Your Brain on Exercise-Critical!

The information provided is adapted from “Alzheimer’s Disease Prevention and Intervention,” a Medical Fitness Specialist Certificate Program authored by Alzheimer’s Research and Prevention Foundation (ARPF) and produced by Fitness Learning Systems.
June M. Chewning MA, BS, AEA

Dementia is a syndrome characterized by a chronic deterioration relating to memory, thinking, behavior, and the ability to perform activities of daily living. Consciousness, however, is not affected. Dementia is not a normal part of aging. The cause may be related to a variety of diseases and injuries that may have affected the brain. The most common form of dementia is Alzheimer’s disease (AD).
There are 47.5 million people suffering from dementia worldwide, with 7.7 million new cases each year. The most common cause of dementia, Alzheimer’s disease, makes up 60-70% of cases. (Dementia 2016) Millions of Americans are challenged by Alzheimer’s disease and other forms of dementia. In 2016, an estimated 5.4 million Americans of various ages are diagnosed with Alzheimer’s disease, and approximately 5.2 million of those are ages 65 and older. (Alzheimer’s Disease Facts and Figures 2016)
Although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging. It is important to take a proactive role in retaining the strength, resiliency, and vitality of the brain. Research has shown that just as the body needs strength-building exercises to maintain muscle strength, so does the brain.
Physical exercise is identified through recent research as one of the key elements in the ARPF 4 Pillars of Prevention™.  “Although at this time, medications have no proven neuroprotective effect on dementia, an evolving literature documents significant benefit of long-term regular exercise on cognition, dementia risk, and perhaps dementia progression.” (Ahlskog 2011 metanalysis)  Many studies suggest that exercise reduces the effects of dementing neurodegenerative mechanisms.
At this time, research significantly indicates that exercise is associated with a reduced risk of cognitive impairment and dementia. This appears to happen in two ways: (Ahlskog 2011)

  1. A convergence of evidence from both animal and human studies indicate that aerobic exercise seems to reduce the risk of degeneration of brain processes and seems to protect the brain from biological and neurological decline.
  2. The cardiovascular benefits of aerobic exercise reduce vascular risk improving cerebrovascular (carotid and brain artery) health, reducing plaque build-up, and maintaining better circulation to the brain.

As health-fitness professionals, we are in a position more than ever to help people with making healthy lifestyle choices and with maintaining quality of life.  Exercise is critical to the biological and neurological health of the brain and vascular system that feeds the brain.  Learn more about ways to prevent cognitive decline to help your clients live a long, healthy life with vigor and clarity.

Bibliography:
Alzheimer’s Research and Prevention Foundation. (2016) Alzheimer’s Disease Prevention and Intervention Medical Fitness Specialist Program. FitnessLearningSystems.com. 888.221.1612.
Ahlskog, J. Eric, Yonas E. Geda, Neill R. Graff-Radford, and Ronald C. Petersen. “Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging.” Mayo Clinic. Proceedings 86.9 (2011): 876-84. Web.

Alzheimer’s Disease is now the 6th leading cause of death in the U.S. All health-fitness professionals are called to stem this epidemic with prevention and intervention. Get educated and get on board!
Alzheimer’s Disease Prevention and Intervention Medical Fitness Specialist Program. www.FitnessLearningSystems.com. 888.221.1612.

 

Scapulohumeral Rhythm

By: Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS

The shoulder is one of the most vulnerable joints in the body due to its vast range of motion and complexity. It is a complex ball and socket joint, uniquely comprised of various connective tissue, supporting structures, including muscles. It is an important joint because functionally, it is involved in most daily and sport activities, such as reaching, lifting, carrying and throwing a ball. Knowledge of the biomechanics of the shoulder can help you with training and aiding in rehabilitation of the shoulder and related injuries.

The shoulder complex involves coordinated movements between the humerus bone and the scapula. The scapula, clavicle, and humerus serve as attachments for most of the muscles in the shoulder. The shoulder is comprised of four primary joints:

  • Glenohumeral joint (GH)
  • Acromioclavicular joint (AC)
  • Sternoclavicular joint (SC)
  • Scapulothoracic joint

 

 

 

Scapulohumeral Rhythm (SHR) is defined as the movement relationship between the humerus and the scapula during both shoulder flexion and shoulder abduction. Arthrokinematics is the movement that takes place between articular surfaces in a joint.

For example, during abduction of the arm at the shoulder (side arm raise) the following happens (See Figure):

  • The glenohumeral joint (concave) is stable (depicted by the vertical arrow), while the humerus (convex) abducts (depicted by the horizontal arrow).
  • There is a sliding down or glide of the convex humerus on the concave glenohumeral joint.
  • The scapula rotates upward (bottom of the scapula moves laterally and upward).

 

During shoulder abduction, there is 120 degrees of movement that occurs at the glenohumeral joint, while 60 degrees occurs at the scapulothoracic joint, creating a 2 to 1 ratio (2:1). This movement is known as the scapulohumeral rhythm (SHR) of shoulder abduction. The same SHR occurs both during shoulder flexion and shoulder abduction. (See Figure)

The muscle actions that occur when you abduct the arm at the shoulder include: (See Figure)

  • Biomechanically, the supraspinatus muscle raises the arm during the first
    15 degrees of shoulder abduction.
  • Then, from 15-90 degrees of shoulder abduction, the medial deltoid assists to raise the arm biomechanically.
  • There are several muscles within the shoulder that play important roles, specifically at the rotator cuff. The rotator cuff is comprised of four primary muscles known as the S.I.T.S muscles. These muscles include the supraspinatus, infraspinatus, teres minor and subscapularis which pull the bone in different directions due to different attachment points and angle of pull.
  • A force couple can be defined as a pair of muscle forces that act together on a joint to produce rotation. These forces may exert pulls in opposite directions. Force couples may be synergistic pairs or agonist/antagonist pairs of muscles.  In the Figure shown, a force couple occurs between the low trapezius and serratus anterior. During shoulder abduction, the lower trapezius and serratus anterior work together to anterior upwardly rotate the scapula on the thorax.

 

Abnormal scapulohumeral rhythm is a dysfunction that occurs within the scapulothoracic junction.  There are many causes for this including:

  • A rotator cuff tear where the individual does not have the musculotendinous connection and strength to abduct the arm.
  • Limitations due to joint and capsule hypomobility (restriction) known as adhesive capsulitis (frozen shoulder).
  • Pain and/or muscular weakness that prevent the ability to raise the arm to the side.
  • Occurrence of excessive upper trapezius and scapular elevation which becomes a means of compensation, and provides the individual with an alternative ability to abduct the arm.

Why is this important?

  • Connective tissue (muscles, tendons, ligaments, and fascia) are supposed to move. Joints, as well, have a certain amount of movement and should glide and translate with everyday movement.
  • Muscle imbalances and tightness create dysfunction. If a muscle does not have adequate muscle length to concentrically and eccentrically contract, compensation will occur typically above and below a joint.
  • If this tightness continues, it will result in trigger points. Trigger points are where a muscle shortens and, in essence, has increased sensitivity affecting the muscle’s ability to completely move as it was designed. If trigger points become bigger and more prominent, they can compress the nerve that innervates the respective muscle creating radicular (fuzzy feeling, numbness, or tingling) symptoms.

If the scapula is not able to properly upwardly rotate on the thorax, an individual will compensate using other muscles to perform the work. This compensation will lead to muscle imbalance, pain, and dysfunction affecting activities of daily living and sports movements.

For more information about working with clients with shoulder issues, see the Fitness Learning Systems Human Movement Matrix: Shoulder continuing education course by Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS of Pinnacle Training & Consulting Systems.  www.pinnacle-tcs.com “Teaching The Science Behind The Movement.” Fitness Learning Systems is an IACET accredited continuing education provider.

Alzheimer’s Disease Part 3

Exercise and Alzheimer’s Disease
Adapted from the Medical Fitness Specialist Certificate Program by Alzheimer’s Research and Prevention Foundation: Alzheimer’s Disease Prevention and Intervention.
(Article 3 in a 3-part series about Alzheimer’s disease.)

In the first article in this series, it was noted that:

  • although there are natural physiological changes that occur with age, memory loss is neither normal nor a natural process of aging.
  • there is no medication at this time that cures fatal Alzheimer’s disease, so prevention is the best line of defense against the disease.
  • exercise plays a very important role in prevention of cognitive decline and brain health.

In the second article, prevention for cognitive decline and Alzheimer’s was discussed with The 4 Pillars of Prevention, a program researched and developed by the Alzheimer’s Research and Prevention Foundation.

This article will look at evidence-based information about the role of exercise in prevention and intervention of Alzheimer’s disease and cognitive impairment.

There are now dozens of research studies that look at the effect of exercise for prevention and intervention for cognitive decline and the risk for developing Alzheimer’s. The evidence supporting exercise continues to grow, as more studies are conducted. Exercise continues to prove to be an important therapeutic strategy for prevention of cognitive decline and Alzheimer’s.

“Although at this time, medications have no proven neuroprotective effect on dementia, an evolving literature documents significant benefit of long-term regular exercise on cognition, dementia risk, and perhaps dementia progression.” (Ahlskog 2011 metanalysis) Many studies suggest that exercise reduces the effects of dementing neurodegenerative mechanisms.

Currently, research significantly indicates that exercise is associated with a reduced risk of cognitive impairment and dementia. This appears to happen in two ways: (Ahlskog 2011)

  1. A convergence of evidence from both animal and human studies indicate that aerobic exercise seems to reduce the risk of degeneration of brain processes and seems to protect the brain from biological and neurological decline.
  2. The cardiovascular benefits of aerobic exercise reduce vascular risk improving cerebrovascular (carotid and brain artery) health, reducing plaque build-up, and maintaining better circulation to the brain.

There are several types and doses of exercise being researched in association with brain function in order to determine the type and dose of exercise that produces beneficial results. Moderate physical activity was reported in many studies to improve brain function. Moderate exercise was quantified in different ways including:

  • the number of blocks walked over 1 week. Walking 72 blocks/ week was necessary to detect beneficial increased gray matter.(Erickson 2010)
  • working at a duration of 40 minutes in a target heart rate zone of 50-60% for the first 7 weeks and then 60-75% for the remainder of the program determined by Karvonen method provided beneficial brain and memory changes. (Erickson 2015)
  • moderate exercise 30 minutes per day for at least 5 days per week showed less accumulation of “beta amyloid plaque” (proteins that build up on brain with Alzheimer’s Disease), less shrinkage of the hippocampus, and less reduction in use of glucose in the brain. They also had fewer neurofibrillary tangles (twisted fibers inside brain cells) and did better on memory tests. (Bernstein 2014 review)
  • current levels of Recommended Physical Activity (RPA). Subjects wore an accelerometer and were categorized as having met physical activity recommendations or not based on the US Department of Health and Human Services recommendations of 150 minutes of moderate-to-vigorous physical activity per week. (Dougherty 2016)
  • sedentary lifestyle (<5 hours activity per week) was significantly associated with more than double the risk for dementia. A physically active status was determined as 5 hr/wk or more of light activity and at least occasional moderate to vigorous activity. (Norton 2012)

Other types of physical activity such as resistance training, moderate intensity cycling, and strenuous activity are being studied to determine their value in maintaining cognitive function in aging. In particular, the dose-response relationship is being explored. If minimum physical activity requirements are found to be neuroprotective, investigation continues to see if higher doses of exercise training are more beneficial. At this time, mixed results have been found.

A clear dose-response relationship exists between exercise and cardiorespiratory fitness. Cardiorespiratory fitness is an indicator for brain health. Adherence to more strenuous exercise programs may be problematic for many older adults. (Vidoni 2015) Health-fitness professionals need to work with clients of all ages, carefully balancing fitness gains and intensity/volume with program adherence.

The ultimate goal for quality of life and good health is not realized if your client does not build healthy exercise behaviors to adhere to exercise long term, at least at minimal physical activity requirements. It is important for the general public, and especially the older adult population, to be properly informed of the benefit to risk relationship for the exercises they choose, and most importantly, for those which they can tolerate and adhere long term.

When looking at the research, it is very difficult to say that exercise is not beneficial to brain health. In fact, it appears to be critical to brain health. Research substantially supports that the currently accepted minimum physical activity requirements are neuroprotective. This gives health-fitness professionals a good starting point from which to build programs with clear minimum requirements.

At this time, other intensities and types of exercise are being researched in relation to brain health. As fitness as medicine continues to evolve and develop, it is imperative for health-fitness professionals to consider all aspects of exercise behavior including exercise tolerance and adherence. The art of exercise prescription is creating and fostering long term adherence for good health through the life span.

For more information about Prevention of cognitive decline and dementia, visit the ARPF website at www.alzheimersprevention.org.

The information in this article is taken from the arpf_seal_of_approval_color“Exercise Prescription for Alzheimer’s Prevention and Intervention” course, the second course in a two-course 11 hour Medical Fitness Specialist Certificate Program: Alzheimer’s Disease Prevention and Intervention.

Alzheimer’s Disease Prevention and Intervention Medical Fitness Specialist Certificateunprecedented-logos

Restore the Core – Step 5 Progress Your Planks

 

By:  Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:
Restore the Core: Integrated Core Training for Real World Function.  See the full course for additional core assessments with video, and several core exercises and progressions with videos.
Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.

 

Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace.

Step 5: Progress Your Planks

After the re-establishment of breathing patterns and the ability to actively brace the abdominals in supine position (lying on the back), progress to more advanced exercises such as planks.

The key to a plank is to first find a neutral spine position while remaining on all fours. From there, raise into a plank position while maintaining the brace and neutral spine position.  A dowel rod or broom stick can be placed on the client’s back to teach the back to stay in position while the stomach can be poked at various angles to ensure the client is maintaining the abdominal brace.

Beginning as a static hold, the plank is utilized to build isometric endurance while teaching the torso to resist movement. Once this exercise can be held statically for time, it can be progressed by moving the arms and legs while maintaining a stable torso.

See Sample Video for Plank Progressions:

About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.

As a fitness speaker, Chris has authored numerous seminars and workshops focusing on back pain and restorative core training along with a variety of related topics. He holds fitness certifications from the National Academy of Sports Medicine and the National Strength and Conditioning Association. Chris received a bachelor’s degree in communications from St. Johns University in Queens, New York, and a master’s degree in journalism with a specialization in health and science from Columbia University in New York City.

An experienced health writer, Chris has also written extensively on fitness, healthcare, and nutrition. His writing has appeared in numerous publications including Exercise for Men, Prevention, Health, and the Boston Globe.

Copyright Fitness Learning Systems Inc. 2016

Restore the Core – Step 4 Free Standing Strength Training

By:  Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:
Restore the Core: Integrated Core Training for Real World Function.  See the full course for additional core assessments with video, and several core exercises and progressions with videos.
Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.

Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace.

Step 4: Free Standing Strength Training

Though weight lifting is traditionally viewed as an opportunity to strengthen the limbs, the truth is that any free standing exercise can also be seen as core training by simply initiating an abdominal brace during the activity. Certain exercises can be modified to increase the stabilization requirements in specific directions.

These include:

Anti-rotation Exercises:
Exercises which involve pressing, pulling or carrying weight on one side of the body forcing muscles of the core to prevent rotation or lateral flexion of the torso.Anti-extension Exercises:
Exercises which involve pressing overhead, rowing against gravity or pushing up against gravity forcing the core to prevent excess extension of the torso or arching of the back.

Including these exercises in your training program allows you to mimic situations for your client which increase stability demands such as carrying a briefcase and lifting items overhead.

See Sample Video for Example Standing Strength Training Exercise:

About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.

As a fitness speaker, Chris has authored numerous seminars and workshops focusing on back pain and restorative core training along with a variety of related topics. He holds fitness certifications from the National Academy of Sports Medicine and the National Strength and Conditioning Association. Chris received a bachelor’s degree in communications from St. Johns University in Queens, New York, and a master’s degree in journalism with a specialization in health and science from Columbia University in New York City.

An experienced health writer, Chris has also written extensively on fitness, healthcare, and nutrition. His writing has appeared in numerous publications including Exercise for Men, Prevention, Health, and the Boston Globe.

Copyright Fitness Learning Systems Inc. 2016

Restore the Core – Step 3 Mobilize the Hips

 

By:  Chris Kelly CSCS (NSCA), CES, PES (NASM)

This information is from Chris Kelly’s eLearning continuing education course:
Restore the Core: Integrated Core Training for Real World Function.  See the full course for additional core assessments with video, and several core exercises and progressions with videos.
Part 2 of the Core Series is Core Complete Training: A Systematic Approach for Aesthetic Core Development by Chris Kelly.

 

Five Step Process for Restoring the Core
Much like a weight belt, the abdominals tighten around the spine to provide support during exercise or daily tasks such as bending over and rotating. Contracting the abs in this fashion is known as an abdominal brace.

Step 3: Mobilize the Hips

In looking at the body as an integrated unit, consider that certain joints are built to move while others require stability. While the goal of bracing is to tone the muscles around the spine to decrease or prevent motion of the torso, we want to gain movement at the hips (the joints directly above and below the lumbar spine) and thoracic spine to allow normal movement to occur.   This task can be accomplished through mobility drills for the hips and thoracic spine while maintaining an abdominal brace in various standing positions.

Because new clients often lack knowledge of coordinated movements, the phase one series begins against a wall. Pressing in to the wall allows the client to balance while pressing in to the wall to maintain abdominal bracing and normal breathing.

Exercises in this phase are simple in nature and intended to mobilize the hips and t-spine in multiple planes of motion. As the client gains proficiency in both bracing and movement, move off the wall for phase two progression by engaging in more complex and integrated movements. For each phase, perform each drill back to back once for 10 reps or 20-30 seconds each.

See Sample Video for Hip Mobilization:

 

About the Author
Chris Kelly is an experienced fitness journalist, speaker, and strength coach. With over ten years in the fitness industry, Chris’s experience spans from work in rehabilitation settings to strength and conditioning for athletes.

As a fitness speaker, Chris has authored numerous seminars and workshops focusing on back pain and restorative core training along with a variety of related topics. He holds fitness certifications from the National Academy of Sports Medicine and the National Strength and Conditioning Association. Chris received a bachelor’s degree in communications from St. Johns University in Queens, New York, and a master’s degree in journalism with a specialization in health and science from Columbia University in New York City.

An experienced health writer, Chris has also written extensively on fitness, healthcare, and nutrition. His writing has appeared in numerous publications including Exercise for Men, Prevention, Health, and the Boston Globe.

Copyright Fitness Learning Systems Inc. 2016