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Don't let pain, fatigue keep you from walking   Daily Herald 3/24/08

We'll bet our pedometers: If you asked your doctor to write one prescription that could boost your health, ward off disease, and keep you trim and upbeat, the Rx would be walking.

Unfortunately, some side effects of aging -- joint and back pain, foot problems, fatigue, and poor balance -- make many women chuck their sneakers just when exercise could do them the most good.

Don't give up, says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston.

"There are very few women who can't overcome these obstacles," she said.

In fact, she says, most women can stick with a walking program for a lifetime. Whether you're starting out or ramping up, or just want to maintain your pace for the long haul, here's how to walk past any roadblock.

1. Ease back and knee pain

When you're aching from arthritis, an injury, or everyday wear and tear, it's easy to let your workout slide, but walking has been proven to reduce all these pains, says Dr. Roger Chou, a professor at Oregon Health and Science University who recently co-authored new medication guidelines for lower-back pain for the American College of Physicians.

If your joints are really complaining, it helps to shed extra weight. A Danish review of studies concluded that overweight patients who lost at least 5 percent of their body mass experienced significant symptom relief.

To feel better instantly during your walks, try slowing your pace. Researchers at the University of Colorado found that obese walkers cut the stress on their knees by 45 percent by downshifting from 3 mph to 2 mph. And as long as you cover the same distance, you'll actually burn slightly more calories because you're exercising for a longer period of time.

2. Strengthen key muscles

Adding moves such as squats and leg extensions to your routine two or three times a week will work the quadriceps, the muscles on the fronts of the thighs that support the knees. Do one or two sets of 10 to 15 repetitions.

Also make sure to include gentler movements: "Slow, controlled activities with some twisting or sideways movement -- like yoga and tai chi -- can improve knee function and reduce pain," says Katherine S. Rudolph, Ph.D., of the University of Delaware. A couple of times a week, pop in a yoga or tai chi DVD.

3. Move through moderate back pain

If it's your back that's keeping you sidelined, remember this: Studies show that you'll heal faster if you stay active.

"It might hurt a bit while exercising, but you won't do permanent damage -- and you'll recover faster," says Chou.

Keeping your back strong may prevent muscle spasms and tightness, experts say. What's more, you might also find yourself coping better psychologically.

"If you learn that you can function despite having some pain, you'll be less likely to limit your activities," he says.

4. Banish fatigue

For years, research has shown a link between regular exercise and decreased fatigue. A recent University of Georgia analysis of 70 studies confirms that working out boosts energy levels by about 20 percent. The lift may come when exercise triggers the release of dopamine, a "feel-good" mood-regulating neuroïtransmitter, says Patrick O'Connor, a professor of kinesiology at the University of Georgia.

Lace up your shoes and log 20 minutes or more of walking at least twice a week, and you'll feel more charged up in as little as four weeks.

5. Fight foot ailments

Up to 7 million Americans suffer from plantar fasciitis, a condition in which the tissue connecting the heel bone to the toes becomes inflamed. It's common in active people, particularly in middle age, when the ligaments in the foot get more slack, putting pressure on the arch. It may start as a mild pain that feels like a bruise under the heel, and it often becomes severe.

Try this stretch: Sit in a chair with one leg crossed over the other. Take hold of top foot and pull toes back toward shin to stretch arch. Hold to a count of 10; repeat 10 times. Do this stretch first thing in the morning, plus two or three more times each day.

A study from the University of Rochester School of Medicine found that 94 percent of patients who did the stretch felt a significant decrease in pain and some reported being completely pain free.

6. Strengthen legs

Strong legs can prevent a trip from becoming a nasty fall. In one study, volunteers who did a 16-week resistance-training program of knee extensions, leg presses, and calf raises improved their overall leg strength by 7 percent -- the group who did no strength work experienced an 8 percent drop -- and recovered from tripping 20 percent more often. A few times a week, break up your walk with a few calf raises and step-ups on a curb.


A little exercise can do your bones good   Daily Herald 3/24/08

For older adults, falling down is a big deal. It's the biggest risk factor for a fracture, which -- particularly when it's in the hip -- can be exceedingly dangerous.

The one-year mortality rate after a hip fracture is as high as 25 percent. So, argue researchers in a recent analysis published in the medical journal BMJ, preventing deadly breaks should include preventing falls, not just treating osteoporosis with drugs.

Falls happen for many reasons, and studies have suggested that cutting back on medications that may cause dizziness, supplementing with vitamin D and calcium (to build stronger bones), and making sure the home is safe all have their roles to play.

But once you've tackled the tripping hazards and railing-less staircases, there's no getting around it -- exercise is called for, a program of regular strength and balance training as well as a cardiovascular routine to build endurance.

For the do-it-yourselfers, the U.S. Centers for Disease Control and Prevention has a general strength-training program for older adults on its Web site (cdc.gov/nccdphp/dnpa/physical/growing_stronger/exercises/index.htm).

You may want to start out by focusing on a smaller set of key exercises that work the lower body and are thus aimed specifically at preventing falls, suggests Anne Shumway-Cook, a professor in the department of rehabilitation medicine at the University of Washington. Here are some recommended exercises:

• One can be done at the kitchen sink: Rise on your toes, then lower your heels to the ground, and then rock back on your heels and lift your toes before lowering again. She also recommends front and side kicks to work the hip.

• Another is to sit down, then lift and straighten alternating legs.

• Finally, try easing into and out of a sitting position without using your hands. Most people could benefit from ankle or leg weights to increase the resistance, she says.

• For balance, you can begin with something as simple as standing on both feet and focusing on a point on the wall, trying not to move your body to keep steady, says Joseph Scott, an athletic trainer who is outpatient team leader for orthopedics at Southcoast Hospital Group and Rehabilitation Services, North Dartmouth, Massachusetts.

That can progress to doing the same thing for 30 seconds with closed eyes, then balancing on one foot for 30 seconds, first with eyes open, then with them closed.

Taking up exercise doesn't mean you should ignore other precautions; sometimes a simple change in footwear or making sure electrical cords are out of the way can cut the odds of falling, says Scott. And in some cases, drugs may be appropriate.




Yes, Running Can Make You High


Filip Kwiatkowski for The New York Times




By GINA KOLATA

Published: March 27, 2008

THE runner’s high: Every athlete has heard of it, most seem to believe in it and many say they have experienced it. But for years scientists have reserved judgment because no rigorous test confirmed its existence.

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Yes, some people reported that they felt so good when they exercised that it was as if they had taken mood-altering drugs. But was that feeling real or just a delusion? And even if it was real, what was the feeling supposed to be, and what caused it?

Some who said they had experienced a runner’s high said it was uncommon. They might feel relaxed or at peace after exercising, but only occasionally did they feel euphoric. Was the calmness itself a runner’s high?

Often, those who said they experienced an intense euphoria reported that it came after an endurance event.

My friend Marian Westley said her runner’s high came at the end of a marathon, and it was paired with such volatile emotions that the sight of a puppy had the power to make her weep.

Others said they experienced a high when pushing themselves almost to the point of collapse in a short, intense effort, such as running a five-kilometer race.

But then there are those like my friend Annie Hiniker, who says that when she finishes a 5-k race, the last thing she feels is euphoric. “I feel like I want to throw up,” she said.

The runner’s-high hypothesis proposed that there were real biochemical effects of exercise on the brain. Chemicals were released that could change an athlete’s mood, and those chemicals were endorphins, the brain’s naturally occurring opiates. Running was not the only way to get the feeling; it could also occur with most intense or endurance exercise.

The problem with the hypothesis was that it was not feasible to do a spinal tap before and after someone exercised to look for a flood of endorphins in the brain. Researchers could detect endorphins in people’s blood after a run, but those endorphins were part of the body’s stress response and could not travel from the blood to the brain. They were not responsible for elevating one’s mood. So for more than 30 years, the runner’s high remained an unproved hypothesis.

But now medical technology has caught up with exercise lore. Researchers in Germany, using advances in neuroscience, report in the current issue of the journal Cerebral Cortex that the folk belief is true: Running does elicit a flood of endorphins in the brain. The endorphins are associated with mood changes, and the more endorphins a runner’s body pumps out, the greater the effect.

Leading endorphin researchers not associated with the study said they accepted its findings.

“Impressive,” said Dr. Solomon Snyder, a neuroscience professor at Johns Hopkins and a discoverer of endorphins in the 1970’s.

“I like it,” said Huda Akil, a professor of neurosciences at the University of Michigan. “This is the first time someone took this head on. It wasn’t that the idea was not the right idea. It was that the evidence was not there.”

For athletes, the study offers a sort of vindication that runner’s high is not just a New Agey excuse for their claims of feeling good after a hard workout.

For athletes and nonathletes alike, the results are opening a new chapter in exercise science. They show that it is possible to define and measure the runner’s high and that it should be possible to figure out what brings it on. They even offer hope for those who do not enjoy exercise but do it anyway. These exercisers might learn techniques to elicit a feeling that makes working out positively addictive.

The lead researcher for the new study, Dr. Henning Boecker of the University of Bonn, said he got the idea of testing the endorphin hypothesis when he realized that methods he and others were using to study pain were directly applicable.

The idea was to use PET scans combined with recently available chemicals that reveal endorphins in the brain, to compare runners’ brains before and after a long run. If the scans showed that endorphins were being produced and were attaching themselves to areas of the brain involved with mood, that would be direct evidence for the endorphin hypothesis. And if the runners, who were not told what the study was looking for, also reported mood changes whose intensity correlated with the amount of endorphins produced, that would be another clincher for the argument.

Dr. Boecker and colleagues recruited 10 distance runners and told them they were studying opioid receptors in the brain. But the runners did not realize that the investigators were studying the release of endorphins and the runner’s high. The athletes had a PET scan before and after a two-hour run. They also took a standard psychological test that indicated their mood before and after running.

The data showed that, indeed, endorphins were produced during running and were attaching themselves to areas of the brain associated with emotions, in particular the limbic and prefrontal areas.

The limbic and prefrontal areas, Dr. Boecker said, are activated when people are involved in romantic love affairs or, he said, “when you hear music that gives you a chill of euphoria, like Rachmaninoff’s Piano Concerto No. 3.” The greater the euphoria the runners reported, the more endorphins in their brain.

“Some people have these really extreme experiences with very long or intensive training,” said Dr. Boecker, a casual runner and cyclist, who said he feels completely relaxed and his head is clearer after a run.

That was also what happened to the study subjects, he said: “You could really see the difference after two hours of running. You could see it in their faces.”

In a follow-up study, Dr. Boecker is investigating if running affects pain perception. “There are studies that showed enhanced pain tolerance in runners,” he said. “You have to give higher pain stimuli before they say, ‘O.K., this hurts.’ ”

And, he said, there are stories of runners who had stress fractures, even heart attacks, and kept on running.

Dr. Boecker and his colleagues have recruited 20 marathon runners and a similar number of nonathletes and are studying the perception of pain after a run, and whether there are related changes in brain scans. He is also having the subjects walk to see whether the effects, if any, are because of the intensity of the exercise.

The nonathletes can help investigators assess whether untrained people experience the same effects. Maybe one reason some people love intense exercise and others do not is that some respond with a runner’s high or changed pain perception.

Annie might question that. She loves to run, but wonders why. But her husband tells her that the look on her face when she is running is just blissful. So maybe even she gets a runner’s high.