Tag Archives: exercise

Stanford Study Shows Apple Watch May Detect Heart Problem; More Research Needed

STANFORD (AP) — A huge study suggests the Apple Watch can detect a worrisome irregular heartbeat at least sometimes — but experts say more work is needed to tell if using wearable technology to screen for heart problems really helps.

More than 419,000 Apple Watch users signed up for the unusual study, making it the largest ever to explore screening seemingly healthy people for atrial fibrillation, a condition that if untreated eventually can trigger strokes.

Stanford University researchers reported Saturday that the watch didn’t panic flocks of people, warning just half a percent of participants — about 2,100 — that they might have a problem.

But even among those flagged, “it’s not perfect,” cautioned Dr. Richard Kovacs of the American College of Cardiology, who wasn’t involved with the study.

People who received an alert were supposed to consult a study doctor via telemedicine and then wear an EKG patch measuring cardiac activity for the next week to determine the watch’s accuracy. Some skipped the virtual check-up to consult their own doctors; overall, about 57 percent sought medical attention.

Among those who got EKG monitoring through the study, a third had atrial fibrillation, according to preliminary results being presented at an American College of Cardiology conference in New Orleans.

A-fib tends to come and go, and a week of monitoring might have missed some cases, said Stanford lead researcher Dr. Mintu Turakhia. But if the watch detected another irregular heartbeat while someone was wearing the EKG patch, 84 percent of the time it really was a-fib, he said.

“This study we believe provides very encouraging evidence that a device, the Apple Watch, can be used to detect a-fib and to point out to people when additional monitoring or testing may be needed,” said Dr. Lloyd Minor, Stanford’s dean of medicine.

Other cardiac experts said the study, which was funded by Apple, suggests screening with wearable technology might be technically feasible eventually, but needs lots more research.

“I would not advise this to the overall general population,” said Dr. Valentin Fuster, director of Mount Sinai Heart in New York and a former American Heart Association president, who wasn’t involved with the study. Instead, he’d like to see it tested in seniors with risk factors like high blood pressure.

WHAT IS ATRIAL FIBRILLATION?

A-fib occurs when the heart’s top chambers, called the atria, get out of sync with the bottom chambers’ pumping action. Sometimes patients feel a flutter or a racing heart but many times they’re not aware of an episode.

Sometimes the heart gets back into rhythm on its own. Other patients get an electric shock to get back into rhythm, or are prescribed blood thinners to counter the stroke-causing blood clots that untreated a-fib can spur. A-fib causes 130,000 deaths and 750,000 hospitalizations a year in the U.S.

HOW DO DOCTORS CHECK FOR IT?

A-fib is most common in older adults, and other risks include high blood pressure or a family history of arrhythmias. But routine screening isn’t recommended for people without symptoms. Studies haven’t yet proved that early detection from screening would prevent enough strokes to outweigh risks from unnecessary testing or overtreatment.

HOW DOES THE APPLE WATCH CHECK FOR IT?

A mobile app uses the optical sensor on certain versions of the watch to analyze pulse rate data. If it detects enough variation from beat to beat over a 48-hour period, the user receives a warning of an irregular heart rhythm.

The latest version of the Apple Watch also allows wearers to push a button to take an EKG and share the reading with doctors. Saturday’s study didn’t include watches with that capability.

DOES THE NEW STUDY SHOW MASS SCREENING IS A GOOD IDEA?

No. The study was designed to tell how the watch compared to a week of standard EKG monitoring — not if the wearer’s health improved because the screening uncovered the arrhythmia. To prove if detecting a-fib early lowers risk of stroke would require years of study.

And since the study didn’t have a comparison group getting routine EKGs, there’s no way to know if the watch missed heartbeat problems, giving a false sense of security, Kovacs said.

The puzzling low numbers of alarms might be because most participants were young or middle-aged, not the seniors who are most at risk for a-fib, he said.

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The Tao of Bro-Science

When the gym is your lab: Bro-Science

If you go to any gym, you’ll find a great deal of unusually specific information about strength training. Strangely, you’ll find very little in-depth knowledge of anatomy, physiology, or scientific literature appended to it.

This information is Bro-Science. The problem with Bro-Science is that it differs from gym to gym based on a combination of the shared experience present and the amount of time people spend on the Internet and what lifting forums they frequent.

I used to make fun of Bro-Science. Truth be told, some Bro-Science could kill or a least injure you.

But some of it has proved remarkably prescient. Sarcoplasmic hypertrophy, occlusion training, increased protein for cutting fat, training to failure, and the rep-ranges for muscle growth all seem to have been discovered, not by bespectacled dorks in white lab-coats but by oiled gym-bros in sleeveless shirts. But what process gives us bro-science?

Tradition is Antifragile

Enter Nicolas Taleb. Taleb describes systems in terms of three traits: fragility, robustness, and antifragility. Fragile systems break when they encounter chaos. Robust systems survive. Antifragile systems grow and adapt. He describes this process in connection with tradition here:

Consider the role of heuristic (rule-of-thumb) knowledge embedded in traditions. Simply, just as evolution operates on individuals, so does it act on these tacit, unexplainable rules of thumb transmitted through generations— what Karl Popper has called evolutionary epistemology. But let me change Popper’s idea ever so slightly (actually quite a bit): my take is that this evolution is not a competition between ideas, but between humans and systems based on such ideas. An idea does not survive because it is better than the competition, but rather because the person who holds it has survived! Accordingly, wisdom you learn from your grandmother should be vastly superior (empirically, hence scientifically) to what you get from a class in business school (and, of course, considerably cheaper). My sadness is that we have been moving farther and farther away from grandmothers.

Taleb, Nassim Nicholas (2012-11-27). Antifragile: Things That Gain from Disorder (Kindle Locations 3841-3847). Random House Publishing Group. Kindle Edition.

In other words, bro-science works because the people who practice bro-science are still in the gym. Sometimes this is because their genetics and luck helped them survive and thrive under dangerous training methodologies. But sometimes it’s because the methods keep training interesting, help them get stronger, and keep them injury free.

Knee Tendinitis and Squatting Every Day

TLDR

I did an experiment based on some new data I discovered about tendons. My 8-year knee tendinitis is gone as of 2014. It had to do with exercising more frequently. I got a lot stronger in just 3 weeks. After 6 weeks, I hit my then all-time squat max of 365 for an easy single rep.

Training Efficiently

In my own life experience, perhaps the safest and least time-consuming way to pursue total body fitness is to train with somewhere between 6 and 12 exercises and train with perfect form, taking each exercise to a state of complete positive muscular failure, briefly resting and then moving to the next exercise. Your muscles are getting an intense workout, your hardest reps happen when the muscles are producing the least force (because they are tired) and none of the movements are “explosive” thus accelerating the weight to very high velocities and risking injury. During workouts of this nature, your heart feels like it might explode out of your chest, you breath very hard, and your veins pump lava or pieces of broken glass. The problem with training this way, at least for me, is psychological. Every workout must be all out if you wish to make steady progress. Other problems are related to trying to plan for enough rest and when you train this way the metabolic demands are high. Research shows that muscle protein adaptations last for up to 21 days after the most recent bout of training. Energy system adaptations can begin to regress within 4-7 days. I wish I could remember where I found that data, but I remember everything but the name of the study and it’s authors…which means nothing. Nevertheless, training like every workout is a zero-sum game can be psychologically defeating. Also, the training is seldom enough that other types of adaptations apparently cannot happen (more on that later, as it is the point of the article).

Personal Story: Knee and Back Pain

When I was 20 I woke up one morning with very bad knee pain. This came right around the same time I seriously injured my back. I went to a doctor and received an x-ray on both offending pieces of my body. The knee pain was determined to be very serious tendinitis (probably from a knee collision in a jiujitsu match a while before). The back injury, which was missed in the x-ray but was confirmed by another doctor, was a torn ligament between a rib and one of my vertebrae (don’t remember which). Anyhow, I was told to lay off exercise for 6 weeks. If my knee still hurt, it was recommended that I start walking more than just at work and home to facilitate recovery for 6 more weeks. It was especially important that I do no squats or dead lift. If it still hurt, I was told to go back (maybe to get recommended for physical therapy). A weird series of events involving a car accident occurred which lead me to hit the weights again despite the pain about 3 months later. I was weak, fatter than I’d ever been, and my first set of squats did two things: left me gasping for breath and trying my hardest not to puke and when the muscle soreness my knee and back hurt less. TMy knee never stopped hurting, it just hurt less.

Research on Tendon Adaptation

Anyhow, fast forward to now and I started using Ebsco to do research through the public library (out of grad school so I don’t get my own key code anymore). I discovered that there have been several advancements in the knowledge of connective tissue adaptation since my time as an exercise science major. For instance, in 2007 a study was published (though with no control group) observing the effects of leg extension training on subjects doing heavyweight with one leg and light-weight with the other. There were several interesting observations, but what was most pleasing to discover was that the patellar tendon actually experienced hypertrophy as well as increased stiffness (a good thing for joint health) in the leg trained with heavier weight:

In summary, the present study is to the best of our knowledge the first human study to report tendon hypertrophy following heavy resistance training. Further, the data show that tendon hypertrophy to heavy-resistance training in the patellar tendon was related to the proximal and distal region, but not to the mid-region of the tendon.

Kongsgaard, M., S. Reitelseder, T. G. Pedersen, L. Holm, P. Aagaard, M. Kjaer, and S. P. Magnusson. 2007. “Region Specific Patellar Tendon Hypertrophy in Humans Following Resistance Training.” Acta Physiologica 191 (2): 111–21. doi:10.1111/j.1748-1716.2007.01714.x.

In the abstract of a literature review from 2006, I found that

For tendons, metabolic activity (e.g.detected by positron emission tomography scanning), circulatory responses (e.g. as measured by near-infrared spectroscopy and dye dilution) and collagen turnover are markedly increased after exercise. Tendon blood flow is regulated by cyclooxygenase-2 (COX-2)-mediated pathways, and glucose uptake is regulated by specific pathways in tendons that differ from those in skeletal muscle. Chronic loading in the form of physical training leads both to increased collagen turnover as well as to some degree of net collagen synthesis. These changes modify the mechanical properties and the viscoelastic characteristics of the tissue, decrease its stress-susceptibility and probably make it more load-resistant.

Kjær, Michael, Peter Magnusson, Michael Krogsgaard, Jens Boysen Møller, Jens Olesen, Katja Heinemeier, Mette Hansen, et al. 2006. “Extracellular Matrix Adaptation of Tendon and Skeletal Muscle to Exercise.” Journal of Anatomy 208 (4): 445–50. doi:10.1111/j.1469-7580.2006.00549.x

Several other studies report the same sort of results. The most interesting things to me are A) The increase in protein synthesis B) The increase in blood flow (which can provide nutrients for recovery) C) That actual hypertrophy can be stimulated in tendons D) that even body weight squats increase tendon stiffness in elderly and untrained populations. But what was most interesting to me on a personal level was that “collagen synthesis in human tendon rises by around 100% with just one bout (60 min) of acute exercise, and the elevated collagen synthesis is still present 3 days after exercise (Fig. 3; Miller et al. 2005). In skeletal muscle, the rate of collagen synthesis also increases with exercise, in a time-dependent manner that follows the increase in myofibrillar protein synthesis with exercise (Miller et al. 2005).” What this means for people who have had chronic tendinopathy, is hard to say. But what inferred that it could mean is that training with more frequency than I’m used to could increase the protein turnover rate in my knee and promote recovery. Given my own hypothesis that overuse injuries often come from explosive exercise and sudden acceleration of a limb which puts tremendous force on connective tissue despite low resistance, I decided that squatting more frequently with heavy enough weight to induce protein synthesis could help my knee.

Method:
I thus decreased my weight on squats, began using a high-bar Olympic depth, squat and hit the gym 3 days in a row during week one. Then week two I did the same thing and the weights that were very heavy using that style of squat went up very easily. I ended up squatting a personal best (345 pounds with no belt, no spotter, and no struggle) even compared to my wider power-lifting stance. This week I did heavy high-bar squats for five days in a row.

Results:
Starting Thursday morning I woke up with no knee pain. Today I still have no knee pain. Now, any number of things could have contributed to my apparent recovery after eight years of tendinitis. I could have just finally eaten enough protein, I could have finally slept enough, maybe I ate a magic vegetable like in a video game, it could be placebo though I imagine that would have fixed it years ago, or perhaps a wizard did it. But, the only variable I changed in my one subject sample group was exercise frequency. Now, my shoulders feel a bit beat up from squatting heavy for 5 days in a row. My lower back is pretty sore too. I certainly read less this week because the trips to the gym eat up evening time after work, but my knee feels better. I did chores around the house all morning and hardly noticed. Normally my knee remains in the fore on my consciousness when I’m picking things up, fixing things, or bumping it into stuff. It was unnoticeable today. I’ll tell you what happens in the future.

Group Fitness Studios Running Strong In Bay Area

PALO ALTO (KPIX 5) – Brick and mortar stores have been struggling for years, but there is one kind of business that isn’t threatened by the internet. Group fitness studios are fast expanding in the Bay Area.

In January, Barry’s Bootcamp, which offers a high-intensity interval workout that mixes running and weights, opened two new locations in Burlingame and Palo Alto.

The company first arrived in San Francisco in 2014. A Castro location opens next month, followed by one at San Jose’s Santana Row. And plans are in the works for the East Bay and Marin.

“People are spending a lot more money on their health and wellness right now. And people are choosing to do that as their social outlet too. So I think a lot of people you mentioned — Millennials — are taking the time right now to really go to the fitness club and really meet their friends and hang out,” said Barry’s Bootcamp partner Adam Shane.

Managing partner Adam Shane says the company is also investing a lot. Each location costs up to $3 million to build. But in the Bay Area, there are a lot of people willing to pay a premium. Each class costs $35, which is close to the highest rates in the country.

Nikki Shah has been going to Barry’s about three times a week for more than four years.

“I think it is a community thing, right?” said Shah. “It is something very different to be sprinting with the person next to you, and it pushes you well past what you’re going to do by yourself.”

Matt Holmes works with fitness tenants as the founder of brokerage Retail West. He says right now group fitness studios occupy up to 40 percent of leasing spaces in the Bay Area. 10 years ago, it was a different story.

“Everything had to be big. It was like the Texas mentality: 24 Hour Fitness, 50,000 [square] feet. Now it’s, ‘Hey, let’s take that component of 24 Hour Hitness and let’s do a Pilates portion’ or, ‘Let’s do a spinning portion of it.’ So it’s much more of a specialized breakdown,” said Holmes.

Take East Bay-based X-CORE. It is the only Bay Area studio to offer classes using the VersaClimber. It also offers high-intensity Pilates classes and has plans to expand into San Francisco.

Newly opened boxing-inspired Rumble has plans to add more studios in Palo Alto, the Castro, SoMa and the Marina this year as well.

“There’s also the dynamic of having people that are always on camera, everyone’s doing selfies, everyone’s posting, everyone wants to look better,” said Holmes.

Bad News for Weight Gain: There is a point of no return

Researchers have found that under the typical conditions of care for obese and overweight individuals that:

“current nonsurgical obesity treatment strategies are failing to achieve sustained weight loss for the majority of obese patients. For patients with a BMI of 30 or greater kilograms per meters squared, maintaining weight loss was rare and the probability of achieving normal weight was extremely low. Research to develop new and more effective approaches to obesity management is urgently required.(58)”

The article isn’t entirely pessimistic and it ends on a positive note, I recommend reading it.

The point I wish to highlight is that once a certain threshold of weight gain is reached, it can be difficult or impossible to reverse.

I do not mean to take away hope from people who have overfatted themselves. The data reviewed was from the UK primary care database. That means, it doesn’t include people who see dietitians, personal trainers, or who take personal ownership of their own well-being through research and hard work. That means it doesn’t include you. Why? Because if you read this blog you aren’t the kind of person who lets a statistic enslave you.

My doctor friends tell me that it is rare for patients to respond positively to non-surgical and non-prescription intervention recommendations. And there is some evidence that doctors often don’t tell patients that they are over-weight. The same article linked in the previous sentence indicates that many doctors to not feel competent to help patients lose weight and keep it off.

As the Fildes article states, “the greatest opportunity for tackling the current obesity epidemic may be found outside primary care (58).” While your doctor may not be able to help you lose weight or prevent you from gaining it, you can choose to do it. You can lift weights, you can base your diet on meat, eggs, and veggies. You can throw away all of your junk food. You can walk every day. You can lift 3 days a week. You can make food your fuel rather than your fun. You can do these things. And if you finished reading this post, you will.

References

Alison Fildes et al., “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records,” American Journal of Public Health 105, no. 9 (July 16, 2015): 54–59.

Teen Contracts Deadly Illness After Working Out Too Much

HOUSTON, TX (CBS Local) – A teen in Texas is lucky to be alive after what he thought was soreness from the gym turned out to be a deadly illness.

Seventeen-year-old Jared Shamburger first noticed the pain after a strenuous arm workout with his family. The Houston teen told reporters he felt he had to “catch up” with his older brother and father who had been lifting weights for years.

“It was super-duper sore,” Shamburger said, via WWAY. “Everything hurt. It hurt to the touch. It was swollen.” The teen’s condition sent his mother into a search online for answers. She soon linked her son’s symptoms with a sometimes fatal illness.

“The mama bear in me kind of took over and I called the pediatrician and said, I really think my son has rhabdo,” Judy Shamburger said.

The concerned parent was correct; Jared had contracted Rhabdomyolysis. The illness breaks down muscle tissue and releases a damaging protein into the blood. If left untreated, it can possibly damage the kidneys and cause death in extreme cases. Rhabdo can be triggered by an injury, an infection, or simply by overdoing it at the gym.

The teen was hospitalized for five days, but is expected to make a full recovery. Doctors say muscle pain, weakness, or severe swelling after an intense workout can all be warning signs that you should go to a hospital for examination.

Regular Exercise Can Take Away ‘Years Of Damage’ From Laziness And Doing Nothing, Study Says

CBS Local — A new study has revealed that the statement ‘it’s never too late to get in shape’ actually does hold water after all.

According to researchers from the study, which was published in the journal Circulation, a group of middle-aged men and women with inactive lifestyles were able to follow a two-year program based on exercise guidelines recommended by the American Heart Association and significantly reduce their risk of heart failure.

Dr. Benjamin Levine, director of the Institute of Exercise and Environmental Medicine at Texas Health Resources, recruited 53 volunteers ranging in age from 45 to 64 who were self-professed “couch potatoes” and put them to work on a four to five day per week exercise routine. The routines varied, with some consisting of moderate and high-intensity workouts, while others were weight training, balance work, and yoga based exercises.

After following their respective routines, participants that did just yoga and weight sessions didn’t see results, but those that worked out at least four to five days per week reportedly were fitter and had healthier hearts and arteries.

“This study demonstrates that prolonged (two years) exercise training, initiated in middle age, can forestall the deleterious effects of sedentary aging by reducing cardiac stiffness and increasing fitness,” researchers wrote.

The American Heart Association recommends “150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity)” to keep the heart healthy.