Thursday, January 22, 2009

Getting Fit Article

Fitness Isn’t an Overnight Sensation

Filip Kwiatkowski for The New York Times

Published: January 21, 2009

CARL FOSTER, an exercise physiologist at the University of Wisconsin, La Crosse, was amused by ads for a popular piece of exercise equipment. Before-and-after photos showed pudgy men and women turned into athletes with ripped bodies of steel. And it all happened after just 12 weeks of exercising for 30 minutes three times a week. Then there was the popular book, with its own before-and-after photos, promoting a program that would totally change your body in six weeks with three 20-minute exercise sessions a week.

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Have you had success changing your appearance through exercise?

There are many examples of people who took up exercise and markedly changed their appearance. But how long does it take? And how much time and effort are required? Six weeks sounded crazy to Dr. Foster.

“We said: ‘Wait a minute. You can’t change yourself that much,’ ” Dr. Foster said. So he and his colleagues decided to experiment. Suppose they recruited sedentary people for a six-week exercise program. Would objective observers notice any changes in their bodies?

The plan was to photograph volunteers wearing skimpy bathing suits and then randomly assign them to one of three groups: cardiovascular exercise, weight lifting or control. Six weeks later, they would be photographed again.

Their heads would be blocked out of the photos, which would be shuffled. Then the subjects and judges would rate the body in each photo on a scale of 1 to 10, with 10 being spectacular.

The volunteers were men, age 18 to 40 (the university’s human-subjects review board looked askance at having women photographed and rated like that). And they were sedentary. “These were people who were just sort of dumplings,” Dr. Foster said.

Results were not surprising. The subjects rated themselves more highly than anyone else rated them, and female panelists rated the subjects lower than the male subjects or panelists rated them. But, over all, the subjects’ ratings barely changed, if at all, after their exercise program. And neither did objective measures, like weight or percentage of body fat, or waist size or the size of the bicep or thigh.

Exercise physiologists approach the whole new year, new you, total body transformation mania with a jaundiced eye. Yes, they said, people can change the way they look. But not overnight.

“I think it’s pretty clear,” said William Kraemer, a kinesiology professor at the University of Connecticut. Often the promises are just marketing, he said. “A lot of times when you are dealing with health clubs, they are trying to get new members who have made New Year’s resolutions.”

“To make a change in how you look, you are talking about a significant period of training,” Dr. Kraemer said. “In our studies it takes six months to a year.” And, he added, that is with regular strength-training workouts, using the appropriate weights and with a carefully designed individualized program. “That is what the reality is,” he said.

And genetic differences among individuals mean some people respond much better to exercise than others, said Dr. Mark Tarnopolsky, an exercise researcher at McMaster University in Hamilton, Ontario. He added that although he does not think the before-and-after photos in ads are doctored, most people will not change so markedly no matter how hard or long they work. “I believe they are taking the top one or two people out of thousands,” Dr. Tarnopolsky said.

People who did change their bodies say six months is a bare minimum to see real change.

Schuyler Antane, 43, a research scientist, is one. He began in January 2006 with a diet, which meant, he said, “letting go of the foods that taste good, but are wicked evil. And no more beer.”

In three months, he had lost 10 pounds and was down to 190 pounds on his 5-foot-8-inch frame. Then he read a magazine article on 5-kilometer races and decided to try to run. He could run for only five minutes when he started, and it took two months to train for his first race. But he kept at it and improved. Within six months, he weighed about 150 pounds. Then he added bicycling and swimming, becoming a triathlete. That, he said, got him to his fighting weight of 140 to 145 pounds.

“My beer belly is long gone,” he said. “The only flab in my midsection is excess skin, but I am not vain enough to have an operation.”

Now, said Mr. Antane, who runs with a group in Princeton on Thursday nights, “everything changed — my outlook on life, who I hung out with, how I felt about myself.”

Jim Lisowski, 45, the owner and chief executive of SciTec, a research and development company in Montgomery, N.J., said he had let himself slip out of shape, going from 189 pounds to 225 pounds. He is 5-foot-10 1/2. Then his wife bought a joint membership at a gym within walking distance of his office. At first, he went sporadically, but he decided to get serious after about three years.

That was the end of February 2005. By the start of 2006, Mr. Lisowski, who goes to one of my gyms and whose company employs one of my best friends, was a changed man. He weighed 184 pounds and had a muscular, utterly transformed body. He did it with a routine he continues to this day — working out five or six days a week with more than an hour of hard cardio, first on an elliptical cross-trainer and then a rowing machine followed by lifting weights for about an hour.

“My approach was to get fit,” Mr. Lisowski said. “I knew I would lose weight.”

The nine months or so that it took to lose the weight and gain strength and endurance seemed fast to him. He attributes it to the fact that he had been fit before he let himself go, and to his attitude.

“You can go to a gym and spend time there and not make changes,” he said. “You’ve got to break a sweat, you have to increase the weights. You’ve got to challenge yourself.”

Then there’s Charles Reilly, a federal prosecutor in Manhattan and a marathon runner who took a 10-year hiatus from the sport when he joined his local school board. He just did not have time to exercise, he said. Along with exercising less, he ate more. Soon he ballooned from 159 pounds to 282. “It came on gradually, but it came on,” Mr. Reilly said of the weight.

On April 18, 2005, he had his last school board meeting — he’d decided not to run for any more terms. Eight days later, he went out for a run.

“After half a mile, I had to stop and walk,” Mr. Reilly said. But he kept trying. A month later, he could run three miles without stopping. After three or four months, he says, he could run for five miles. By the end of 2006, he ran 10 miles. In the meantime, he also changed his diet. “My goal was to lose 100 pounds,” Mr. Reilly said. He did it, hitting his goal on Feb. 3, 2007, in a little over 21 months.

Mr. Reilly continues to run and has maintained his lower weight. Many who knew him when he was on the school board no longer recognize him, he said. “They do a double take and say, ‘Is that you?’ ”

But, Mr. Reilly said, he never believed those ads saying you can transform yourself almost overnight.

“It’s not really possible,” he said.

Overnight Success-Not !

http://www.nytimes.com/2009/01/22/health/nutrition/22best

Sunday, January 11, 2009

Healthy Joints

January 11, 2009

ShouId I Take Glucosamine and Chondroitin Sulfate?

I

get asked this question a lot. If you have osteoarthritis, you might have heard about these two supplements: Glucosamine and Chondroitin Sulfate. If you've read or listened to any of the mainstream media, you've probably also have heard that neither of these supplements are effective for people with osteoarthritis.

The media latched onto an article published in Arthritis & Rheumatismin 2008 and declared that the supplements were ineffective even though the lead author, Allen Sawitzke, said that the study had significant limitations, like a small sample size, and that the study couldn't determine whether glucosamine and chondroitin are effective for patients with arthritis. Sawitzke also admitted that the study needed a better method for measuring the joint space. Some critics have argued that the method used was not sensitive enough to detect meaningful change.

Here's my suggestion. Chondroitin Sulfate is a disease modifying agent for osteoarthritis. It slows the progression of the disease and deterioration of the joint cartilage. If you have osteoarthritis and have clearance from your doctor (people who have diabetes, are allergic to shellfish or take blood thinners need to visit with their doctor first), you should be taking at least 800 mg of Chondroitin Sulfate for at least two years. This is how long it takes for the supplement to slow the deterioration of the cartilage and the disease modifying effects are independent of symptoms. So, take it even if you feel fine.

DK

**
Stephan Reichenbach, Rebekka Sterchi, Martin Scherer, Sven Trelle, Elizabeth Bürgi, Ulrich Bürgi, Paul A. Dieppe, and Peter Jüni Meta-analysis: Chondroitin for Osteoarthritis of the Knee or Hip
Ann Intern Med 2007; 146: 580-590

Michel BA, Stucki G, Frey D, et al. Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: a randomized, controlled trial. Arthritis Rheum 2005 Mar;52(3):779-86

What is alternative?

Alternative Medicine is Mainstream Medicine

Deepak Chopra - January 09, 2009

Co-authored by Dean Ornish, Rustum Roy and Andrew Weil
 
In mid-February, the Institute of Medicine of the National Academy of Sciences and the Bravewell Collaborative are convening a "Summit on Integrative Medicine and the Health of the Public."This is a watershed in the evolution of integrative medicine, a holistic approach to health care that uses the best of conventional and alternative therapies such as meditation, yoga, acupuncture and herbal remedies. Many of these therapies are now scientifically documented to be not only medically effective but also cost effective.
 
President-elect Barack Obama and former Sen. Tom Daschle (the nominee for Secretary of Health and Human Services) understand that if we want to make affordable health care available to the 45 million Americans who do not have health insurance, then we need to address the fundamental causes of health and illness, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery.
 
Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle. As Mr. Obama states in his health plan, unveiled during his campaign: "This nation is facing a true epidemic of chronic disease. An increasing number of Americans are suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not prevented entirely."
The latest scientific studies show that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. These studies show that integrative medicine can make a powerful difference in our health and well-being, how quickly these changes may occur, and how dynamic these mechanisms can be.
 
Many people tend to think of breakthroughs in medicine as a new drug, laser or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle -- what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support -- can be as powerful as drugs and surgery. But they often are. And in many instances, they're even more powerful.
 
These studies often used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. Integrative medicine approaches such as plant-based diets, yoga, meditation, and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia, and other chronic conditions.
 
A recent study published in the Proceedings of the National Academy of Sciences found that these approaches may even change gene expressionin hundreds of genes in only a few months. Genes associated with cancer, heart disease, and inflammation were downregulated or "turned off" whereas protective genes were upregulated or "turned on." A study published in The Lancet Oncology reported that these changes increase telomerase, the enzyme that lengthens telomeres, the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this.
 
Our "health-care system" is primarily a disease-care system. Last year, $2.1 trillion were spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases such as heart disease and diabetes that are preventable or even reversible.
The choices are especially clear in cardiology. In 2006, for example, according to data provided by the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion. In other words, Americans spent more than $100 billion in 2006 for these two procedures alone.

Despite these costs, a randomized controlled trial published in April 2007 in The New England Journal of Medicine found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., 95% of those who receive them). Coronary bypass surgery prolongs life in less than 3% of patients who receive it. So, Medicare and other insurers and individuals pay billions for surgical procedures like angioplasty and bypass surgery that are usually dangerous, invasive, expensive, and largely ineffective. Yet they pay very little -- if any money at all -- for integrative medicine approaches that have been proven to reverse and prevent most chronic diseases that account for at least 75% of health-care costs. The INTERHEART study, published in September 2004 in The Lancet, followed 30,000 men and women on six continents and found that changing lifestyle could prevent at least 90% of all heart disease.
 
That bears repeating: The disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable simply by changing diet and lifestyle. And the same lifestyle changes that can prevent or even reverse heart disease also help prevent or reverse many other chronic diseases as well. Chronic pain is one of the major sources of worker's compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong. Herbs usually have far fewer side effects than pharmaceuticals.
 
Joy, pleasure, and freedom are sustainable, deprivation and austerity are not. When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain may grow so many new neurons that it could get measurably bigger in only a few months. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- similar to the way that circulation-increasing drugs like Viagra work. For many people, these are choices worth making -- not just to live longer, but also to live better.
 
It's time to move past the debate of alternative medicine versus traditional medicine, and to focus on what works, what doesn't, for whom, and under which circumstances. It will take serious government funding to find out, but these findings may help reduce costs and increase health.
 
Integrative medicine approaches bring together those in red states and blue states, liberals and conservatives, Democrats and Republicans, because these are human issues. They are both medically effective and, important in our current economic climate, cost effective. These approaches emphasize both personal responsibility and the opportunity to make affordable, quality health care available to those who most need it. Mr. Obama should make them an integral part of his health plan as soon as possible.
 
Dr. Chopra, the author of more than 50 books on the mind, body and spirit, is guest faculty at Beth Israel Hospital/Harvard Medical School. Dean Ornish, M.D., is Clinical Professor of Medicine at the University of California, San Francisco. His most recent book is The Spectrum (Random House, 2007). Mr. Roy is a professor at Penn State and Arizona State University. Dr. Weil is director of the University of Arizona Center for Integrative Medicine.