Musicians as athletes
I affirm this with the conviction of someone who knows these two universes well: musicians are high-performance athletes, but they do not treat themselves as such. Professional musical performance and high-performance sports require very similar levels of commitment, as well as physical and mental demands. The time, commitment and consistency required to achieve a high level of performance playing an instrument or performing a specific sport skill have much more in common than one might initially think. Some differences will lie in the fact that, in general, neuromuscular recruitment associated with playing an instrument has a greater focus on fine motor skills (i.e. short movements of greater precision and performed mainly with the limbs extremities) and less at the level of gross motor skills (i.e. larger movements involving larger muscle groups) that we normally associate with sports movements. However, it should be clarified that both large muscle groups play an important role, particularly at a postural level, in instrumental performance, and the smaller muscles associated with fine motor skills also play a fundamental role in most sports movements.
For example, if we establish a parallel between playing the violin and performing a given sport specific skill in tennis, we find that, although at different levels, a balance of fine and gross motor control is necessary for better performance in both activities. When we play the violin, we want to maintain a high and controlled posture so that holding the violin with the non-dominant arm and handling the bow with the dominant arm allows the fine work of the hands and fingers to occur as efficiently as possible. Now, if the musculature involved in the stabilization of the trunk and in the elevation of the arms is weak, fatigue sets in more quickly resulting in postural loss, in an execution carried out with greater muscle tension and consequently in a worse performance. In the case of the serve in tennis, due to the high demand for motor coordination and strength involving all the large muscle groups of the lower and upper body, there is also a need for high levels of fine motor skills coordination regarding wrist, hand and finger movements, in order to implement a given spin effect and the desired direction to the ball.
In fact, both musical and sports performance involve neuromuscular recruitment to produce movement and work that requires precision, speed, endurance and strength. In addition, and particularly at a professional level, playing an instrument and playing a sport are activities that require long hours of repetitive movements that, combined with poor physical conditioning, can lead to a variety of clinical conditions. It is unthinkable that a highly competitive athlete does not follow a training program targeting the development of his/her physical qualities which should be complementary to the practice of his/her sport. It is easy to recognize that a good physical fitness level will ensure greater resilience and longevity in sports. The same applies to musical performance. Musicians are high-performance athletes and should prepare themselves as such! Living and playing with pain is not inevitable, it is an option.
The prevalence of pain and injury in musicians
As the years go by and the hours playing their instrument accumulate, it is almost inevitable that professional musicians develop musculoskeletal and/or neuromuscular problems of varying severity at some point in their career. More so if they do nothing about their physical preparation. Review studies on the prevalence of injuries in professional musicians point out that 76% of musicians suffer or have suffered from physical problems that prevent them from performing at their usual level and 84% had injuries that interfered negatively with their musical practice1. Some musicians will develop tendinopathies and low back pain of varying intensity, which they will be able to manage with chronic intake of anti-inflammatory medications or simply by playing less frequently and/or just by enduring pain and discomfort. Others will develop more serious overuse injury syndromes that will become chronic and compromise not only quality of musical performance, but also quality of life, forcing them to periods of musical inactivity. Additionally, others will suffer from even more serious forms of injury that may result in abandoning their career as an instrumentalist musician.
In general, the most frequent injuries affecting musicians manifest themselves through pain and/or dysfunction, especially on the joints, tendons, ligaments and nerves of the upper limb, head, neck and spine. For example, in orchestral instrumentalists, injuries of musculoskeletal and/or neuromuscular origin are more common and affect about 64% musicians, of which 20% consist of peripheral nervous problems and about 8% of cases of focal dystonia2. It makes sense, considering that these are the most stressed areas of the body during instrumental practice. An exception would be the cases of focal dystonia, which, although it may be accompanied by pain and musculoskeletal injury, the root cause of the dysfunction observed at the peripheral level is actually central, that is, the dysfunctional neuronal circuits are at the upper levels of the central nervous system such as the cerebral cortex. Thus, the most frequent injuries in instrumentalist musicians can be summarized as follows3:
- Musculoskeletal injuries – epicondylitis, tendinopathies (tendinosis, tendinitis, tenosynovitis), bursitis, arthritis, arthrosis, osteoarthritis, contractures, injuries to the temporomandibular joint;
- Nerve trapping and inflammation – carpal tunnel syndrome, thoracic outlet syndrome, radial tunnel syndrome, ulnar nerve compression syndrome, ulnar tunnel syndrome, cervical and lumbar radiculopathies;
- Focal dystonia;
- Hearing loss.
The onset of injuries in musicians is due to an array of factors that naturally interact. Several authors have identified the following factors facilitating and/or causing the development of injuries in musicians1:
- Physiological and biological factors such as gender and age. Women seem to be more likely to develop peripheral musculoskeletal and nerve injuries compared to men, and individuals who engage in high volume instrumental practice at an early age, at 4-5 years of age, are also more likely to develop injuries later in life4,5. In the case of focal dystonia, there is a clear higher prevalence in males (over 90%) and in women with menstrual disorders, which suggests that hormonal factors may be predisposing to the development of this disorder6.
- Type of instrument. The characteristics of the instrument (size, shape and weight) and the time of practice imply different levels of physical demand, in which fatigue onset and an execution based on too much physical effort can lead to the development of injuries7. For example, the position needed to play the clarinet implies that the entire weight of the instrument is supported on the right thumb, and at the same time it requires a large amount of short and fast movements of the fingers of both hands8. Another example particularly special to me is the double bass. A bulky instrument with an air column of considerable inertia, which requires not only considerable grip strength to press on the strings, but also considerable whole body physical effort (which, can of course, be optimized with efficient technique) to move this column of air and make the instrument vibrate and produce sound. Anyone who has tried playing the double bass for a few minutes realizes the physical demands that playing this instrument encompasses.
- Instrumental technique. A poor instrumental technique, with non-optimized positions, based on physical effort rather than on movement efficiency, associated with long hours of practice without rest, will naturally predispose the player to pain and injury, especially in the wrists, hands, neck and shoulders9 .
- Specific technical demands. The technical demands of a particular musical piece that often requires high-speed and high-intensity execution, with fatiguing repetition of movements or maintenance of extreme hand positions for a long period of time. All of this creates high levels of mechanical stress and may cause injury10,11.
- Body asymmetry. In the same way that an athlete of a one-side dominant sport will try to compensate for these asymmetries by working out both sides of the body, a musician is in a similar situation, because playing an instrument implies asymmetrical work in very unnatural positions for long periods of time, which will favor the occurrence of various muscular imbalances12.
- Poor physical fitness. Good levels of strength and general physical conditioning are essential to maintain a good position to play an instrument for long periods of time. Most of these positions are very unnatural. Being in good physical fitness will allow to resist the onset of fatigue, recover more quickly between rehearsals or practice sessions, and in fact, it will allow to tolerate more hours of practice avoiding technique and performance deterioration7. Muscle imbalances and weakness resulting from long hours of sitting in certain positions and high volume repetition of short movements must be prevented through exercise programs aiming to strengthen the body globally, and at the same time to compensate for muscle imbalances induced by instrumental practice13.
- Other lifestyle factors. We know that lifestyle factors such as smoking or smoke exposure, alcohol consumption, sleep deprivation, malnutrition, poor hydration and obesity have very damaging effects at a systemic level on our body. Regarding neuromuscular injuries, we know that all these forms of toxicity weaken the body’s connective tissue (cartilage, tendons, ligaments, membranes), muscles and nerve conduction, predisposing to the development of localized inflammatory processes as well as chronic injuries. For example, did you know that obesity is highly predisposing to development of carpal tunnel syndrome?14 Or that smoking is strongly associated with development of injuries and dysfunctions in the shoulder?15
Preventing and resolving injuries in musicians
Any elite athlete empirically knows something that has long been supported by science. That the most effective way to prevent (and also treat) overuse or overload injuries due to high volume sports practice is to ensure good levels of physical fitness combined with good recovery habits, adequate rest and nutrition. Regarding physical fitness, it is unthinkable for an elite athlete, not to follow a regular physical training program. An athlete knows that this will have negative consequences both on sports performance and on the susceptibility for developing injuries. The athlete knows that the weaker his/her musculoskeletal system is, the greater the vulnerability to injury. The question is, and if we consider that professional musicians are required to engage on activities requiring high physical and mental performance for long hours of daily practice, shouldn’t musicians treat themselves as high-performance athletes? I am certain that they should.
In fact, a 2019 systematic review investigating the topic of physical training for professional orchestra musicians1 indicates that following a structured physical training program of varying durations (from a few weeks to several months) has generally resulted in significant improvements in musical performance and in reducing (and even eliminating) chronic pain1.
To keep playing at the highest level for a long time, musicians would greatly benefit if they treated themselves as high-performance athletes and ensure that they maintain good physical shape combined with good habits of recovery, rest and nutrition. And to be clear, when I talk about staying in good physical shape, I don’t mean playing sports. In fact, playing sports as a mean to improve one’s physical fitness is not ideal and can even be harmful. More activity with asymmetric characteristics would be added on top of another, also asymmetric, which is playing a musical instrument. In general, all sports are constituted by specialized movements, and for that reason, also asymmetrical. So, except for purely recreational reasons (which can also be positive at a mental and stress release level), the practice of a sport as a strategy to improve physical fitness is not ideal and should not be the first choice particularly by musicians (I discuss this very topic in this article: Why musicians should not play sports).
General physical fitness is improved through the process of training our physical qualities. This should entail an assessment of the initial status in order to identify specific limitations and outline a specific intervention strategy. One should always start at the base and progress from there, just like the process of learning to play a musical instrument. Here, attention to detail is key. A well-designed training program implies the management of training variables specific to the profile and objectives of the athlete or, in this case, the musician. A correct selection of exercises is crucial, as well as close monitoring of their implementation regarding form of execution, training load and progression over time. As I mentioned, it is not very different from the process of learning to play a musical instrument!
For a musician, playing the instrument is the top priority. It can be obsessive, I know. But playing better in the long run does not necessarily mean playing more hours, but rather investing in taking care of the ‘’machine’’ that is our body. I reiterate once more that playing with pain or discomfort is an option and not an inevitability. Take care of your body and treat it well, because you will need it in the long run!
Train well to play well!
- Gallego, C., Ros, C., Ruíz, L., Martín, J. (2019). The physical training for musicians. Systematic review. Sportis Sci J, 5 (3), 532-561.
- Lederman, R. J. (2003). Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle & Nerve, 27(5), 549–561.
- Betancor Almeida, I. (2011). Hábitos de actividad física en músicos de orquestas sinfónicas profesionales: un análisis empírico de ámbito internaciona Tesis Doctoral. Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria.
- Fishbein, M., Middlestadt, S., Ottati, V., Straus, S., y Ellis, A. (1988). Medical problems among ICSOM musicians: Overview of a national survey. Medical Problems of Performing Artists, 3(1), 1–8.
- Viaño, J. J. (2004). Estudio de la relación entre la apariciación de lesiones musculoesqueléticas en músicos instrumentistas y hábitos de actividad física y vida diaria. En III Congreso De La Asociación Española de Ciencias Del Deporte. Valencia: Universidad de A Coruña.
- Rosset-Llobet, J., Candia, V., Fàbregas, S., Ray, W., & Pascual-Leone, A. (2007). Secondary motor disturbances in 101 patients with musician’s dystonia. Journal of neurology, neurosurgery, and psychiatry, 78(9), 949–953.
- Sardá, E. (2003). En forma: ejercicios para músicos. Barcelona: Paidos.
- Thrasher, M., y Chesky, K. (1998). Medical problems of clarinetists: Results from the U.N.T. musician health survey. The Clarinet, 25(4), 24–27.
- Wynn, C. B. (2004). Managing the physical demands of musical performance. En Williamon A. (Ed.), Musical excellence: Strategies and techniques to enhance performance (pp. 41–60). Londres: Oxford University Press.
- Bejjani, F. J., Kaye, G. M., y Benham, M. (1996). Musculoskeletal and neuromuscular conditions of instrumental musicians. Archives of Physical Medicine and Rehabilitation, 77(4), 406–413.
- Mark, T., Gary, R., y Miles, T. (2003). What every pianist needs to know about the body: a manual for players of keyboard instruments: piano, organ, digital keyboard, harpsichord, clavichord. GIA Publications. Martín.
- Ackermann, B., Adams, R., y Marshall, E. (2002). Strength of endurance training for undergraduate music majors at a university? Medical Problems of Performing Artists, 17(1), 33– 41.
- Frabretti, C., y Gomide, M. F. (2010). A saúde dos músicos: dor na prática profissional de músicos de orquestra no ABCD paulista. Revista Brasileira de Saúde Ocupacional, 35(121), 33– 40.
- Shiri R, Pourmemari MH, Falah-Hassani K, Viikari-Juntura E. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies. Obes Rev. 2015;16(12):1094-1104.
- Bishop, Julie Y. et al. (2015). Smoking Predisposes to Rotator Cuff Pathology and Shoulder Dysfunction: A Systematic Review. Arthroscopy, Volume 31, Issue 8, 1598 – 1605.
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!
The International Society of Sports Nutrition published in 2017 a position stand (see reference below) on the safety and efficacy of creatine supplementation in the context of exercise, sports and medicine.
Creatine supplementation, one of the most popular and studied nutritional supplements, has in fact been shown to be effective in improving athletic performance (especially in high intensity exercise) and inducing relevant training adaptations. The consequent increase in intramuscular creatine (and phosphocreatine) reserves facilitates the rapid re-synthesis of ATP, the so-called energy “currency” of the body, which is essential for almost every reaction in our body. Thus, the increased availability of creatine in the cell through supplementation contributes to improve performance because it increases the energy availability in order to exercise (i.e. muscle contraction) as well as a whole range of other muscle cell related reactions. Creatine supplementation can in fact enhance strength production, muscle work, accelerate recovery and help preventing injury.
Additionally, creatine supplementation appears to be highly safe and effective not only in athletes but also in non-athletes (such as the so-called exercise enthusiasts), as well as in various clinical populations. In fact, several studies (see ISSN article, reference below) point to benefits of creatine supplementation in various populations and clinical settings, such as:
– Accelerating injury rehabilitation (because it attenuates muscle atrophy);
– Protection of neuronal injuries (spinal and cerebral);
– Mitigation of debilitating consequences in people with congenital syndromes of creatine synthesis deficiency;
– Attenuating the progression of neurodegenerative diseases (e.g. Huntington’s disease, disease, Parkinson’s disease, mitochondrial diseases, amyotrophic lateral sclerosis);
– Prevention and / or improvement of bioenergetics in patients with myocardial ischemia or stroke victims;
– Improving metabolic and functional indicators associated with aging;
– Possible benefit during pregnancy for optimal growth, development and health of the fetus.
In conclusion, creatine does indeed appear to be a safe and beneficial nutritional supplement for a wide range of populations and ages. Indeed, this is a supplement that actually works!
Take creatine and power to you!
Kreider, R.B. et al., 2017. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 14(1), p.18. Available at: http://jissn.biomedcentral.com/articles/10.1186/s12970-017-0173-z.
“People don’t decide their future, people decide their habits and their habits decide their future.”
– F.M. Alexander
Nine years ago (2010)1, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition of sarcopenia that has been widely used worldwide and this definition has fostered advances in the identification and care of people at risk or with sarcopenia. It was defined as a syndrome characterized by progressive and widespread loss of muscle mass and strength at risk of adverse outcomes such as physical disability, poor quality of life and death. Because the relationship between muscle mass and strength is not linear (the ability to generate strength is not only dependent of muscle mass), the criteria for its diagnosis included low muscle mass and low muscle function (i.e. strength or physical performance).
After learning that in 2016 sarcopenia was classified as a disease by the World Health Organization, as noted in the first part of this article, the EWGSOP22 updated its operational definition and various diagnostic strategies, considering now that muscle strength (measured by grip strength or the chair stand test) is the main parameter for measuring muscle function, even more important than the amount of muscle mass. Therefore, it is in this context that we justify the title of this article and reinforce the importance of sharing this message with all health professionals.
The implications of this condition on human health are several and widely known: increased risk of falls and fractures3,4; impairment of activities of daily living5; association with heart disease6; respiratory disease7 and cognitive dysfunction8; lower quality of life9; loss of independence10,11,12 and death13. In financial terms, public health costs have also been calculated in several papers. In a study by Janssen et. al.14, in 2004, the costs of sarcopenia in the United States were estimated at $ 18.5 billion annually, representing about 1.5% of total health costs. In a study conducted here in Portugal at the Hospital de Santo António in Porto and published in 201615, it was found that hospitalization costs associated with sarcopenia were higher by 58.5% for patients under 65 years and by 34% for patients aged 65 and over. More recently (2018), the Hertfordshire Cohort Study in the United Kingdom16 found that the costs associated with lack of muscle strength were estimated at £ 2.5 billion annually.
In the present scenario, where the phenotype of unhealthy aging is proliferating in the eyes of all industrialized nations, in which diseases such as hypertension, cancer, depression, Alzheimer’s disease and type II diabetes are destroying people’s lives, it is essential to adopt measures aimed at improving function of each individual rather than diagnosing illnesses and administering medicines which, in addition, do not help solving this problem, and may further aggravate their condition. We know that the main health problems are related to poor diet, physical inactivity, lack of sleep, excess alcohol, exposure to tobacco and polluted environments but also lack of movement quality, vigor and muscular strength.
The benefits of strength training in health are well supported in the scientific literature and the most important ones are: decrease in blood pressure; decreased risk of osteoporosis and sarcopenia; improvement of lipid profile; increased cardiorespiratory capacity; prevention and management of chronic pain; increased insulin sensitivity; improvement of wellbeing and self-confidence. Moreover, several studies17,18,19 have shown a strong and consistent correlation between increased strength and muscle mass with decreased mortality, reinforcing the fact that the decline in strength associated with the current levels of sedentarism and aging need to be addressed. Therefore, a well-designed strength training program that meets the individual’s competency and follows the principles of adaptation to training will improve all of the above health indicators and all the necessary physical qualities (strength, power, speed, agility, balance, coordination, mobility, endurance) to carry out the activities of our daily life. These are the parameters of physical function that are currently being proposed as biomarkers of aging in humans20.
Consequently, program design will be the determining factor in this equation. And while it is true that this process requires imperative knowledge of sports sciences, it must be borne in mind that it also requires field work and art in coaching. Instead of being so preoccupied with following the guidelines and looking for statistically significant results, we should be concerned that our approach is relevant to one’s life. Because we work with people. People who have time constraints to train. People with different family and professional responsibilities. People who have different lives from each other. People who have a host of metabolic and / or orthopedic problems that no randomized controlled trial can ever reproduce! Yes, this is a complex process.
Finally, we know that one of the mechanisms responsible for muscle atrophy, sarcopenia and aging is apoptosis, a form of programmed cell death and a fundamental process in aging. But when we train, eat and rest properly, we are sending a signal to our body to create an anabolic environment, an environment that enhances the release of growth factors and suppresses apoptosis. That is, strength training is a macroscopic growth factor that suppresses programmed cell death (i.e. apoptosis), but unlike drugs, where an increasing in dose means more disease and dependence, an increase in load (even if reduced) means more health, more strength and more vigor. This way, the daily decisions will always be up to each one: treat the body like a Ferrari or treat the body like a rental car.
- Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 2010; 39: 412–23.
- Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31.
- Bischoff-Ferrari HA, Orav JE, Kanis JA et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 2015; 26:2793–802.
- Schaap LA, van Schoor NM, Lips P et al. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study Amsterdam. J Gerontol A Biol Sci Med Sci 2018; 73: 1199–204.
- Malmstrom TK, Miller DK, Simonsick EM et al. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016; 7: 28–36.
- Bahat G, Ilhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med 2016; 6: 220–23.
- Bone AE, Hepgul N, Kon S et al. Sarcopenia and frailty in chronic respiratory disease. Chron Respir Dis 2017; 14: 85–99.
- Chang KV, Hsu TH, Wu WT et al. Association between sarcopenia and cognitive impairment: a systematic review and metaanalysis. J Am Med Dir Assoc 2016; 17: 1164.e7–64.e15.
- Beaudart C, Biver E, Reginster JY et al. Validation of the SarQoL(R), a specific health-related quality of life questionnaire for Sarcopenia. J Cachexia Sarcopenia Muscle 2017; 8: 238–44.
- Dos Santos L, Cyrino ES, Antunes M et al. Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function. J Cachexia Sarcopenia Muscle 2017; 8: 245–50.
- Akune T, Muraki S, Oka H et al. Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: the ROAD study. Geriatr Gerontol Int 2014; 14: 695–701.
- Steffl M, Bohannon RW, Sontakova L et al. Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging 2017; 12: 835–45.
- De Buyser SL, Petrovic M, Taes YE et al. Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing 2016; 45: 602–8.
- Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004 Jan;52(1):80-5.
- Sousa AS, Guerra RS, Fonseca I, Pichel F, Ferreira S, Amaral TF. Financial impact of sarcopenia on hospitalization costs. Eur J Clin Nutr. 2016 Sep;70(9):1046-51. doi: 10.1038/ejcn.2016.73. Epub 2016 May 11.
- Pinedo Villanueva, R. A., Westbury, L. D., Syddall, H. E., Sanchez, M., Dennison, E. M., Robinson, S. M., & Cooper, C. (2018). Health care costs associated with muscle weakness: a UK population-based estimate. Calcified Tissue International.
- Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337(7661):a439. Published. doi:10.1136/bmj.a439.
- Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547-53.
- Dos Santos L, Cyrino ES, Antunes M, Santos DA, Sardinha LB. Changes in phase angle and body composition induced by resistance training in older women. Eur J Clin Nutr. 2016 Dec;70(12):1408-1413. doi: 10.1038/ejcn.2016.124. Epub 2016 Jul 13. PubMed PMID: 27406159.
- Cadore EL, Izquierdo M. Muscle Power Training: A Hallmark for Muscle Function Retaining in Frail Clinical Setting. J Am Med Dir Assoc. 2018 Mar;19(3):190-192.
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.
CAN CALORIE RESTRICTION OR INTERMITTENT FASTING HELP PREVENT “AGE-RELATED DISEASES” AND LIVE LONGER? – PART 1
In this article I will look into the possibility of calorie restriction or intermittent fasting, which is just an alternative strategy to induce a caloric deficit, effective nutritional therapeutic strategies to prevent, alleviate or even eliminate some of the so-called “age-related diseases”, thus contributing for a better and longer life. It is important to note that most studies on the effects of calorie restriction or intermittent fasting (or intermittent calorie restriction) on life expectancy are mechanistic, and conducted in animal and / or in vitro models. It is understandable that there are fewer human intervention studies in this area. If we think about it, it is not easy to conduct studies with humans on calorie restriction to study its effects on life expectancy and the incidence of “age-related diseases”. Not only it is not easy to recruit people to voluntarily incur in a calorie restriction period, it is also not practical to study in humans (in a randomized controlled manner) the effects of calorie restriction or fasting on life expectancy, because they simply “live a long time”. ” In order to obtain timely results, it is essential to conduct studies on species with a shorter life expectancy. However, observational studies and some human intervention studies (discussed later) appear to confirm the same health benefits and molecular mechanisms as those observed in animals.
It should also be noted that, in the experimental context, caloric restriction is defined as “reduced food intake without malnutrition”. In other words, nutritional interventions imply a 10-40% reduction in daily caloric requirements in which only calories, and not nutrients, are restricted (in most controlled studies this is ensured with vitamin and mineral supplementation) (Kitada & Koya, 2013b; Robertson & Mitchell, 2013). This notion is important! Caloric deficit does not imply nutrient deficit and caloric surplus does not imply that nutrient requirements are met. Intermittent fasting will be no more than an alternative method of calorie restriction in which food intake is restricted for a certain period of time (usually 16 to 24 hours) followed by an unrestricted intake period and has been touted as producing beneficial health effects similar to more constant calorie restriction protocols (Martin, Mattson, & Maudsley, 2006; Robertson & Mitchell 2013).
Should we accept being “sick” just because we get older?
It is recurrent to hear that the disease is something that “comes with the age package.” In fact, getting older is a drag! The general perception of a progressive decline of all our capabilities as we age is, unfortunately, not an illusion. There are several theories about aging. While certainly a very interesting topic, a detailed description of the various theories of aging is not the purpose of this article. These are some of mechanisms underlying the aging process which are generally pointed out as the main ones:
- The “Hayflick limit” (phenomenon discovered by Leonard Hayflick) determines that human cells have a replication limit number, after which they become senescent. Telomeres (i.e. a kind of protective “helmets” at the end of each chromosome) become progressively shorter with each cell division (Shay & Wright 2000). However, DNA methylation (an essential and repairing process consisting of the addition of methyl groups to DNA and which can be promoted by the abundance of dietary methyl donors for example) is said to be protective of telomere length and that way to postpone cell death and aging. For example, in animal models, hypomethylation of the enzyme telomerase reverse trancriptase has led to the preservation of leukocyte telomere length (Zhang et al. 2003; 2014). In this example, it is plausible to infer that delaying leukocyte senescence (through methylation and consequent telomere length conservation) may contribute to a stronger immune system and thus positively influence longevity.
- This theory suggests that unresolved chronic inflammation induces the human organism not to allocate resources for the functioning of other body functions (as they are permanently allocated to unresolved inflammation) and thus leading to early aging of various organs and tissues, and the early onset of “age-related diseases”.
- This theory, originally proposed by Dr. Denham Harman in 1956, is based on the premise that the aging process is mediated by free radical damage. Theoretically, by reducing free radical accumulation (e.g. reactive oxygen species) and at the same time increasing the antioxidant capacity of the organism (increasing glutathione, and antioxidant enzymes such as SOD and catalase), tissue damage can be prevented (by slowing down aging process) and to prevent the occurrence of “age-related diseases” and consequently contribute to increase functional longevity (Harman, 1988; 2006).
Very well, getting older is inevitable! We already know that. However, if we give it a little thought, all the mechanisms mentioned have an environmental root, that is, we can, to some extent, control them through decisions that we make every day. Namely decisions about what we eat and how we move. And this is good news! It is in fact in our hands to slow down the process of senescence and prevent the onset of the so-called ‘’age-related diseases’’. Note that if for us (Westernized world) it is statistically “normal” to grow old with diabetes, hypertension, cancer, dementia, sarcopenia, osteoporosis, cardiovascular disease, insulin resistance, obesity and chronic inflammation (because the population studied incurs in a lifestyle that leads to disease), in other contemporary (non-Westernized) populations such diseases are rare or even non-existent. In this context, I invite the reader to consult what I consider to be one of the best books I know about nutrition and lifestyle, and its relation to the incidence of so-called “Western” diseases: Food and Western Disease: Health and Nutrition from an Evolutionary Perspective by Staffan Lindeberg. In fact, if we want to aim at maximizing health and lifespan potential, we should not just look at what is ‘’normal’’ in a given population, because that may be a sick population. Rather, we should look for what is “biologically normal” for a human being! A species that is designed (evolutionarily) to deal with a range of environmental stimuli that include certain levels of physical activity, nutrition, sun exposure and sleep. And, although aging is a normal process, it should not be “biologically normal” to age with chronic disease.
In this context, the Okinawa Centenarian Study is also frequently cited. The Okinawan population has the highest ratio of (healthy) centenarians on the planet (50 / 100,000 vs 10-20 / 100,000 in the USA) and as such is of greatest interest to study the factors that potentiate this kind of longevity. One of the factors identified (in addition to an appreciable level of physical activity and social interaction) was the fact that populations over 70 eat about 11% of calories below (about 1785kcal / day, which is a very moderate level of calorie restriction) than would be recommended for maintaining body weight (according to the Harris-Benedict equation), however on a nutrient-rich diet (Wilcox et al., 2006).
What we can do to live longer and better is one of my main interests. As I mentioned, our choices regarding the type of exercise, food we eat and other lifestyle factors can affect how long we live and, perhaps most importantly, how healthy and functional we live. In Part 2 of this article I will discuss some mechanisms by which nutritional interventions such as calorie restriction or intermittent fasting can lead to health benefits. And in Part 3 I will address the possible implications and practical applications of the practice of calorie restriction or fasting, as well as which populations can benefit most from these nutritional strategies and whoshould avoid them.
Dröge W., 2009. Avoiding the First Cause of Death. New York, Bloomington. iUniverse, Inc.
Harman D., 1988. Free radicals in aging. Mol Cell Biochem. Dec; 84(2), pp.155-161.
Harman D., 2006. Free radical theory of aging: an update: increasing the functional life span. Ann N Y Acad Sci. May;1067, pp.10-21.
Kitada, M. & Koya, D., 2013b. SIRT1 in Type 2 Diabetes: Mechanisms and Therapeutic Potential. Diabetes & metabolism journal, 37(5), pp.315–25.
Lindeberg, S., 2010. Food and Western Disease: Health and Nutrition from an Evolutionary Perspective. Oxford, United Kingdom: Wiley-Blackwell.
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.
Robertson, L.T. & Mitchell, J.R., 2013. Benefits of short-term dietary restriction in mammals. Experimental gerontology, 48(10), pp.1043–8.
Shay J.W., Wright W.E. 2000. Hayflick, his limit, and cellular ageing. Nat Rev Mol Cell Biol. Oct;1(1), pp.72-76.
Zhang D. et al., 2013. Homocysteine-related hTERT DNA demethylation contributes to shortened leukocyte telomere length in atherosclerosis. Atherosclerosis. Nov; 231(1), pp.173-179.
Zhang D.H., Wen X.M., Zhang L. & Cui W., 2014. DNA methylation of human telomerase reverse transcriptase associated with leukocyte telomere length shortening in hyperhomocysteinemia-type hypertension in humans and in a rat model. Circ J. 78(8), pp.1915-1923.
Wilcox D.C. et al., 2006. Caloric restriction and human longevity: what can we learn from the Okinawans? Biogerontology 7, pp.173–177.
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!
“Do not judge a man’s strength by the size of his biceps. Things do not always look what they seem.”
– Pavel Tsatsouline
In my opinion a normal human being should aim to be strong. And when I say strong, I’m not talking about those bulked individuals with a strange gait. Anyone (of any age) can become stronger by working consistently for this. Unfortunately, most people are more WILLING to be strong than doing what they need TO DO to be strong. Yes, these are different things. And yes, it’s not easy. One thing is WANTING a top-of-the-range Porsche, another thing is DOING the things needed to have a top-of-the-range Porsche. With strength is the same situation. To be strong, you need to have a plan (or have someone design a plan for you) and to work consistently to execute that plan – this is what your objective should be: to execute the plan. That’s it. You do not become what you THINK about every day, you become what you DO every day. Yes, there are no miracles, no one gets stronger without effort and without spending the time necessary for that to happen. The fitness magazines and the marketing associated with this industry want to make you believe that it’s possible to get stronger or leaner without great effort and quickly. It’s because of these kinds of messages that people still believe in shortcuts and / or allude to the power of genetics. They want it all but they don’t do anything (nothing useful at least). And then they still blame genetics!
There is one thing you should be aware of right now, strength is a skill. And in this sense, strength is the ability to generate more tension in muscles. And that is why strength is the basis for the development of speed, endurance and even flexibility. Like all skills, there are techniques or more appropriate ways to develop it. And that’s what I’m going to share with you. I will teach you some techniques for you to get stronger faster but this will only work if you apply them consistently in training. So, do them! Some of these techniques have already been used with me and with my clients / athletes, so I can assure you that they work and that they are scientifically proven, if that interests you as well. And before explaining them, I want to refer to Pavel Tsatsouline (I love reading his books), since he has been one of the individuals who has shared most of the “Russian secrets” of strength and one of the persons who have inspired me most in this journey. I hope I can meet him someday. Ready? Let’s do it!
This one is easy, this one any five-year-old understands.
First make a bicep curl set of 5-6 repetitions with good form, keeping the elbow close to the body and without tilting the trunk back. You can use a dumbbell or a barbell. But a serious dumbbell, it’s not worth using Barbie and Ken-style dumbbells, let these tools for people to have fun in aerobic classes! After doing this set, rest for a few minutes and make the following changes: before doing the movement again, i) squeeze hard the dumbbell or barbell; (ii) squeeze your glutes as if you wanted to crack a nut with your buttocks and (iii) tighten your abs and imagine that Mike Tyson will punch you in the stomach.
If you can do these three things, you will realize that the weight will get lighter and you will be able to do a few more reps – in a better and safer way. The explanation is this: when you create tension at various points in the body this will increase total body stability (via the neural impulses produced by the contracting muscles) and this stability / force will irradiate (i.e. spread) to the neighboring muscles as if it were an electric current to start the engine. And the most interesting part lies on the fact that the strength of a particular muscle, for example the bicep, can be amplified if the neighboring muscles also help! Have you realized why in the union lies strength? The formula is simple: more tension = more stability = more force.
Who still does arm wrestling in school? I perfectly remember the times when I was in school and this was one of the games we did in during class breaks or when we had a hole in our schedule. I remember very well the agonizing look of my classmates when they were about to be defeated or their expression of jubilation when I let them gain advantage and then finished strong. Yes, this was fun at the time! And yes, most of the time I won ?.
I gave the example of arm wrestling because I think this is the best way to understand this phenomenon. Lets’ see: an individual who can generate more tension before squeezing his opponent’s hand will have a superior neuromuscular activation level and a clear advantage over an individual who only begins to squeeze when someone (the referee) gives the signal to begin the “combat”. According to Prof. Yuri Verkhoshansky, if we create a sort of pre-tension in the muscles before starting a dynamic contraction, this can lead to increases of up to 20% in performance! Now imagine the advantage you can have if you can apply this technique and if your opponent does not know about it.
Try this technique as follows. Do five normal push-ups and relax on the floor between reps. Then do another five and this time think about creating tension in the whole body, that is, think of squeezing your glutes and abs before pushing against the floor to come up. If you do this well, you will realize that you are much stronger than you thought. Therefore, the key to this technique is in creating tension in the whole body before counteracting resistance. If you do not create this tension before, you will remain weak. Do not be that person.
- Power Breathing
First, a few notes on breathing. Proper breathing is very important to maximize performance, a normal person breathes on average more than eight million times a year and it is more likely that he will not do it efficiently. If there was a movement pattern that you had to repeat 23,000 times a day, would you not make an effort to improve it? Think about this a little bit. Most people only use a small percentage of the body’s ability to extract oxygen from the air into the lungs because they tend to breathe only with the upper body (apical breathing), instead of breathing deeper by using the most efficient respiratory muscle we have, the diaphragm (I think we do not talk much about the diaphragm in fitness / bodybuilding magazines because this is an invisible muscle that will not really impress women). But the fact is that this daytime breathing will affect several things: your recovery ability, your anatomical structure, the functioning of your autonomic nervous system, and your cognitive ability. So, if we are talking about performance optimization, be sure to improve your breathing patterns as well.
Second, regarding power breathing, this technique consists of holding the breath during the various phases of lifting. For example, the legendary Bruce Lee used to say that in the martial arts the power of breathing was more important than body strength. In general, the effect of breathing patterns and intra-abdominal and intra-thoracic pressure on strength is strangely ignored or misunderstood by fitness professionals and some medical authorities. These authorities seem to forget that orthopedic injury is much more common than cerebrovascular injury. That traditionally taught breathing pattern of inhaling when we lower the weight (eccentric phase) and exhaling when we raise the weight (concentric phase) may be useful in some cases (and we can’t say that’s wrong) but it’s not the one you want to do when you want to generate as much tension / strength as possible in the muscles. Why? Because the increase in intra-abdominal and intra-thoracic pressure will boost muscle excitability (through the pneumo-muscular reflex) and it is this process that will guarantee more stability in the spine and that will amplify your strength. This is the most natural way to produce strength! Yes, your fitness instructor may have said that forced exhalation of air against the glottis (i.e. the Valsalva maneuver) is hazardous to your health and that you may have a stroke doing this. But is this assertion correct? Prof. Yuri Verkhoshansky and Dr. Mel Siff, two of the world leading authorities on strength training, say the following in this regard in the book Supertraining, one of the strength training bibles:
“For example, the Valsalva maneuver associated with holding breath has a vital role in increasing intra-abdominal pressure to support and stabilize the lumbar spine during heavy lifting… It has been corroborated on many occasions that stress on the spine is decreased during any movement against high resistance and that exhalation during lifting increases the risk of injury to the lumbar spine. Thus, it is unwise to follow popular medical advice that people must exhale during the effort”. The authors further add: “while this may be appropriate for patients with heart disease or hypertension, this same action performed by an athlete who is doing squats or heavy lifting overhead, can seriously compromise spine stability and safety”.
Got it? This means that any healthy person can and should apply this technique if they aim to get stronger and lift heavy loads in a safe way. People with hypertension and heart disease should be more cautious in this regard but please note: this is not to say that they can’t strength train, there are many other ways to develop strength. By the way, it is already well documented in the scientific literature that these people can and should do strength training to improve their condition!
- Successive Induction
Successive Induction, such as the Law of Irradiation we have seen above, is another of the Sherrington Laws exploited to the maximum by the Russians. According to this law, contraction of a muscle – for example, the triceps – will make your muscle antagonist – in this case, the biceps – stronger than normal. In the early 1980s scientists suggested that this technique had a disinhibiting effect and later confirmed that a strength training program that included pre-tensioning an antagonist muscle (i.e. successive induction) was more effective than a program of conventional training. And the most interesting thing is that these benefits were not only limited to an acute performance increase, but also resulted in long lasting strength improvements.
Do the following test. Grab a barbell or free weight and get ready to make a bicep curl set with a load that allows you to do 5-6 solid repetitions. Remember, hold your elbows close to your body and do not lean your trunk back. Do one set and count the number of repetitions you can do with good form. After resting for a few minutes, keep the same weight and do another set, but this time using this new technique. When you bring the weight up, apply the other techniques you already know (irradiation and bracing) and on the descent apply the technique of successive induction, “pulling” the weight down with the triceps. In this way, you will give the biceps some rest on the descent (by preventing them from locking the movement) and will allow the triceps to also have a more active participation in the movement. You should expect to be able to do one or two more reps this way!
Therefore, when applying this technique, you will have two engines controlling the movement. And because of the co-contraction of both muscle groups, this technique may also offer greater benefits in terms of joint stability since the stress on them will be reduced (note: do not forget to discuss this with your doctor if you have joint problems).
Finally, my advice to you is this: if you want to start lifting heavy loads safely begin applying these principles in training (if you can’t do this alone ask someone you know to help you) and enjoy learning one of the skills (i.e. strength) you will need most to optimize your health. And be patient, do not expect to learn all these things from one day to another – it takes time and practice, good practice of course.
See you soon!
Tsatsouline, P. (1999). Russian Strength Training Secrets for Every American. Dragon Door Publications.
Tsatsouline, P. (2003). The Naked Warrior. Master Secrets of the Super Strong – Using Bodyweight Exercises Only. Dragon Door Publications.
Verkhoshansky, Y; Siff, M.; (2009). Supertraining. Sixth Edition – Expanded Version. Ultimate Athlete Concepts.
Verstegen, M.; Williams, P. (2014). Every Day is Game Day. Penguin Group.
“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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This is an article on a topic that is very special to me. I’m going to talk about myself, about music, about musicians, about sports and about physical preparation.
I will explain how it is possible to play at the highest level for many, many years in a healthy way and without having to practice endless hours of scales with perfect technique. I will explain how it is possible to avoid tendinitis and other musculoskeletal injuries that typically affect musicians sooner or later, which result from long hours of practice of repetitive gestures in very “unnatural” positions. Yes, it is possible to avoid, mitigate or even eliminate pain in your back, shoulders, neck, elbows, wrists and fingers, which are so common among professional musicians.
Me and music …
Those who have known me for less than 10 years probably don’t know, but I have had a career as a professional musician for at least the previous 10 years. I’ve started playing bass guitar and at a certain point I switched to double bass. I’ve studied at several schools in Portugal (Lisbon Conservatory, Lisbon Superior School of Music and Hot Club of Portugal Jazz School where I would become a teacher) and graduated from the Conservatory of Amsterdam. I was in fact obsessed with playing double bass and particularly obsessed with playing it with perfect technique! I used to practice a reasonable number of hours a day and was able to subject myself to incredibly boring exercises for many hours in a row, just because I wanted to improve a certain aspect of my performance. I could practice about 10 hours a day. For the less familiar with music instruments, the double bass is a very physically demanding instrument, and 10 hours of repetitive gestures in unbalanced positions is very stressful on the body.
Due to long hours of musical practice, I developed a debilitating neuromuscular pathology (focal dystonia) that led me to a long rehabilitation process and to put my music career on hold. To know what focal dystonia is follow this LINK. In addition to focal dystonia, the list of complaints included:
- Frequent back pain, particularly in the lower back;
- Pain and stiffness in the neck, the sensation of having a wry neck that never went away;
- A thoracic kyphosis already up to a non-physiological degree;
- Protruded (forward) shoulders;
- Uneven hips. Because I spent many hours standing leaning mostly over my right leg and in slight lateral flexion, my pelvis was tilted to that side, just like my torso and shoulder. In fact, my right side was all “shortened”, as if I had one leg shorter than the other, which anatomically does not occur;
- Highly rigid and weak wrists, hands and fingers. For instance, I could not hold a push-up position on the floor with arms straight and shoulders over the hands, because my wrists would hurt and did not extend enough.
To aggravate all these imbalances caused by specific and repetitive gestures, my choices for physical activity (yes, because my past in sports impelled me not to be sedentary) relied on activities that were also specific and that also included repetitive gestures, that is, I would play sports! By definition, any sport and its related gestures are specific, cyclic, repetitive and asymmetric. There are sports “less bad” than others, but they are all asymmetrical. And no, swimming is not a complete sport, none is!
All this, and particularly the highly traumatizing and time-consuming process of neuromotor retuning that I underwent to treat dystonia, has prompted me to better understand processes related to the neuromuscular function, motor control, and musculoskeletal injuries. I decided to go back to the university and start a new career, and discovered other obsessions: anatomy, physiology, nutrition, strength training. And here I am today!
Musicians and the myths about “frailty” of their fingers and body …
I have to acknowledge, and my musician friends must forgive me, but musicians are usually very lazy to do any physical activity. We live to play our instruments and to be available for rehearsals. We make up excuses such as not having time and / or that our working tools (e.g. hands and fingers) are very “sensitive” and prone to injury if we engage in any vigorous physical activity. The fear of twisting a finger or cutting a lip (for wind instrumentalists) or even a foot (for drummers) is understandable! In fact, a finger injury for example may be enough to impede a musician from working for several weeks.
Who hasn’t witnessed or lived the situation where when playing soccer with friends those who are musicians try to avoid playing as the goal keeper with fear of injuring their fingers? Perfectly legitimate and understandable. And it’s precisely for this reason that if musicians want to get in better shape and ensure they can play music without injuries for many more years, doing sports is not the solution. They can do it for pleasure, and the energy expenditure that results from it can have positive metabolic effects. However, all asymmetries and musculoskeletal injuries that result from playing an instrument will not be corrected by playing a particular sport and will most likely will be worsened.
Musicians should do general physical preparation instead! Because a professional musician is a highly specialized high-level athlete. A high-level athlete practices his sport and in his training program is (or at least should be) included a very important component which is basic physical preparation. In his physical preparation program our athlete trains for strength, mobility and endurance, and other physical qualities in order to establish a general athletic base that will make him more resilient and protect him from injuries that his sport, which is repetitive and asymmetrical, makes him vulnerable to.
We don’t get fit FROM PLAYING sports, we should get fit TO PLAY sports. The repetition of specific sports gestures induces specific musculoskeletal adaptations. It is easy to understand that for an athlete, it does not make sense to try to compensate for a specific adaptation induced by a sport gesture with another one which might apparently look as an opposite one! For example, will it be smart for a right-handed tennis player to try compensating for the asymmetries resulting from playing with his right arm by engaging in the practice of table tennis with his left arm? Or, if our player exhibits pain in the right shoulder associated with lack of flexibility and strength, does it make sense to start practicing gymnastics just because apparently gymnasts have strong and flexible shoulders? No and no! This athlete should follow a program of general physical preparation to become stronger and more mobile, which can in fact compensate for the asymmetries induced by the sport that he practices.
What is the similarity between playing an instrument and practicing a sport? It’s the same…
Imagine compensating for the unbalanced position of playing double bass with playing another instrument in a seemingly opposite position?
Let’s explore that idea…
For example, playing double bass (a string instrument that can be played with a bow or fingers of the dominant upper limb) implies (usually) standing in a position characterized by unilateral rotation and flexion of the torso, accompanied by a forward leaning of the trunk, in a bipedal position with greater weight over the side of the torso’s lateral flexion, with elevation of both non-dominant arm and shoulder paired with depression of both dominant arm and shoulder, and rotation and slight lateral flexion of the head.
So, to compensate for or correct all these adaptations will it make any sense to go play the violin for example? Because apparently, it’s the opposite! You are (usually) sitting and not standing, the rotation and flexion of the head is in the opposite direction, where both dominant arm and shoulder are apparently more depressed, and the dominant arm raised …? Of course not…
By the same token, this musician will not be stronger, more flexible and more resilient to injuries due to his musical practice if he chooses to compensate for these adaptations with the practice of a sport. If you enjoy playing football or tennis with friends, you should do so, but it will not make you more resilient to injuries or attenuate the ones you may already have.
You must go to the basics: physical preparation.
Musicians should follow physical preparation program such as an athlete. Playing an instrument is highly specific and doing it regularly and long-term will require some specificity and in terms of exercises that can compensate for those unnatural positions that are held for such long periods of time. Yet, the basis of physical preparation will always be (for the athlete, musician, or any other) of a general nature. It is necessary to make the body stronger and more flexible, because only that way one can make it more resilient in order to endure the highly demanding physical requirements of playing a musical instrument for hours, days and years on end.
The pain and discomfort that you my fellow musician feel now, can improve with physical training! Smart training in a controlled environment. A kind of training that can make all the structures of our body stronger and less rigid. A kind of training that promotes a better alignment of the kinetic chain and that enables you to produce force in fundamental movement patterns such as pulling, pushing, lifting objects off the floor, squatting, crawling, walking and jumping.
And no, your body is not fragile! If it hurts, it’s because it’s somehow weak!
Believe me, I’ve been there, done that… ?
Most women are afraid to lift weights like men because they think they will look bulky and like the women we see on the left hand pictures. It is time to demystify this idea and explain why this is impossible (provided than no hormones and/or anabolic steroids are used), and why strength training is key and a great ally to improve a number of parameters, including body composition.
Overuse of low-intensity training protocols by women is too common. Too much emphasis is placed on cardio, machine use, treadmills, bicycles, light loads, and too little emphasis is put on what will promote better physiological adaptations for increasing women’s functional capacity – strength training. If you want to bring more years into your life, you should start looking at strength training as one of the most effective anti-aging tools on Earth. There is no system in our body that is not influenced by strength training! Have I told you that it is cheaper than the creams you rub on your body every day?
I will divide this article into three parts. First, let’s highlight the myths of strength training for women, which were already addressed by Ebben & Jensen in 1998 in Strengthening for women: debunking myths that block opportunity. Second, let’s highlight its main benefits, and third, let’s explain why you will not look like Arnold Schwarzenegger.
1. MYTHS OF STRENGTH TRAINING FOR WOMEN
- Strength training will cause women to become big and heavy.The truth is that strength training helps to reduce body fat and increase lean mass. These changes may result in a slight increase in weight since the lean mass is more dense than fat (note: if this disturbs you throw the scale away and look more at yourself in the mirror!). Strength training will result in increased strength, no change or a decrease in the hip and waist perimeters and a slight increase in the perimeter of the upper body. Only women who are genetically predisposed for hypertrophy and who participate in high volume and intensity workouts may see substantial increases in the circumference of their limbs.
- Women should use different training methods than men.Women are often encouraged to use machines and to do many repetitions slowly because they are afraid that the use of free weights, manual resistance, explosive movements or exercises that use their body weight as resistance will cause injury. In fact, there is no evidence suggesting that women are more likely than men to injure themselves during strength training. The most important factors to reduce the risk of injury are based on exercise technique and training individualization.
- Women should avoid high intensity training or training with high loads.Women are usually encouraged to use smaller weights in their strength training (i.e., light dumbbells) but the problem is that these light loads are substantially below what is required to promote physiological adaptations. Women need to train at intensities high enough to promote adaptations in bones, muscles, cartilage, ligaments and tendons. When the intensity of the exercise is low, that is, when the stimulus is insufficient, the physiological benefits are minimal. To maximize the benefits of strength training, women should train close to their maximum. For women who have had children, imagine that this is what you have to “push” to get the greatest benefits.In short, there is no reason for women to train differently from men with regard to training intensity. If you intend to get different results, you need to leave aerobic classes and pink weights to start lifting real weights.
2. STRENGTH TRAINING BENEFITS FOR WOMEN
In addition to improving body composition (loss of fat mass and increase in lean body mass), strength training will help you:
- Increase bone remodeling. You will get stronger bones and reduce the risk of osteoporosis (LINK, LINK, LINK). Keep in mind that stronger bones can also result in total weight gain, but this is good, strong bones are a sign of health;
- Strengthen the connective tissue. You will increase your joint stability and reduce the risk of injury (LINK). As in the previous point, same thing can happen regarding weight gain;
- Increase functional strength for activities you enjoy or for your daily activities (e.g. playing with your kids, carrying grocery shopping, climbing stairs).
- Increase self-esteem and confidence. A stronger body will make your mind stronger and unstoppable!
- Fight the effects of metabolic syndrome and other common chronic diseases in our society, such as cardiovascular disease, type II diabetes, cancer, fibromyalgia, rheumatoid arthritis and Alzheimer’s disease (LINK, LINK).
- Increase longevity in a healthy way. Strength training will potentiate the release of anabolic hormones that play an important role in tissue regeneration and anti- aging (LINK).
In summary, strength training has the potential to restore the shape of your glutes, the glow of your skin and the tonus of those parts of the body that you think is only possible through surgery, miracle supplements and advanced techniques of “muscle toning”. Strength training can also help you live the life of your dreams.
3. WHY I WILL NOT BECOME ARNOLD SCHWARZENEGGER?
Women have different physiological characteristics from men and this is the reason why women have greater difficulty in gaining muscle than men. As I said at the beginning of this article, if there are no hormones and/or anabolic steroids involved, it is very unlikely that women will look like men.
- Diferences in muscle fibersAlthough women have the same types of muscle fibers that men have (fast-twitch fibers and slow-twitch fibers), the amount of muscle fibers they have and their size is smaller. Remember that slow-twitch fibers (type I) are used primarily in endurance efforts whereas fast-twitch fibers (type II) are used primarily in rapid and explosive movements. In women, because they have 70-75% type I fibers, it becomes even more difficult to move loads at high speeds. This means that the potential for increasing the cross-sectional area of the muscle (i.e. muscle size) and for increasing the rate of force development is lower in females than in males.
- Diferences in strength and powerThe average total body strength of a woman corresponds to about 60% of the average total body strength of a man. In average, upper body strength in women ranges from 25-55% of men’s upper body strength. Regarding lower body strength, it seems that women are stronger in relative terms. In average their capacity is 70-75% of what is observed in men. It is therefore not surprising that most women find it more difficult to lift weights with arms and upper body (e.g. push-ups and pull-ups) than with legs and lower body (e.g. squats and lunges).
- Diferences in hormone levelsThe most obvious difference in the mechanisms that determine the adaptations to training of men and women is the sex hormone, testosterone. Both men and women produce testosterone, the difference is that testosterone concentrations in men are 10 to 20 times higher than in women! It appears that women are more dependent on pituitary secretion from growth hormone and other growth factors to help mediate changes in muscle, bone and connective tissue. In fact, although strength training adaptations do not occur in the same way, it has been reported that women have higher bioavailable concentrations of growth hormone at rest than men. Fortunately, strength training and metabolic resistance training can also increase growth hormone levels.Also, if you begin to lift weights in a progressive manner, you will continue to maintain your femininity, you will not grow a mustache, beard or hair in your chest. You will not get bigger or full of muscles. On the contrary, you will get leaner, stronger, younger, smarter and much more attractive to the opposite sex. But do not be fooled, to get the greatest benefits in training, you need to work hard and realize that it takes serious effort to induce the metabolic adaptations you seek (e.g. improving body composition and biological aging). This does not happen overnight. You will need time, consistency and discipline. There are no miracle pills.
In conclusion, before beginning a strength training program, be aware that you must have movement competency in the first place. Just as you would not begin to calculate derivatives in mathematics before you know how to add and subtract, it also makes no sense to start lifting heavy loads if you have restrictions and/or asymmetries in your movement profile. The quality of movement is the foundational support for functional strength development so this “ingredient” will always have to come first.
For a graphic resource check out this nice infographic from Positive Health Wellness.
See you soon and enjoy 🙂
Ciccolo Joseph T, Carr Lucas J, Krupel Katie L, Longval Jaime L. The Role of Resistance Training in the Prevention and Treatment of Chronic Disease. American Journal of Lifestyle Medicine July/August 2010 vol. 4 no. 4 293-308.
Cussler EC, Lohman TG, Going SB, Houtkooper LB, Metcalfe LL, Flint-Wagner HG, Harris RB, Teixeira PJ. Weight lifted in strength training predicts bone change in postmenopausal women. Med Sci Sports Exerc. 2003 Jan;35(1):10-7.
Ebben WP, Jensen RL. Strength training for women: debunking myths that block opportunity. Phys Sportsmed. 1998 May;26(5):86-97. doi: 10.3810/psm.1998.05.1020.
Hurley BF, Hanson ED, Sheaff AK. Strength training as a countermeasure to aging muscle and chronic disease. Sports Med. 2011 Apr 1;41(4):289-306. doi: 10.2165/11585920-000000000-00000.
Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to resistance exercise and training. Sports Med. 2005;35(4):339-61.
Nickols-Richardson SM, Miller LE, Wootten DF, Ramp WK, Herbert WG. Concentric and eccentric isokinetic resistance training similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women. Osteoporos Int. 2007 Jun;18(6):789-96. Epub 2007 Jan 31.
Stone MH. Implications for connective tissue and bone alterations resulting from resistance exercise training. PubMed PMID: 3057317.
Winters KM, Snow CM. Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. J Bone Miner Res. 2000 Dec; 15(12):2495-503.
Zatsiorsky V., Kraemer, W. Science and Practice of Strength Training 2nd Edition. Human Kinetics (2006).
If your grandfather is a normal person, it is very likely that he has been to the doctor many times, that he is on medication, that he does not hear very well and that he does not have the same locomotion capacity and reasoning that he had some years ago.
Doctors say this is “normal” and typical of the advancing age. They also prescribe drugs based on the belief that this will improve the quality of life of these people. I do not say that this is not necessary in some cases, but I do not believe that this is the best approach to increase health span. Although they “breathe” I think that they deserve better and more.
More than two years ago, a piece in a portuguese newspaper stated that the Portuguese lived longer and longer but less healthy. The piece also mentioned: “Portuguese women have one of the longest life expectancy in the world, but, paradoxically, enjoy far fewer healthy years than women from the best-ranked countries in Europe.”
When reading the piece, the first thing I thought was: we have to be really stupid, because even with the daily advances of medicine and scientific knowledge, we have not yet been able to understand what are the causes behind this SICK LONGEVITY. The problem is not the advancing years, the problem lies in nutrition and exercise related advice we hear every day (especially in hospitals), which is simply erroneous. If prevention campaigns and the information leaflets in hospitals were really supported by scientific evidence, one would not witness so many people suffering from chronic pain, diabetes, heart disease, osteoporosis, sarcopenia, autoimmune diseases and cancer.
Everyone recognizes that physical exercise is key to optimal body function (our brain and body did not develop while sitting on our asses), and that, unlike drugs, has a positive and self-regulating impact on the various systems of the human body.
Exercising is more effective on improving your health than any patented medicine.
“But I walk an hour every day”
Let me tell you one thing, walking is the least you can do to keep your body working. If you tell me that is either walking or lying back on the couch eating ice cream, then you better walk. But if you tell me that you want to live a healthy life until you die, maintain your autonomy, decrease the risk of falls, increase self-confidence, sleep better, recover faster from an injury and not be part of the statistics we saw above, then I recommend you start seriously thinking about lifting weights and engaging in strength training. Walking will not give you, even by shadows, the same benefits as strength training.
Another thing, if you are one of those people with cardiovascular disease, your doctor (or some Dr. from Google) has probably told you that walking is important to improve your cardiovascular health. The problem is that walking will not help you much. The lack of aerobic capacity is not a risk factor for heart disease, a sedentary lifestyle is! This means that you may have a huge aerobic capacity and a heart disease at the same time. In fact, according to this study published in the 2006 American Heart Association Journal (LINK), to this one published in 2008 in the European Heart Journal (LINK) and to this one published in the Mayo Clinic Proceedings (LINK) in 2012, marathoners are those who appear to be at increased risk of developing cardiovascular disease.
Furthermore, according to the cardiologist Henry A. Solomon in the book “The Exercise Myth”, cardiovascular health refers to the absence of heart and blood vessel disease, and not to an individual’s ability to do a certain amount of physical work. According to Dr. Solomon, your cardiac health is determined by the condition of various structures of the heart, including the heart muscle, the valves, the special cardiac tissues that carry electrical impulses and the coronary arteries. So, do not expect exercise to “clean” what you practice in your daily diet.
The cardio craze came about in the late 60’s / early 70’s through Dr. Kenneth Cooper, the person who designed the Cooper test for US military use. It was roughly from this moment on that VO2max (a measure of aerobic capacity) was “elected” the holy grail of physical fitness. Although relevant for performance and longevity, VO2max is not the only marker of physical fitness. Strength in its various forms has been more strongly correlated with increased longevity than VO2max. While strength training can increase both functional strength and aerobic capacity, the typical cardio training will not make you stronger and will only slightly “at best” increase your VO2max.
Why Strength Training?
Because you tend to lose strength and power as you age, and because several studies have shown that loss of strength and muscle mass are associated with increased mortality (LINK, LINK, LINK). Fortunately, lifting weights is the best stimulus to counteract this trend and to increase our functional capacity. Under normal conditions, strength peaks between the ages of 20 and 30, remaining relatively stable or decreasing slightly over the following 20 years. But this is dependent, of course, of what one does in training.
It is in the sixth decade of life that decreases in strength are quite pronounced. According to several longitudinal studies, declines in muscle strength are around 15% between 60-70 years of age and 30% after age 70. Most reasons relate to the loss of muscle mass, pronounced loss of fast-twitch muscle fibers, decreased endocrine function, loss of tissue mobility / elasticity and cell dehydration. All of these can be minimized by following a proper strength training program.
Yes, it is possible to start strength training at any age, I know people who started training at 50, 60 and over 80, it’s all a matter of mindset and willpower. Also, you need to train according to your needs as opposed to the convenience of most gyms (i.e. spending hours on the treadmill / elliptical / bike, going through all the machines and ignore training with free weights) where supervision, tutoring and skill learning are dismissed.
Does this mean that I should get my grandparents to lift Olympic bars and weights without any criteria? Of course not, that would not be very smart. To get the most benefit of lifting weights you have to walk a path and create a solid movement base. You have to be screened and assessed for movement quality and physical parameters. Preferably guided by a fitness professional or personal trainer knowledgeable in movement and strength training science.
Listen, your doctor’s opinion might be highly valuable, however remember the following: 1) your doctor is not a specialist in movement (which is ok, they can not be trained in everything); 2) your doctor has no experience training people (which is also ok, it’s not their job); 3) your doctor probably does not even know how to lift weights or to move well (this is obviously not ok!). In other words, just as you would not ask advice on surgery techniques from strength coaches, you should also not ask advice on training methodologies and forms of physical exercise from surgeons.
Oh, and before you tell me that I’m being fundamentalist and suggesting that you should not train other physical abilities (such as stability, mobility, endurance, speed, agility, motor coordination, power), allow me to conclude with the following observation: ideally, the training program of any human being on the planet should always be the one that induces the adaptations necessary to fulfill his /her personal goals.
The key word here is adaptation! The more adapted you are the better prepared you will be to face any situation. Adults are free to do whatever they want in life. Everyday we make decisions and choices and those decisions matter. My goal is to increase longevity and live until the last days of my life feeling great and strong.
See you soon!
Möhlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R; Marathon Study Investigators; Heinz Nixdorf Recall Study Investigators. Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J. 2008 Aug;29(15):1903-10. doi: 10.1093/eurheartj/ehn163. Epub 2008 Apr 21.
Neilan TG1, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation. 2006 Nov 28;114(22): 2325-33. Epub 2006 Nov 13.
O’Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012 Jun;87(6):587-95. doi: 10.1016/j.mayocp.2012.04.005.
Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K, Guralnik JM. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci. 2000 Mar;55(3):M168-73.
Ruiz JR, Sui X, Lobelo F, Morrow JR Jr, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008 Jul 1;337:a439. doi: 10.1136/bmj.a439.
Takata Y, Ansai T, Soh I, Akifusa S, Sonoki K, Fujisawa K, Awano S, Kagiyama S, Hamasaki T, Nakamichi I, Yoshida A, Takehara T. Association between body mass index and mortality in an 80-year-old population. J Am Geriatr Soc. 2007 Jun;55(6):913-7.
Zatsiorsky V., Kraemer, W. Science and Practice of Strength Training 2nd Edition.
Human Kinetics (2006).
Several lines of evidence suggests that mitochondrial dysfunction is associated with sarcopenia (loss of strength and muscle mass in aging). In every cell of our body there are hundreds or thousands of mitochondria, they exist in greater quantity in the most active organs and tissues (muscles, heart and brain). The reason we age faster derives from the constant injuries and insults inflicted to the mitochondria. Chronic stress, lack of sleep, poor eating choices, lack of exercise (particularly strength training), alcohol, tobacco, and exposure to pollutants are just a few examples of how our lifestyle can influence the function of these small structures.
Mitochondria are the organelles responsible for energy production in our body. If you feel always tired, if you experience memory loss, if you have frequent muscle pain and if you are one of those people taking medications for cholesterol, hypertension, diabetes and other chronic diseases, it is very likely that your mitochondria are not in “great shape”. But let’s look at some evidence.
This study may be considered revolutionary because of its highly relevant findings regarding the benefits of strength training in older people. This study was published in 2007 and was the first study human study to demonstrate that strength training can reverse the aging process at molecular level. If it was a drug or a food supplement demonstrating these effects, I think everyone already knew.
The researchers recruited 25 healthy elderly people (mean age 68 years), who already did some type of physical exercise (walking, gardening, tennis, golf, cycling) three to four times a week, and 26 young adults (mean age 24 years) relatively inactive, some of them participating in recreational activities.
The authors selected relatively active older adults and sedentary young adults in order to study the aging process on healthy elderly and not just the putative aging effect of physical inactivity. All older subjects underwent a thorough screening process before being admitted to the study to ensure that other factors (e.g. metabolic diseases) would alter mitochondrial function.
All subjects completed a medical evaluation before participating in the study. Exclusion criteria were: evidence of heart disease (by history and sub-maximal graded exercise test); hypertension; chronic obstructive pulmonary disease; diabetes mellitus; renal insufficiency; orthopedic injury and smoking. None of the subjects had previously participated in a structured resistance training program.
Subjects performed resistance exercises with supervision on two nonconsecutive days of the week (monday/thursday or tuesday/friday) for 26 weeks (six months). The subjects performed twelve different exercises including chest press, leg press, leg extension, leg flexion, shoulder press, lat pull-down, seated row, calf raises, crunches, back extensions, bicep curl and triceps extension.
Subjects initially started with a set of 50% of 1 maximal repetition (1RM), and gradually increased to three sets at 80% of their 1RM during the intervention period. Subjects tested their 1RM for every exercise every two weeks, and training loads were adjusted to maintain 80% of their 1RM.
All younger subjects (N = 26) underwent a muscle biopsy (incision and extraction of a small part of muscle) from the vastus lateralis (thigh muscle) before and after the 26-week study. The elderly subjects (= 25) did their biopsies before the study and after (N = 14) of the study. Muscle RNA (ribonucleic acid) was analyzed to determine age-related gene expression variation.
The authors identified 596 genes that were differentially expressed between the two age groups. Of the 596 genes, the researchers identified 179 associated with age and exercise that showed a remarkable reversal in their expression profile after six months of resistance training. This literally means that resistance training not only can slow down but also reverse the aging process at the genetic level. The genetic expression of the elderly individuals became similar to those of the younger group. The researchers also noted that mitochondrial dysfunction (closely related to physical inactivity) began to reverse after six months of training.
As for muscular strength, results were as expected, that is, the ones who strength trained got stronger. The initial gap of 59% in maximal isometric strength in older people vs. young adults was reduced to 38% after six months of resistance training.
Nowadays, it is widely accepted that physical exercise is associated with a decrease in morbidity and mortality in humans. This is not a belief. What people probably do not know is that there are forms of physical exercise that are more effective in increasing strength and longevity. This study demonstrated for the first time that resistance training can reverse age-related aspects at the gene level. Yes, you are reading well, resistance training can reverse aging at the molecular level!
The fact that older people got stronger was no surprise to me and certainly not for fitness professionals. It is not uncommon for older people to begin their training with minimum weights and, in a short time, evolve to loads equal to or greater than those in their twenties. It’s all about dedication, consistency and method.
Over the years, personal trainers and fitness professionals have been preaching their clients / athletes about the importance of physical exercise in improving health. This message, in my opinion, has not been well perceived by most people. Understanding the notion that movement and physical exercise is as important as the food they eat every day is, unfortunately, still lacking.
In short, this fascinating study is basically telling us that it is within our power to increase health and longevity. In this case, the “fountain of youth” is something we know and something that is relatively accessible to everyone – Strength Training.
However, for these benefits to occur, people have to be willing to work hard and with consistent effort, something rare in our “all in moderation” oriented society. Most people are in search of a miraculous pill and rather rely on faith than doing something for themselves. Therefore, I believe that only focused individuals and those who follow these principles in training (and in life) will end up having the most benefits. Things will not happen by chance, certainly.
See you soon!
Melov S, Tarnopolsky MA, Beckman K, Felkey K, Hubbard A (2007) Resistance Exercise Reverses Aging in Human Skeletal Muscle. PLoSONE 2(5): e465. doi:10.1371/ journal.pone.0000465
The Swing exercise is the foundation of hardstyle kettlebell training methodology and an essential exercise in our training programs at The Strength Clinic. The hardstyle Swing is an explosive movement characterized by a vigorous and complete extension of the knees and hips (in the top position) preceded by near maximal hip flexion and slight knee flexion (in the bottom position). The Swing is known for its effectiveness in improving performance in daily life activities as well as performance of athletes of the most varied modalities, from long distance runners to combat sports, among others. We can point out five reasons that make the hardstyle kettlebell Swing an exercise of choice for athletic development:
- Strength. The acceleration and deceleration component inherent to the Swing induces important adaptations in the power production capacity despite the relatively light loads used. Reminding Newton’s second law (force = mass x acceleration), it is possible to increase force acting on a given system by increasing acceleration without increasing mass. In this case, the real load manipulated during some moments of the Swing performance will exceed the weight in Kg of the kettlebell, where peak forces generated can be up to 10 times more. This allows for significant maximal strength gains especially in the posterior chain;
- Power. Due to its explosive nature based on a fundamental movement pattern (i.e. “hip hinge”, used in deadlift exercise). The vigorous extension of the hips and knees is at the base of any explosive athletic movement. The Swing not only allows you to work explosive strength, but also allows you to do it in a cyclical and repetitive way, and also in a very safe way. This feature constitutes an advantage of the kettlebell Swing in terms of benefit / risk, when compared to the Olympic movements like the Snatch or the Clean for power development. The Swing is not only less technically complex to learn, it allows greater number of repetitions without fatigue compromising (in a dangerous way) technical execution;
- Trunk stability and rotational strength. The biofeedback offered by holding a kettlebell and the need to balance the forces generated by the acceleration and deceleration of the kettlebell, induces a marked activation of the stabilizing muscles of the trunk and shoulder joints. When performed with one hand, the Swing further accentuates muscle activation in a crossed chain fashion due to the anti-rotational component created. This type of rotational power generation manifests itself in the most varied sports movements, such as: the golf swing; the serve, forehand and backhand stroke in tennis; shooting in handball; shooting and serve in volleyball; shooting and kicking in soccer; throwing events in track and field athletics; etc;
- Muscle and cardiovascular endurance. Due to its particular design, the kettlebell Swing allows repetition of explosive movements with maximum or near maximum acceleration. This possibility of safe repetition with an additional load delivers significant muscle and cardiovascular endurance adaptations;
- Fat loss. Because it entails the stimulation of large amounts of muscle mass at a high intensity and repetitive way, the kettlebell Swing induces high metabolic stress levels. This metabolic stress results in increased oxygen consumption in the subsequent hours (i.e., increased calorie expenditure due to increased metabolism), thus contributing greatly for fat loss.
Indeed, the inclusion of the kettelbell Swing is a wise choice when structuring a well-rounded training program. The Swing is also highly versatile in terms of programming. By combining different loads, number of repetitions, rest periods and variations of the exercise (e.g. two-handed Swings, one-handed Swings, double Swings, dead stop Swings), one can easily shift the pointer in order to work on specific adaptations of the strength continuum (i.e. from the maximum strength end to the muscular endurance end) as well as on the various energy systems. And all this in a very safe way!
A 12-week fat loss program suggestion
Get a kettlebell (at least 16kg for women and 20kg for men) and have it in your living room or bedroom. Learn how to perform the hardstyle swing exercise with a certified instructor. Every day, whether you train in the gym or not, perform 5 sets (spread throughout the day according to your own convenience) of 20 swings during the first week, 25 swings during the second week, 30 swings during the third week and 35 swings during the fourth week. On the second month repeat the process with a kettlebell at least 4kg heavier, and on the third month with a kettlebell 8kg heavier. At the end of 12 weeks rejoice with the results!
Swing and enjoy…! 🙂