Muscle Matters for your Mind

According to a new study published in the Archives of Neurology, elderly people with weak muscles may be at increased risk for Alzheimer's disease. The study followed 970 people with an average age of 80 years old for an average perod of 3.6 years. Those with the highest levels of muscle strength at the start of the study were 61% less likely to develop Alzheimer's than those with the weakest muscles. The link remained even when factors such as body mass index (which is a ratio of height and weight that does not account for body composition) and physical activity. As I've said for years. physial activity alone is not enough. Exercise must involve specific resistance that maintains or increases muscle mass and strength. All those doing brain exercises for mental sharpness should be sure to spend some time in the gym as well. More and more evidence demonstrates how important your muscles are for your mind.

Re-wiring your brain

Exciting stuff. Keeping fit is proving to be one of the most essential aspects of brain health.

Enough

Every now and then something happens that reminds me very clearly why I am in business. Once again this week I had the pleasure of working with a gentleman in his eighties. He told me how he had thought he was very healthy, regularly playing sports and staying active. In fact, he felt good enough to start going to the gym to further improve his abilities. Big mistake. Within weeks of starting his new program, his ability to perform even normal daily activities plummeted. He was experiencing back pain and leg weakness. He was unable to lift his arms above shoulder height. Golfing became intolerable. But wait, exercise is supposed to be good for us, right? So what happened?

As I've said before, exercise is physical medicine. Like any medicine, it ought to be prescribed properly. You need to take the right amount of the right type to produce the desired result. Just going to the gym is kind of like diagnosing yourself with a google search and then visiting the pharmacy or drugstore and taking a little bit of everything you think might help. I applaud all those who take responsibility for their own health and it is certainly admirable to see someone motivated to take up exercise. However, it can come with unwanted side effects. The downside of exercise is frequently pain or injury. It is important to fully understand your current status and your goals. Know where you are and where you want to go. Then determine an appropriate plan to get you there without unnecessary detours.

Far too many people injure themselves at the gym in pursuit of health. Don't get me wrong, I am all for exercise and know it can have an incredible impact on your quality of life. By all means, take responsibility for your health, but be sure to get the expert advice you need to get where you want as quickly and safely as possible.

Movement Science Podcast

Rod Henderson, a PT in Texas, recently began podcasting about various topics in movement science. Rod is a passionate researcher and interrogator committed to raising the bar in the rehab world. He recently interviewed one of my most important clinical influences, Barrett Dorko, a brilliant writer, thinker, and physical therapist from Ohio. I highly recommend listening to their enlightening discussion.

Through careful observation and extensive study, Barrett has developed and shared a perspective that is essential for understanding movement, particularly as it relates to dealing with pain. He has described, in multiple essays and reflections, the potential impact of more complete expression of something we all ordinarily keep hidden: ideomotion. Ideomotor activity is a category of nonconscious movement. It sometimes sounds a bit surreal or even purposely ambiguous, but it is really quite a simple concept once you understand a few basics of neurophysiology. Unfortunately, the rehab and medical world has somehow mostly disconnected the pieces between pain and the nervous system. Once grasped, the connection is beyond obvious, but many still languish in the realm of muscles and joints without realizing they are little more than hunks of meat without being animated by their puppetmaster - the brain.

The concept Barrett introduces is nothing less than a complete reinterpretation of the meaning of muscular activity. Here it is as I currently understand it:
(1) Muscles do nothing that the brain is not telling them to do (okay, that the nervous system is not telling them to do - they can contract via local reflex action).
(2) Although we consider skeletal muscle "voluntary", muscle tension is most often involunary. For instance, think about tension in your neck and shoulders. No one chooses to be tight there, but many frequently are.
(3) Most people think the solution to this problem is to just relax. Physios can often be heard complaining, "I can't treat her; she just won't relax." Many treatments have been devised to try to make that muscle tension go away, but few are successful in the long-term.
(4) Consider for a moment that the nonconscious part of the brain - the part that generates involuntary muscle tension - causes muscles to tighten up for a reason and, far from being the problem, this tension is actually part of the solution.
(5) A muscle that is tight (because the brain is sending excitatory signals) is contracting. A muscle that contracts will either remain tight (isometric contraction where there is no movement) or produce movement (isotonic contraction where the muscle shortens). Movement can be, and frequently is, easily inhibited. However, willingness to allow this movement to be expressed results in decreased tension, increased freedom of movement, and less pain.
(6) Non-volitional movement is ideomotor in origin and arises in the presence of increased mechanical tension in the nervous system. This often results from sustained positions, repetitive motion, or excessive force. The right movement is always the solution to mechanical pain.

Physiotherapists fashion themselves as movement experts, yet almost no attention is ever given to the most basic reactions of human physiology. Nonconscious movements have huge implications for our patients. They can no longer be ignored.

Provisional Nature

Val Jones, a contributor to one of my favorite blogs, recently wrote how she's noticed that being right is not the same thing as being influential. She onders how to advance the cause of science in the name of public health to "an audience drawn more to passion than substance." She correctly, I think, diagnoses the problem as a fundamental lack of understanding of the scientific method.

In his book The Science of Good and Evil, Michael Shermer writes the following:
"Our knowledge of nature remains provisional because we can never know if we have final Truth. Because science is a human activity and nature is complex and dynamic, fuzzy logic and fractional probablilities best describe both nature and the estimations of our approximation toward understanding that nature...What separates science from all other human endeavours is its belief in the provisional nature of all conclusions. In science, knowledge is fluid and certainly fleeting. That is the heart of its limitation. It is also its greatest strength."

Fuzzy...fractional...provisional...not really comforting for those who want certain answers. I frequently hear people dismiss scientfic evidence because "studies can show anything" or "they'll be saying the opposite in a few months." And, in some ways, they may be right. Science, however, provides a cumulative body of knowledge, that by its very nature, is self-corrective. Sure, it is fraught with bias and requires examination. Skepticism is a completely appropriate response. It is not the skeptics I worry about, but the true believers - those that claim to hold a truth from which they are unwilling to budge. Or even reflect upon. Skepticism is often derided as being too close-minded. It is, however, not an unyielding position, but rather a method, a means of examining claims through the wonderful lens of doubt. Don't be fooled by the loudest voices.

Understanding Fat Loss

Physical Activity & Childhood Obesity

Let me be very clear: there are many benefits to physical activity. It appears, however, that fighting childhood obesity is not want of them.

This meta-analysis recently published in the Canadian Medical Association Journal, demonstrates that school-based physical activity programs had no significant influence on Body-Mass Index (BMI). This is surprising to many who claim that lack of activity is the cause of an epidemic of obesity. The authors make the following point:
"The association between reduced physical activity and obesity has been well established. However, there is no conclusive evidence that reduced physical activity is a causal component in the pathway leading to childhood obesity. Rather, there is evidence to suggest that the observed association may be a downstream effect of obesity."
In other words, kids who are overweight are less likely to be active. This can compound their problems by leading to a decline in other health indicators that our linked to activity. One of the most alarming findings in the past number of years is that many obese kids show muscle loss and fatty infiltration of muscle that ordinarily does not show up until well into adulthood.

There are two main issues that I want to point out here:
(1) Body-Mass Index is not an ideal measure because it does not account for differences between fat mass and lean muscle tissue. One thing that may be lost in this overview is that muscle may have been gained. Resistance training would be a far more effective means of achieving this, but kid in the "growth phase" of life may add muscle more easily than adults who need to work harder for such gains. The challenge of the activity would be an important factor in this regard.
(2) Nutrition is, by far, the most important element in achieving fat loss. Put simply, many kids eat way too much simple sugars and starches for their body to do anything else but store fat. Food choices and portions have significant impact on hormonal responses that set up a slippery slope to obesity.

I highly recommend the book Strong Kids, Healthy Kids by Fred Hahn for those wanting more insight to these issues. It is a great book about a very serious issue. Here's my summary: Build muscle. Eat less sugar - way less. It can be that simple.