimes … like the typical “but my grandfather is 90 years old and always ate this and that”) to justify the intake of certain foods that, essentially, they are just used to or like eating. Nutrition is like a religion for some, believe me …!
Back to human studies …
The other practical reason for the lack of controlled randomized human trials on the effects of CR or fasting to study its effects on life expectancy and the incidence of “age-related diseases” is that human life expectancy is long. However, some randomized controlled trials in humans point to clear benefits of CR practice in certain populations. Listed below are some of these studies, type of intervention and significant effects observed.
• Wang et al. (2013)
- Sample: obese individuals.
- Intervention: 5 days of 30% CR (low-fat / high-carb or high-fat / low-carb) after isocaloric diet period.
- Significant results:
- CR diets decreased fasting insulin and leptin levels by increasing free fatty acid levels (indicating mobilization of fat stores);
- Insulin sensitivity did not improve significantly (perhaps due to the short 5-day period), however muscle insulin signaling (in response to insulin) increased only in the low-fat / high-carb diet subjects. Note that this effect on insulin signaling in response to the low-fat / high-carb diet (rather than the high-fat / low-carb diet) may represent only a transient adaptive response due to the higher glycemic load in the diet. The short duration of the study does not allow the conclusion of a sustained improvement in insulin regulation.
- Kitzman et al. (2016)
- Sample: elderly obese individuals (67 ± 5 years) with heart failure.
- Intervention: 20 weeks of CR (350-400kcal / day deficit) with or without exercise (1 hour walking 3 days per week).
- Significant results:
- Both CR and exercise (separately) increased aerobic capacity (indicated by increase in VO2 peak), with even greater effects if combined;
- Both CR and exercise (separately) improved body composition (fat loss) with even greater effects if combined;
- CR (but not exercise) reduced the inflammatory marker C-reactive protein (CRP) and correlated with weight loss.
- Snel et al. (2012)
- Sample: obese individuals with type 2 diabetes mellitus (T2DM) and insulin-dependent.
- Intervention: 16 weeks of CR (450kcal / day) with or without exercise (1 hour + 4 30-minute sessions on a cycle ergometer per week).
- Significant results:
- Both CR and exercise improved fasting glucose, insulin and glycosylated hemoglobin (HbA1c) levels;
- The RC + exercise group lost more fat and waist circumference compared to the CR group only;
- Both CR and exercise increased insulin receptor expression and signaling (revealed by muscle biopsy) as well as peripheral insulin sensitivity.
- Pedersen et al. (2015)
- Sample: overweight or obese, non-diabetic individuals with coronary artery disease.
- Intervention: 12 weeks of CR (800-1000kcal / day) with or without exercise (3 days / week interval aerobic sled).
- Significant results:
- Separately, CR was superior to exercise in weight loss, fat mass and waist circumference, as well as fasting blood glucose, insulin sensitivity and glucose tolerance. However, CR led to better results combined with the exercise program.
- Razny et al. (2015)
- Sample: non-diabetic obese individuals
Intervention: 3 months CR (1200-1500 kcal / day) with or without 1.8 g / day omega-3 fatty acids (in a 5: 1 DHA / EPA ratio).
- Significant results:
- CR with or without omega-3 supplementation resulted in similar decrease in body weight and fat mass;
- CR had a superior positive effect on triglyceride and insulin levels when combined with omega-3 supplementation;
- Sample: non-diabetic obese individuals
RC + omega-3 (but not only CR) improved indicators of insulin resistance (HOMA index).
- Prehn et al. (2016)
- Sample: postmenopausal obese women.
- Intervention: 12 weeks CR (<800kcal / day) followed by 4 weeks on an isocaloric diet or 16 weeks on an isocaloric diet (control group). Recommendation to increase physical activity per week.
- Significant results:
- CR (but not the isocaloric diet) resulted in better scores on memory performance tests;
CR (but not the isocaloric diet) resulted in improved glycemic control and HbA1c levels;
- CR-induced increase in cerebral gray matter density was negatively correlated with glucose levels.
- CR (but not the isocaloric diet) resulted in better scores on memory performance tests;
Recommendations and Conclusions
In fact, CR or fasting interventions do indeed appear to have clear therapeutic utility in improving health parameters related to obesity, inflammation, insulin resistance, oxidative stress, and cardiac function. It is important to note that just reducing the amount of food you eat may not be enough and perhaps not recommended. Such a simplistic and long-term intervention can result in nutritional deficits and thereby boycott putative positive health outcomes. It is therefore important to monitor and ensure adequate nutrient levels through supplementation and / or in choosing nutritionally dense foods. Also noteworthy are the positive synergistic effects that CR seems to have when combined with exercise (Snel et al., 2012; de Luis et al., 2015; Kitzman et al., 2016), which may be prescribed concomitantly. In this context, a very mild CR intervention (e.g. 10% deficit) or short intermittent fasting periods (> 14 hours and does not need to be daily) combined with exercise may have very positive effects and are likely to have higher compliance compered to more aggressive fasting or CR interventions.
Of course, severe and prolonged CR with no exercise (especially strength training) can induce lean mass loss that is highly undesirable if the goal is to improve health. Once again, and as with almost everything, the secret lies in the right dosage! In certain populations such as pregnant women (or women trying to conceive) and young growing individuals, prolonged CR interventions should be avoided as they may compromise development. However, I emphasize again that the most important thing is not to ingest “calories” but ingest “nutrients”! In older individuals with sarcopenia, CR should perhaps be avoided, although the most determining factors for reversing sarcopenia are strength training and adequate protein intake (which should be higher for older individuals (> 2g / kg bodyweight).
Regarding the specific case of intermittent fasting (note: the focus of this article is not to discuss the use of intermittent fasting as a fat loss and / or maintenance strategy or muscle mass gains in the sports context, but rather its potential for general health benefits) although few, the available randomized controlled trials in humans indicate that intermittent fasting do offer beneficial effects similar to those of constant CR and perhaps is easier to implement (Donati et al., 2008; Marzetti et al., 2009; Alirezaei et al., 2010; Arum et al.; 2014; Godar et al., 2015). Irregular fasting episodes (e.g. not eating breakfast once or twice a week on non-training days) can not only be a strategy easy to implement strategy as a mean to control total weekly calories ingested, and it also has positive hormonal effects is mediated by some of the mechanisms described above. “Hormesis” is defined as a mild stressor that is beneficial to health, stress resistance, growth and longevity. It results from exposure to an “adequate” dose of a stressor. CR or fasting (or exercise) is something that we are evolutionarily designed to tolerate, and which at the right dose gives us benefits and greater resilience. The occasional stress of not eating can be a “healthy discomfort”!
Until next time!
What mechanisms underlie the effects of calorie restriction or intermittent fasting on longevity and “age-related diseases”?
But after all what is “getting old” … and why …?
Aging has been characterized by several authors as a process of progressive deterioration of molecular, cellular and tissue structures and functions that is conditioned by genetic and environmental factors (Hu & Liu, 2014). This multifactorial and complex process resulting from this progressive loss of function makes the individual more vulnerable to disease and ultimately leads to death. The main determinants (resulting from genetic predisposition and environmental factors) that characterize the aging process at the cellular level have been identified as: free radical damage; mitochondrial dysfunction results in an accumulation of reactive oxygen species (ROS) and consequent oxidative stress; decrease and inefficiency of autophagy (an evolutionarily conserved process of recycling and “cellular waste removal” that is essential for cellular integrity, more details a bit ahead); changes in hormone-related signaling processes such as type 1 insulin-like growth factor (IGF-1), insulin and growth hormone; change in cholesterol and glucose metabolism; telomere shortening (Testa et al., 2014).
Now it seems that the aging process is indeed multifactorial. Probably the various aging theories (see part 1) are correct! In general, molecular processes are becoming more inefficient, slower and the system is progressively moving towards entropy. However, it seems that knowing the autophagy process (whose decline is associated with aging) may offer a “new” perspective on aging. Autophagy (or “self-digestion”) has been defined as an evolutionarily conserved (normal and important) catabolic process characterized by degradation in the lysosomes (cell organelle that functions as a “litter”) of damaged organelles, “defective” proteins and intracellular pathogens (Lavallard et al., 2012). Autophagy provides macromolecule degradation and recycling, not only providing new nutrients and energy during energy restriction (during calorie restriction or fasting), but also preventing the accumulation of cell metabolism by-products and protein aggregates in the cytoplasm. Therefore, autophagy is a protective and essential process for cellular homeostasis (Rubinsztein, Mariño & Kroemer, 2011) (note: rest assured that autophagy will “eat all the muscles” for a few hours without eating. That simply does not happen!). In fact, several authors have pointed deficient autophagic capacity as an important mediator of cellular senescence and consequent occurrence of “diseases or characteristics of old age” such as cardiovascular and neurodegenerative diseases; oxidative stress; weak immune system; chronic inflammation; osteoporosis; sarcopenia; diabetes; obesity; cancer (Pallauf & Rimbach, 2013; Pyo, Yoo & Jung, 2013). Specifically, reviews of mechanistic animal studies have indicated that loss of function in autophagy-related genes has resulted in intracellular accumulation of defective proteins and organelles and consequently in the acceleration of aging, while promoting autophagic activity increased life expectancy (Yen & Klionsky 2008)
(Note: Autophagy mechanisms have been in the mainstream news since 2016 with the Nobel Prize in Medicine 2016 awarded to the Japanese biologist Yoshinori Ohsumi. Their findings in autophagy mechanisms point in the direction that this cellular cleaning and recycling process is essential to prevent neurodegenerative and other diseases. This is the LINK for the news article).
Overall, and since the first rat studies by Dr. Clive McCay in 1935, calorie restriction has been extensively reviewed and recognized as a “potent” anti-aging strategy! Interventions in various types of animal species (from invertebrates to larger mammals such as primates) have shown that calorie restriction (without malnutrition) not only increases life expectancy (average and maximum), but delays the onset of so-called “age-related diseases ”(Martin, Mattson & Maudsley, 2006; Xiang & He, 2011; Lee & Min, 2013; Kitada & Koya, 2013b; Szafranski & Mekhail, 2014; Testa et al., 2014). The intermittent fasting regime (nothing more than another calorie restriction strategy as described in part 1 of this article) seems to offer the same kind of benefits (Martin, Mattson, & Maudsley, 2006; Robertson & Mitchell 2013).
Now the mechanisms by which calorie restriction or fasting induce health benefits appear to be (to a large extent) related to this antagonistic relationship between insulin signaling and autophagy. It is easy to understand, being autophagy a catabolic process (essential, normal and protective, I highlight that again) and the activation of insulin signaling pathways an anabolic process (equally important and essential in protein synthesis, insulin is not the “villain”), when one of these pathways is activated the other will be inhibited. Practically speaking, fasting activates the autophagy “machinery” and eating a meal (mainly containing protein and / or carbohydrates) activates the insulin signaling “machinery”. What seems to be essential is in fact that there are periods that allow the process of elimination and recycling provided by autophagy, and for this to happen it is necessary not to eat for a while. If there is no “room” for this process, due to constant food intake, it may lead to constant and “aberrant” insulin signaling state which may lead to many diseases that are usually associated with poor glucose and insulin metabolism which make the most of the so-called “age diseases”.
(Warning: the “less nerds“ should skip next paragraph)
Briefly, some of the mechanisms identified in animal studies that appear to underlie the health benefits induced by caloric restriction or intermittent fasting through regulation of autophagy and insulin pathway signaling are: 1) Inhibition of insulin / IGF-1signaling (due to the decrease in circulating amino acids and glucose) and its target pathways protein kinase B (PKB) / mammalian target of rapamycin (mTOR) ; 2) Activation of the sirtuin 1 pathway (SIRT1) due to the increase in NAD + / NADH ratio, which targets include activation of adenosine monophosphate protein kinase (AMPK), forkhead box O (FOXO) transcription factors, proliferator- activated gamma receptor-1-alpha coactivator (PGC-1α) (a mitochondrial biogenesis factor), and inhibition of the pro-inflammatory transcription factor NFkB; 3) Activation of the AMPK pathway due to the intracellular increase of the AMP / ATP ratio, which in turn induces up-regulation of FOXO and PGC-1α transcription factors and inhibition of the PKB / mTOR pathway. (Martin, Mattson & Maudsley, 2006; Han & Ren 2010; Rubinsztein, Mariño & Kroemer, 2011; Yen & Klionsky, 2008; Xiang & He, 2011; Pallauf, & Rimbach, 2013; Pyo, Yoo, & Jung, 2013; Hu & Liu, 2014; Szafranski & Mekhail, 2014; Amigo & Kowaltowski, 2014; Testa, G. et al., 2014; Madeo et al., 2015).
In humans, despite the smaller abundance of randomized controlled trials (for the reasons mentioned in Part 1 of this article), several reviews of intervention and observational studies (Yen & Klionsky, 2008; Marzetti, E. et al., 2009; Han & Ren 2010; Robertson & Mitchell, 2013; Testa et al., 2013; Madeo et al., 2015; Fan et al., 2016) indicate that the putative health benefits induced by calorie restriction or intermittent fasting are based on the same mechanisms related to insulin pathway signaling and regulation of autophagy. Some pointed benefits include: longer healthy longevity; better lipid profile; controlled blood pressure; optimization of diastolic and systolic function; better homeostatic control of insulin and glucose; better sensitivity to insulin and glucose; lower incidence of neurodegenerative diseases; lower adiposity; better mitochondrial biogenesis in the skeletal muscle; higher antioxidant capacity; lower levels of ROS and oxidative stress.
Can Calorie Restriction / Intermittent Fasting (CR / IF) alleviate age-related disease by regulating “aberrant” insulin signaling and autophagy?
In conclusion, the effect of caloric restriction or intermittent fasting on the regulation of insulin signaling and autophagy seems to emerge as a central regulatory axis that deserves attention (at least from me).
In the third part of this article I will then discuss what may be practical implications and applications of calorie restriction or fasting. Should we all do calorie restriction? Permanently? For how long? How much? What stage of life? Under what health conditions? Is the “intermittency” factor that delivers the best benefits?
Amigo, I. & Kowaltowski, A.J., 2014. Dietary restriction in cerebral bioenergetics and redox state. Redox Biology, 2(1), pp.293–304.
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Fan, J. et al., 2016. Autophagy as a Potential Target for Sarcopenia. Journal of Cellular Physiology, 231(7), pp.1450–1459. [Epub 2015 Dec 10].
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Hu, F. & Liu, F., 2014. Targeting tissue-specific metabolic signaling pathways in aging: the promise and limitations. Protein & cell, 5(1), pp.21–35.
Lavallard, V.J. et al., 2012. Autophagy, signaling and obesity. Pharmacological Research, 66(6), pp.513–525.
Lee, S.-H. & Min, K.-J., 2013. Caloric restriction and its mimetics. BMB reports, 46(4), pp.181–7.
Lee, S.-H. & Min, K.-J., 2013. Caloric restriction and its mimetics. BMB reports, 46(4), pp.181–7.
Lindeberg, S., 2010. Food and Western Disease: Health and Nutrition from an Evolutionary Perspective. Oxford, United Kingdom: Wiley-Blackwell.
Madeo, F. et al., 2015. Essential role for autophagy in life span extension. Journal of Clinical Investigation, 125(1), pp.85–93.
Martin, B., Mattson, M.P. & Maudsley, S., 2006. Caloric restriction and intermittent fasting: two potential diets for successful brain aging. Ageing research reviews, 5(3), pp.332–53.
Masoro.E. L., 2002. Caloric Restriction: A Key to Understanding and Modulating Aging. Texas, USA: ELSEVIER.
Pyo, J.O., Yoo, S.M. & Jung, Y.K., 2013. The interplay between autophagy and aging. Diabetes and Metabolism Journal, 37(5), pp.333–339.
Robertson, L.T. & Mitchell, J.R., 2013. Benefits of short-term dietary restriction in mammals. Experimental gerontology, 48(10), pp.1043–8.
Rubinsztein, D.C., Mariño, G. & Kroemer, G., 2011. Autophagy and aging. Cell, 146(5), pp.682–695.
Rubinsztein, D.C., Mariño, G. & Kroemer, G., 2011. Autophagy and aging. Cell, 146(5), pp.682–695.
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Yen, W.-L. & Klionsky, D.J., 2008. How to live long and prosper: autophagy, mitochondria, and aging. Physiology (Bethesda, Md.), 23(70), pp.248–262.
Strength training has been recognized as the strategy of choice to stay more functional and live longer. The benefits of strength training are in fact ubiquitous and positively affect the various biological systems that tend to decline with age, namely systems related to neuromuscular, cardiovascular and cognitive functions.
It has been observed that strength training programs in which the included exercises are performed at higher intensities (> 80% of maximum intensity) or with lighter loads but performed explosively tend to produce better results compared to training protocols where exercises are performed at lower intensities and / or non-explosively (Mendonça et al., 2016a). The magnitude of the load used (i.e. heavy or lighter but performed explosively) are especially relevant for older populations. Why? Because aging is associated with the loss of Type II muscle fibers, which are responsible for producing maximal strength (e.g. lifting a weight and not being able to lift it again in the next minutes or hours) or as explosive strength (e.g. moving an object or your own bodyweight at maximal speed). Now, the overwhelming majority of daily life movements are ballistic in nature (i.e. fast, short duration movements) and often for the purpose of moving relatively heavy objects for a short period of time. Therefore, it is not surprising that a training program that includes exercises that imply moving heavy loads and / or loads moved explosively is more effective in “preparing” people for everyday activities.
Training at higher intensities in a training program based on fundamental movement patterns (squatting, pushing, pulling, loading and lifting objects off the ground) makes people less vulnerable to falls and “tweaks”, and at the same time more able to recover from such incidents should they occur.
Train hard and smart! A structured training program that respects the principle of progressive overload is more valuable than a program that always keeps you within the comfort zone. Be as active as you can get during the day but IF TRAINING AT GYM DO NOT WASTE YOUR TIME, AND REALLY TRAIN! Seriously, it works!
Good lifting! ?
Mendonca, G. V. et al., 2016a. Impact of Exercise Training On Physiological Measures of Physical Fitness in the Elderly. Current aging science, 9(3).
The self-reported prevalence of shoulder pain is estimated to be 16-26% and this is the third most common cause of musculoskeletal disorder on consultation (see reference below). Physical factors such as your exercise habits and repetitive (low and high intensity) movements in inappropriate positions can result in injury or chronic pain.
For these reasons, at The Strength Clinic, we consider that there are four fundamental pillars in the way your shoulder should function:
1) Breathing – Breathing properly is very important to maximize performance. A normal person breathes on average more than eight million times a year, and it is likely that he/she does not do it efficiently. Most people use only a small percentage of the body’s ability to draw oxygen from the air into the lungs because they tend to breathe only through the upper respiratory tract (apical breathing), instead of breathing deeper from the most efficient respiratory muscle we have, the diaphragm.
2) Posture – Although overrated most of the time, each individual’s posture may have an influence on the onset of injuries and in the prevalence of chronic pain. Especially when we talk about activities with high impact / high loads (in which biomechanics assumes a fundamental role) and the daily habits of movement that each person has. A poor posture is usually the result of various structural, muscular and joint imbalances. However, it should be noted that our body has a huge adaptive capacity and that the lack of quality movement is probably the main problem. Contrary to what you may think there are no perfect postures!
3) Grip Strength – There is a phenomenon called irradiation, so the higher the grip strength, the greater the activation of nerves and muscles along the kinetic chain. Therefore, there will be an increase in neurological efficiency, and we will have the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) firing the way they should, which is as dynamic stabilizers centering the head of the humerus on the joint, and not otherwise inhibited due to lack of grip strength. The hands are closely linked with the functioning of the physiological and neurological system but unfortunately this is a phenomenon largely ignored in today’s training programs.
4) Joint Position – Rotator cuff training alone will not ensure the functional health of your shoulder. The stability of the shoulder blades, which depends on the mobility of the thoracic spine, is critical to ensure that the glenoid cavity is well positioned for the applied forces. The stability of the hips and trunk is also necessary to serve as a foundation for the position and functioning of the shoulder blades. In other words, if your central axis control is weak, your shoulder blades are most likely to be drawn into unfavorable positions and this will impair force transmission.
Therefore, any strategy aimed at improving the functionality of the shoulder should consider these four pillars because a seemingly strong shoulder is not necessarily a stable shoulder and it is stability that must precede force production.
Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ: British Medical Journal. 2005;331(7525):1124-1128.
For many years, breast cancer survivors have been told not to lift anything heavier than a handbag because of the risk of lymphedema (swelling / edema caused by accumulation of lymphatic fluid in the tissues of the body’s surface). This accumulation of lymphatic fluid (lymph) arises as a consequence of changes in the lymphatic system due to surgery and / or radiotherapy to the lymph nodes in the axilla and surrounding areas.
In this regard, it is recommended that women should ask for help with shopping bags, should avoid lifting or carrying children, and should only engage in exercise modalities such as walking, swimming and other light aerobic activities – these are the general recommendations. However, a study published in the New England Journal of Medicine in 2009 (see reference below) has shown that lifting weights can be a substantial aid to women with or at risk of developing arm lymphedema.
In this study the researchers recruited 141 breast cancer survivors with stable arm lymphedema and divided the sample into two groups – one group did strength training and the other did not change their exercise routine. These were the conclusions of the authors of the study: “in breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength.”
So, the main question here is not whether women who suffer from this condition may or may not lift weights but HOW they should do it to improve their condition. Again, the critical component is the program design, and this is one of our distinctive competencies at The Strength Clinic.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009 Aug 13;361(7):664-73. doi: 10.1056/NEJMoa0810118. PubMed PMID: 19675330.
Following up on the topic addressed in the last article, let’s talk today about a common swing characteristic that affects a lot of golfers and that can compromise their swing efficiency and their performance on the golf course: Early Extension.
What is Early Extension?
Early extension can be understood as an integral part of loss of posture, this happens when the player’s hip and spine begin to extend too early in the downswing, i.e. the hips and pelvis move towards the ball in the downswing. In practical terms, if your body is not prepared to perform an efficient golf swing while maintaining good posture throughout the movement, you will end up lifting the upper body (spine) and miss the necessary hip rotation at impact. Your hips play a key role in injury prevention and performance improvement. If you have poor hip mobility, sooner or later your lower back will complain (and you can be sure that this situation will not be very pleasant).
According to studies conducted by the Titleist Performance Institute, 64.3% of amateur golfers early extend
Players who early extend usually refer that they feel trapped during the downswing as if they had to shrug their arms to hit the ball. And it’s normal for that to be so because when you extend your hips too early on the downswing, the space that was supposed to be occupied by your arms and hands was occupied by the lower body. Therefore, the end result will be a blockage of the movement, since your arms and hands can’t get out of the way and will still be needed to hit the ball.
How can I diagnose?
An easy and simple way to check if you do early extension is with your Smart Phone (you probably already have applications that allow you to draw lines and analyze your swing). All you need to do is to ask a friend to film you in the direction of the swing line and capture its full motion from the starting position (setup). After having your swing recorded, compare the position of your pelvis in the initial position with the position of the pelvis in the position of impact, if you notice that it moved towards the direction of the ball is because you extended your hip too early. If this is not possible, you can always ask your golf teacher to help you, I am sure he will be happy to do that.
What are the physical limitations?
“If you’re not assessing, you’re just guessing” – Greg Rose
The physical limitations can be many and to determine the causes that are affecting you, it would be important to make a functional assessment with a professional who understands how your body should move and its relation to the golf swing. According to what I have observed in my practice, I would like to highlight the following:
- Limitations on performing a full squat with the arms extended overhead;
- Limitations in hip mobility (especially in internal rotation of the leading hip and in anterior or posterior pelvic tilt);
- Limitations in the ability to separate / disassociate the thorax from hips (X factor);
- Limitations in the ability to stabilize the pelvis because the glutes and core muscles are inhibited.
What can I do to improve?
Although the causes may vary from person to person, I’m pretty sure that if you do the following exercises, you will improve and increase your body’s functionality to play golf for a longer time. You only need 10 minutes a day.
- Myofascial Release with Roller Stick
Using a roller stick, look for the trigger points of your calf and massage the inner, central and outer sides of the muscle for 30 seconds in each area. The points that hurt you most are those that need more care. Yes, this exercise might be a little uncomfortable but it’s worth it.
- Glute Bridge with Leg Extension
Lying in the supine position, push your heels against the floor, tighten your glutes, and raise your hips to form a glute bridge, with your arms up. Once in this position, extend one leg and form a straight line between the shoulder, hip and heel. Hold this position for 20-30 seconds, always keeping your hips high. Change legs and repeat 5 times on each side.
- Squat with Overhead Arm Reach
In the squat position (with your heels on the floor and your knees out), raise one arm up, lift the other arm (always looking at your hand) and then raise both arms at the same time and return to the standing position. If you can not squat without raising your heels, you can use a rolled up towel or a board to keep your heels high. Do 2-3 sets and repeat 8-10 times.
- Assisted Squat wiht Medicine Ball
In the standing position, with your feet shoulder-width apart and slightly rotated out, hold a medicine ball (or a bucket full of balls) in front of your body, and begin to slowly lower your body into the squat position by keeping your back straight and without lifting your heels off the floor. Do 2-3 sets and repeat 10-12 times.
I believe that these exercises can be helpful to you, but remember: The swing you can do is directly related to what your body is prepared to do.
See you soon!
“We don’t believe there is one way to swing a club; we believe there is an infinite number of ways to swing a club. But we do believe there is one efficient way for all golfers to swing a club and it is based on what they can physically do.”
– Titleist Performance Institute
If you’re reading this, you’re probably interested in improving your physical condition to make more birdies, hit longer drives, and increase your longevity as a golfer. Or, perhaps, your goal is to become the best player in your club or win the next Match Play Championship. No matter what your motivation is, the fact is that if your goal is to improve your game, this will require you to prepare yourself a bit better than most golfers I know. And better does not necessarily mean training longer hours!
If you´re still one of those players who spends hours and hours hitting buckets of balls on the driving range hopping that this will help you improve your golf game, you need to change your strategy. Hitting buckets of balls in the driving range and making chips and putts is not enough. If you truly want to improve your performance in this sport, your practice needs to include general athletic development exercises and specific physical training for golf, in a progressive and periodized manner.
This means that what you normally see in the gym has nothing to do with what you need to do to hit farther, straighter and to go through the 18 holes without getting so tired.
First: Is your swing efficient?
The only way to determine whether your golf swing is efficient or not is through a 3D Biomechanical Analysis. What we can see in the traditional video imaging used by most golf professionals / teachers is just the swing style. There are many golfers who do not have a particularly attractive swing (e.g. Raymond Floyd, Jim Furyk or John Daly) but the reason why these players were or are successful is because their swing is efficient. Having an efficient swing for a golfer means transferring energy (without leaks) through the feet, knees, hips, spine, shoulders, arms, wrists down to the club head and ultimately to the ball. With the data obtained through the 3D system, we can check the kinematic sequence of each player, that is, we can measure the speed of rotation of each body segment involved in the execution of the golf swing and determine if each segment is accelerating and decelerating correctly.
When we look at Jim Furyk and Ernie Els swing through video analysis (and through the naked eye), we can see that both swings are quite different from each other, however, when we look at the kinematic sequence of each player, we find that it’s difficult to see a significant difference between the two swings. This means that although Ernie Els and Jim Furyk have completely different swing styles, they both share the same kinematic sequence.
All great players start by generating speed from the hips and transferring that energy through the torso, arms and club. This is the efficient sequence in the downswing.
The golf swing is a complex multi-dimensional movement that involves a highly coordinated action of the entire kinetic chain (feet, knees, hips, spine, shoulders, arms and wrists) and takes less than two seconds. The golf swing is therefore a ballistic movement which, in order to perform efficiently (i.e. with a correct kinematic sequence), it’s necessary that the various body segments are properly prepared to deal with the inherent shear and rotation forces in this movement. Hence the importance of what follows.
Second: The Physical Assessment in Golf
Before we get to the physical training itself, it’s important to know what your physical limitations and asymmetries in terms of movement are (one of the main causes of injury). Because of this, it’s essential that you perform a functional assessment for golf, preferably with a qualified professional that knows what he’s doing. In the same way that you go to the doctor for exams to find out how your health markers are, you should also do an initial assessment with a golf fitness specialist to find out how your body behaves during a golf swing and which are the main limitations / compensations.
The physical evaluation in golf consists of performing several tests in order to measure the functionality of the body movement patterns necessary for golf, that is, the measurement of various indicators of its stability, mobility, balance and various performance parameters such as strength, power and cardiovascular capacity.
This type of assessment is the starting point for playing better and for preventing injuries. If you still think that your body is fine and that you don’t need any intervention at this level, you’re more likely to be wrong. Our body was not designed to lead the way we live today, so you can be pretty sure there are things in your body that need some work. If you still do not believe me, think of golfers you know who have never complained of back pain or pain in another part of the body (wrists, shoulders, elbow).
Your body is the determining piece of equipment in your game. The quality of the clubs, balls, gloves, shoes and the latest drive or putt on the market, are certainly not the most important aspects. I still see many golfers too preoccupied with the new gadgets and the style of clothing, when in fact these are not the most important things to get more birdies. What will, in fact, bring you better results is improving your body’s functional skills to hit the ball more efficiently and safely.
Many players fail to perform an efficient golf swing not only because the movement itself is complex but also because their bodies are not properly prepared to deal with the forces generated during the movement.
Keep this in mind the next time you hit balls or have a lesson with your golf teacher, maybe that’s why you can’t do what your teacher asks you to do. There is no point constantly insisting on improving technique if there is no synergistic effort in improving physical skills. The swing you can perform is directly related to what your body is prepared to do – think of the golf club as an extension of your body.
In the next articles I will share the most common characteristics in this relationship between the body and the golf swing and suggest some exercises so that you can improve your performance on the golf course.
If you still exercise to “burn calories,” you have not yet realized the purpose of a physical training program and the importance that movement has in our lives. The least important thing about exercise is the number of calories you burn! And that’s what I’ll try to explain in this article.
The power of exercise goes far beyond calorie burning, caloric expenditure is just a (nice) side effect of the type of exercise we do. Exercise consists of potentiating the release of powerful molecules and hormones that “talk” to our body’s organs (it’s not just food that has this kind of influence), and that determines what’s going to happen. And usually, the higher the intensity, the more beneficial the hormonal response.
Therefore, a well-designed physical training program has more to do with increasing energy levels, movement precision, vigor, muscular strength, mobility, agility, speed, work capacity and with an improved hormonal profile.
The Calorie Fever
I still see a lot of people worried about the calories in their food, the calories they burn when they exercise, the calories they consume each day, and I ask: How did we get here? What kind of message is being propagated that made people so obsessed with calories? Is calorie counting that important? Let’s see.
In order to discover the amount of energy in food, scientists burn food samples in a bomb calorimeter. And, to my knowledge, a bomb calorimeter does not share the same physiology and genetic makeup as a human being. As far as I know, a bomb calorimeter does not depend on the functioning of the various systems in the human body which are the real players in the way energy is absorbed and used (examples: digestive, endocrine and nervous system). This way of thinking is most likely unsustainable and ineffective long-term. This way of thinking is too reductive and does not solve the main problem – people’s lack of education regarding the importance of what we eat throughout our lives. Is it just me who finds it strange that most people are more concerned about their cell phones, cars and computers than with the origin and composition of the food they eat?
In fact, just look around and you’ll acknowledge that this is not the path to follow!
It is true that if we have the goal of losing fat mass, we must create an energy deficit, that is, the balance between the amount of calories (energy) entering our body and the amount of energy (calories) burned, must be negative. That’s the number one rule in rigid weight loss programs and that’s why we see Biggest Loser contestants training several times a day.
(Note: I should remind you that the Biggest Loser is a contest in which the goal is to lose weight in the shortest time possible, it’s not a contest to see who gets out of there healthier – if this was the goal probably there was no audience).
However, there is a lot more to be said. There are good calories and bad calories. The foods we eat, besides having a certain number of calories (which can be very difficult to determine with accuracy and can be highly variable), also have different properties with respect to their composition of macronutrients (protein, fat, carbohydrates) and micronutrients (minerals, vitamins, phytochemicals). These bioactive properties and compounds are what makes the difference and what should be studied preferentially. In my way of looking at things, it is more logical to first check the functionality of food (i.e. how its nutrients work) and then look at its caloric density, which can also be more or less functional depending on the objectives, morphology and specific conditions of each individual.
(Note: If you still think low fat diets are the most suitable for weight loss check the following study published in 2003 in the New England Journal of Medicine here, where it was shown that people on a high-fat diet lost more weight as those on a low-fat diet, the diet generally recommended by leading health organizations. But, of course, adherence to the diet will be the most important factor).
Back to calories…
Because the absorption of these nutrients will depend on the functioning of our digestive system – which in turn is governed by the endocrine system (think of hormones) and the nervous system (think of neurotransmitters) – and the health of the organs involved in the digestion process (mouth, esophagus, stomach, pancreas, small intestine, large intestine, liver, gallbladder), it becomes easy to understand that the web of relationships in the human body is much more complex than simple calorie counting. Albert Einstein has a quote that fits perfectly here: “make everything as simple as possible, but not simpler.”
The Power of Exercise
Anyone that is minimally informed about exercise already knows that long distance aerobic training is not the best choice for improving body composition and may even have opposite effects (catabolic effects) due to the pronounced increase in cortisol levels.
This has been known for a long time but it’s always important to remember. This study published by Tremblay, Simoneau and Bouchard in 1994, showed that the group that did 15 weeks of interval training burned NINE TIMES more fat than the group that did aerobic training. And this was in half of the time period!
What you need to “burn calories” is to increase the intensity of your workouts for certain periods of time, it’s this type of stimulus that will increase your metabolism and accelerate fat loss. In this study, a 30-minute training session of metabolic resistance training caused a 38-hour increase in metabolism – the famous afterburn effect or EPOC (post-exercise oxygen consumption). Let’s put this into perspective. Let’s say you trained this way on Friday morning. With this training method your body will still be in a “fat burning” mode on Saturday night, when you’re having dinner with your friends or with your boyfriend / girlfriend.
And why do I insist on combining a good diet with good training? Because I’m aware of the evidence on this topic. This study from 1999 showed that those who did aerobic training and strength training on a low calorie diet burned 44% more fat than those who merely followed dietary guidelines. As I’ve been saying, diet is the most important component for those people who want to lose fat, however, once that aspect is assured, only strength training and interval training can actually bring your results to a higher level. In my opinion, the fact that this study was based on a low-calorie diet combined with aerobic training is limiting, but we have to bear in mind that these are usually the guidelines of the American College of Sports Medicine (ACSM). The guidelines are intended to facilitate nutritional guidance offered by practitioners, but unfortunately that is not what I have observed when I discuss these issues with some colleagues.
I think you have already realized that the type of training you do can be a great ally to put your body in an energy deficit and consequently in fat burning status. Now I will try to explain why this is the least important of all. Stay with me!
Like nutrition, physical exercise is key to improve health, performance and body composition. You’re probably tired of hearing this. But it’s not any kind of physical exercise that works. Doing hundreds of crunches to lose belly fat, using all the gym machinery, running 10 miles a day, doing Pilates twice a week and doing 100 power cleans in the shortest time possible is not enough. You can call it physical exercise if you want, but it’s not just this kind of physical exercise our body needs. A more comprehensive approach is needed.
We need Good Movement (we shouldn’t start running in the first place)
The concept of “move more for your health” is insufficient for our real needs and to improve quality of life. We need good movement, we need to acquire movement competency in the first place. I am talking about the ability to perform fundamental movements with good form. Fundamental movement patterns such as squatting, hinging, pushing, pulling, throwing, carrying, walking, running and jumping.
From my point of view, running should be the last step in this process and yet what we most frequently see is people running all crooked and with an obvious deficit in muscle strength. But the problem is not theirs, they are trying to do something for their health (and probably that’s all they know), the problem is that most of them are not aware that running is a skill, which requires preparation, practice and training. Cristiano Ronaldo did not become the best player in the World over night, it took many hours of training (in the field and in the gym) to reach this level. Although it’s relatively easy and affordable for anyone to put on their shoes and just go out for a run, running also requires preparation, practice and training (technical and physical).
It is necessary to have stability, mobility, strength (every step we take on the ground is subject to the action of gravity and the speed we run, generating reaction forces of 2 to 5 times our body weight), symmetry, quality of movement and good musculoskeletal health. Running to get healthy or fit is one of the greatest physical distresses on our body if we don’t have a solid foundation. First, you need to be in good shape to run. If you don’t hone good movement skills, you are more likely to get injured. According to the available literature, the incidence rate of injury in runners may exceed 90%, this is more than any other sport. Plantar fasciitis, stress fractures, patellar tendonitis and patellofemoral pain are just a few examples. Check this systematic review if you’re interested in learning more.
Again, don’t get me wrong, I’m not anti-running and I admire the effort and suffering capacity of all runners. I think we should all be able to run (by the way, that’s how we evolved as a species), the problem is that most people who run are not properly prepared to run and there are fundamental learning steps that should not be overlooked in order to prevent structural imbalances in the musculoskeletal system and injuries. Cleary the simplistic idea of “move more” is not enough.
A new way to look at training
Different types of training can affect the way our genes work and how they interact with our cells. With good training it’s possible to decrease chronic inflammation, improve insulin sensitivity, strengthen the cardiovascular system, improve lipid profile, slow down normal aging, burn fat (as we’ve seen in more detail above), increase confidence and self-esteem, increase energy levels, increase mental strength, improve a number of physical skills that we need for our daily life activities or sports practice (such as strength, stability, mobility, balance, speed, agility) and our different energy systems (ATP-CP, glycolytic, and oxidative). As we age, these skills naturally decline, but the fact is that with a more comprehensive training program it is possible to reverse and / or at least mitigate this decline.
Most people think that genes are the brain of the cell, they believe that if genes don’t tell you what to do, the cell dies. But if you remove the genes from the cell, the cell is still alive, eliminating waste products and behaving just like another cell. So, instead of genes being the brain of the cell, think of genes as your instruction / repair manual. When a worn part of the cell needs to be repaired or when new substances need to be produced, genes will give instructions for doing so.
Every cell in our body is surrounded by a fatty membrane, which is filled with thousands of receptors. These receptors receive information from different parts of the body and pass this information into the cell to form / encode new proteins, burn more or less fat, etc. (Note: this is why it’s important to eat good fats and avoid the hydrogenated fats present in most processed foods so that the cell membrane is more permeable to nutrient delivery.) It’s this membrane with receptors the cell command center so if we remove these membrane receptors, the cells die. This means that cell function is highly influenced by external factors, namely through hormones and other molecules that bind to these receptors.
These messenger molecules are not randomly created by our body, they are created according to our lifestyle, diet, thoughts, behaviors, temperature, light, sound and… our type of training. It’s possible to be born with some defective genes – for example BRCA 1 and BRCA 2, which increase the risk for breast cancer – but it’s these messenger molecules / hormones that will determine the degree of activation of these genes. Therefore, controlling these hormones means controlling the body.
(Note: Don’t you find it strange that almost 90% of health care costs is related to treat health conditions, while 80% of health problems / diseases arise as a consequence of our lifestyle and the environment we’re exposed to? Check this TED talk from Dan Buettner to realize why we are walking in the wrong direction).
High-intensity exercise is the one that induces a more favorable hormonal environment, with an increase in hormones such as testosterone, growth hormone and IGF-1, interleukins with an important role in inflammation (IL-6), muscle tissue maintenance (IL-15) and growing of new blood vessels (IL-8), lactic acid (which has the ability to keep us young by stimulating the release of testosterone and growth hormone) and nitric oxide, a vasodilator which plays a key role in regulating blood pressure, muscle strength and erectile dysfunction. Unfortunately, long running does not produce the same effects. Compound movements, which require a combination of strength and stamina, in short periods of time, are those that will put your muscles to “talk” more with your body. Burning calories is only a minor side effect when compared to the amount of hormones and other signaling molecules that influence how our body works.
To be clear, we are talking about intensity coupled with movement quality. Intensity coupled with bad movement will have the opposite effect: INJURY.
It’s urgent to give rise to a new mentality on training the movement skills that we will need throughout our lives. And this is a serious limitation of most group classes in conventional gyms. The instructors are obliged to follow a certain beat and choreography. Individualized feedback is almost non-existent. People don’t have time to understand or to learn the movements. And no one learns anything if they don’t know what it’s for, no one learns anything if they don’t understand how it’s supposed to feel and its practical implications. In addition, most machines in gyms annihilate the sensory and body perception that we, humans, need. We live in a three-dimensional world, in a world of constant adaptation and spatial exploration, so it makes no sense that machines and choreographies of group classes dictate the rules of our movement.
And why is it important to learn efficient movements? First, an efficient movement happens when a body is able to produce force through a coordinated action between the various body segments without energy leaks and demonstrating a natural ability to exploit maximum range of motion. Second, it’s movement that will allow you to play more time with your children, change the furniture at home, improve your day-to-day performance and your performance in your recreational activities.
Look at this type of training as the foundation, the support you need to get stronger, faster, smarter, more agile, more competent in a series of physical attributes that will allow you to perform better in the activities you enjoy doing. Would you like to start playing tennis? golf? volleyball? Would you like to start surfing? paddle board? weightlifting? powerlifting? dance? climbing? triathlon? Would you like to be faster when you play football with your friends during on weekends? Obviously, each modality has its specific abilities, but they all share the same foundation: human being’s adaptability capacity. To improve these specific skills safely, you first need to improve your fundamental movement patterns. And to sustainably keep improving these fundamental movement patterns, you need to train better and respect the developmental stages of each one.
To sum up, the great advantage of better training (and I remind you what we learned about the power of exercise, good movement and a new way of looking at training) is to improve your quality of life, maximize your performance and, above all, giving you the freedom and autonomy to choose the activity / sport that you always wanted to try but never had the courage or opportunity to start off.
Think about these things next time you go to the gym to walk on the treadmill with your headphones on and watch some TV series for 40 minutes while looking at the calories burned on the monitor and at the workouts or exercises other people are doing.
See you soon!
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