Friday, June 15

Test !

Mind + Body Fitness Self-Assessment

Are you currently practicing mind + body fitness?
Do you understand the connection between being physically fit and mentally fit, and why it is important to your overall well-being?
Take a few minutes to ask yourself the following questions. Your answers will reveal how aware you are of the connection between mental and physical health.

EXERCISE AND DEPRESSION *

Depression is a prevalent problem in today’s society. Clinical depression affects 2–5% of Americans each year (Kessler et al., 1994) and it is estimated that patients suffering from clinical depression make up 6–8% of general medical practices (Katon & Schulberg, 1992). Depression is also costly to the health care system in that depressed individuals annually spend 1.5 times more on health care than nondepressed individuals, and those being treated with antidepressants spend three times more on outpatient pharmacy costs than those not on drug therapy (Simon, VonKorff, & Barlow, 1995). These costs have led to increased governmental pressure to reduce health care costs in America. If available and effective, alternative low-cost therapies that do not have negative side effects need to be incorporated into treatment plans. Exercise has been proposed as an alternative or adjunct to more traditional approaches for treating depression (Hales & Travis, 1987; Martinsen, 1987, 1990).

The research on exercise and depression has a long history of investigators (Franz & Hamilton, 1905; Vaux, 1926) suggesting a relationship between exercise and decreased depression. Since the early 1900s, there have been over 100 studies examining this relationship, and many narrative reviews on this topic have also been conducted. During the 1990s there have been at least five meta-analytic reviews (Craft, 1997; Calfas & Taylor, 1994; Kugler et al., 1994; McDonald & Hodgdon, 1991; North, McCullagh, & Tran, 1990) that have examined studies ranging from as few as nine (Calfas & Taylor, 1994) to as many as 80 (North et al., 1990). Across these five meta-analytic reviews, the results consistently show that both acute and chronic exercise are related to a significant reduction in depression. These effects are generally “moderate” in magnitude (i.e., larger than the anxiety-reducing effects noted earlier) and occur for subjects who were classified as nondepressed, clinically depressed, or mentally ill. The findings indicate that the antidepressant effect of exercise begins as early as the first session of exercise and persists beyond the end of the exercise program (Craft, 1997; North et al., 1990). These effects are also consistent across age, gender, exercise group size, and type of depression inventory.

Exercise was shown to produce larger antidepressant effects when: (a) the exercise training program was longer than nine weeks and involved more sessions (Craft, 1997; North et al., 1990); (b) exercise was of longer duration, higher intensity, and performed a greater number of days per week (Craft, 1997); and (c) subjects were classified as medical rehabilitation patients (North et al., 1991) and, based on questionnaire instruments, were classified as moderately/severely depressed compared to mildly/moderately depressed (Craft, 1997). The latter effect is limited since only one study used individuals who were classified as severely depressed and only two studies used individuals who were classified as moderately to severely depressed. Although limited at this time, this finding calls into question the conclusions of several narrative reviews (Gleser & Mendelberg, 1990; Martinsen, 1987, 1993, 1994), which indicate that exercise has antidepressant effects only for those who are initially mild to moderately depressed.

The meta-analyses are inconsistent when comparing exercise to the more traditional treatments for depression, such as psychotherapy and behavioral interventions (e.g., relaxation, meditation), and this may be related to the types of subjects employed. In examining all types of subjects, North et al. (1990) found that exercise decreased depression more than relaxation training or engaging in enjoyable activities, but did not produce effects that were different from psychotherapy. Craft (1997), using only clinically depressed subjects, found that exercise produced the same effects as psychotherapy, behavioral interventions, and social contact. Exercise used in combination with individual psychotherapy or exercise together with drug therapy produced the largest effects; however, these effects were not significantly different from the effect produced by exercise alone (Craft, 1997).

That exercise is at least as effective as more traditional therapies is encouraging, especially considering the time and cost involved with treatments like psychotherapy. Exercise may be a positive adjunct for the treatment of depression since exercise provides additional health benefits (e.g., increase in muscle tone and decreased incidence of heart disease and obesity) that behavioral interventions do not. Thus, since exercise is cost effective, has positive health benefits, and is effective in alleviating depression, it is a viable adjunct or alternative to many of the more traditional therapies. Future research also needs to examine the possibility of systematically lowering antidepressant medication dosages while concurrently supplementing treatment with exercise. *

Daniel M. Landers

the relationship between exercise and anxiety reduction

There have been six meta-analyses examining the relationship between exercise and anxiety reduction (Calfas & Taylor, 1994; Kugler, Seelback, & Krüskemper, 1994; Landers & Petruzzello, 1994; Long & van Stavel, 1995; McDonald & Hodgdon, 1991; Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991). These meta-analyses ranged from 159 studies (Landers & Petruzzello, 1994; Petruzzello et al., 1991) to five studies (Calfas & Taylor, 1994) reviewed. All six of these meta-analyses found that across all studies examined, exercise was significantly related to a reduction in anxiety. These effects ranged from “small” to “moderate” in size and were consistent for trait, state, and psychophysiological measures of anxiety. The vast majority of the narrative reviews and all of the meta-analytic reviews support the conclusion that across studies published between 1960 and 1995 there is a small to moderate relationship showing that both acute and chronic exercise reduces anxiety. This reduction occurs for all types of subjects, regardless of the measures of anxiety being employed (i.e., state, trait or psychophysiological), the intensity or the duration of the exercise, the type of exercise paradigm (i.e., acute or chronic), and the scientific quality of the studies. Another meta-analysis (Kelley & Tran, 1995) of 35 clinical trial studies involving 1,076 subjects has confirmed the psychophysiological findings in showing small (–4/–3 mm Hg), but statistically significant, postexercise reductions for both systolic and diastolic blood pressure among normal normotensive adults.

In addition to these general effects, some of these meta-analyses (Landers & Petruzzello, 1994; Petruzzello et al., 1991) that examined more studies and therefore had more findings to consider were able to identify several variables that moderated the relationship between exercise and anxiety reduction. Compared to the overall conclusion noted above, which is based on hundreds of studies involving thousands of subjects, the findings for the moderating variables are based on a much smaller database. More research, therefore, is warranted to examine further the conclusions derived from the following moderating variables. The meta-analyses show that the larger effects of exercise on anxiety reduction are shown when: (a) the exercise is “aerobic” (e.g., running, swimming, cycling) as opposed to nonaerobic (e.g., handball, strength-flexibility training), (b) the length of the aerobic training program is at least 10 weeks and preferably greater than 15 weeks, and (c) subjects have initially lower levels of fitness or higher levels of anxiety. The “higher levels of anxiety” includes coronary (Kugler et al., 1994) and panic disorder patients (Meyer, Broocks, Hillmer-Vogel, Bandelow & Rüther, 1997). In addition, there is limited evidence which suggests that the anxiety reduction is not an artifact “due more to the cessation of a potentially threatening activity than to the exercise itself” (Petruzzello, 1995, p. 109), and the time course for postexercise anxiety reduction is somewhere between four to six hours before anxiety returns to pre-exercise levels (Landers & Petruzzello, 1994). It also appears that although exercise differs from no treatment control groups, it is usually not shown to differ from other known anxiety-reducing treatments (e.g., relaxation training). The finding that exercise can produce an anxiety reduction similar in magnitude to other commonly employed anxiety treatments is noteworthy since exercise can be considered at least as good as these techniques, but in addition, it has many other physical benefits.

ANXIETY REDUCTION FOLLOWING EXERCISE

It is estimated that in the United States approximately 7.3% of the adult population has an anxiety disorder that necessitates some form of treatment (Regier et al., 1988). In addition, stress-related emotions, such as anxiety, are common among healthy individuals (Cohen, Tyrell, & Smith, 1991). The current interest in prevention has heightened interest in exercise as an alternative or adjunct to traditional interventions such as psychotherapy or drug therapies.

Anxiety is associated with the emergence of a negative form of cognitive appraisal typified by worry, self-doubt, and apprehension. According to Lazarus and Cohen (1977), it usually arises “...in the face of demands that tax or exceed the resources of the system or ... demands to which there are no readily available or automatic adaptive responses” (p. 109). Anxiety is a cognitive phenomenon and is usually measured by questionnaire instruments. These questionnaires are sometimes accompanied by physiological measures that are associated with heightened arousal/anxiety (e.g., heart rate, blood pressure, skin conductance, muscle tension). A common distinction in this literature is between state and trait questionnaire measures of anxiety. Trait anxiety is the general predisposition to respond across many situations with high levels of anxiety. State anxiety, on the other hand, is much more specific and refers to the person’s anxiety at a particular moment. Although “trait” and “state” aspects of anxiety are conceptually distinct, the available operational measures show a considerable amount of overlap among these subcomponents of anxiety (Smith, 1989).

For meta-analytic reviews of this topic, the inclusion criterion has been that only studies examining anxiety measures before and after either acute or chronic exercise have been included in the review. Studies with experiment-imposed psychosocial stressors during the postexercise period have not been included since this would confound the effects of exercise with the effects of stressors (e.g., Stoop color-word test, active physical performance). The meta-analysis by Schlicht (1994), however, included some stress-reactivity studies and therefore was not interpretable.

Landers and Petruzzello (1994) examined the results of 27 narrative reviews that had been conducted between 1960 and 1991 and found that in 81% of them the authors had concluded that physical activity/fitness was related to anxiety reduction following exercise and there was little or no conflicting data presented in these reviews. For the other 19%, the authors had concluded that most of the findings were supportive of exercise being related to a reduction in anxiety, but there were some divergent results. None of these narrative reviews concluded that there was no relationship. *

Activity associated with restful sleep Activity associated with ability to respond to stress

Benefits (anxiety and depression) similar to those for other treatments

Activity associated with positive self-esteem

For some time now, it has been common knowledge that exercise is good for one’s physical health. It has only been in recent years, however, that it has become commonplace to read in magazines and health newsletters that exercise can also be of value in promoting sound mental health. Although this optimistic appraisal has attracted a great deal of attention, the scientific community has been much more cautious in offering such a blanket endorsement. Consider the tentative conclusions from the Surgeon General’s Report on Physical Activity and Health (PCPFS Research Digest, 1996) that “physical activity appears to relieve symptoms of depression and anxiety and improve mood” and that “regular physical activity may reduce the risk of developing depression, although further research is needed on this topic.”

The use of carefully chosen words, such as “appears to” and “may” illustrate the caution that people in the scientific community have when it comes to claiming mental health benefits derived from exercise. Part of the problem in interpreting the scientific literature is that there are over 100 scientific studies dealing with exercise and depression or exercise and anxiety and not all of these studies show statistically significant benefits with exercise training. The paucity of clinical trial studies and the fact that a “mixed bag” of significant and nonsignificant findings exists makes it difficult for scientists to give a strong endorsement for the positive influence of exercise on mental health. There is no doubt that the mental health area needs more clinical trial studies. This would be particularly useful in determining if exercise “causes” improvements in variables associated with sound mental health. However, until these clinical trial studies materialize, there is still much that can be done to strengthen statements made about exercise and mental health.

What evidence would prompt some scientists to “stick their necks out” in favor of more definitive statements? One reason for greater optimism is the recent appearance of quantitative reviews (i.e., meta-analyses) of the literature on a number of mental health topics. These reviews differ in several ways from the traditional narrative reviews. A meta-analysis allows for a summary of results across studies. By including all published and unpublished studies and combining their results, statistical power is increased. Another advantage of using this type of review process is that a clearly defined sequence of steps is followed and included in the final report so that anyone can replicate the studies. Two additional advantages that meta-analysis has over other types of reviews include: (a) the use of a quantification technique that gives an objective estimate of the magnitude of the exercise treatment effect; and (b) its ability to examine potential moderating variables to determine if they influence exercise-mental health relationships. Given these advantages, this paper will focus primarily on results derived from large-scale meta-analytic reviews.

Mental Health Benefits of Physical Activity

    Reduced anxiety

  • Best results with “aerobic exercise”
  • Best after weeks of regular exercise
  • Best benefits to those who are low fit to begin with
  • Best benefits for those high in anxiety to begin with
  • Reduced depression

  • Best after weeks of regular exercise
  • Best when done several times a week
  • Best with more vigorous exercise
  • Best for those who are more depressed (needs more research)

The Influence of Exercise on Mental Health

Definitions

Acute. Acute refers to something that occurs at a specific time often for a relatively short duration. For example, acute exercise refers to a bout of exercise done at a specific time for a specific amount of time. Acute anxiety is anxiety that exists in a person in response to a specific event (same as state anxiety).

Anxiety. Anxiety is a form of negative self-appraisal characterized by worry, self-doubt, and apprehension.

Chronic. Chronic refers to something that persists for a relatively long period of time. Chronic depression, for example, would be depression that lasts a long time. A chronic exerciser is someone who does exercise on a regular basis.

Depression. Depression is a state of being associated with feelings of hopelessness or a sense of defeat. People with depression often feel “down” or “blue” even when circumstances would dictate otherwise. All people feel “depressed” at times, but a “depressed” person feels this way much of the time.

Clinical depression. This is depression (see definition) that persists for a relatively long period of time or becomes so severe that a person needs special help to cope with day-to-day affairs.

Meta-analysis. A type of statistical analysis that researchers use to make sense of many different research studies done on the same topic. By analyzing findings from many different studies, conclusions can be drawn concerning the results of all studies considered together. Both unpublished and published studies can be included in this type of analysis.

Positive mood. Positive self-assessments associated with feelings of vigor, happiness, and/or other positive feelings of well-being.

State anxiety. State anxiety is anxiety present in very specific situations. For example, state sports anxiety is present when a person is anxious in a specific sports situation even if the person is not generally anxious.

Trait anxiety. Trait anxiety is the level of anxiety present in a person on a regular basis. A person with high trait anxiety is anxious much of the time while a person low in trait anxiety tends to be anxious less often and in fewer situations.
ORIGINALLY PUBLISHED AS SERIES 2, NUMBER 12, OF THE PCPFS RESEARCH DIGEST

Thursday, June 14

The 7 Things That Personal Trainers Do To Tick Clients Off

"Over the years we have had our share of both excellent and suspect Personal Trainers. From these experiences come the 7 things that they do to tick clients off.

1. Fail to keep appointments: perhaps this should be saved for number 7 as it is the most unbelievable; you know save the best for last. This is the case of the trainer that calls on the day of the appointment, sometimes within hours, and wants to let you know they will be unable to train because they got tied up. Still worse is the trainer that runs perpetually late. Picture yourself at the gym, warming up, and looking out for your trainer. At the appointed hour they are no where in sight so you begin to lightly workout. 10 minutes into the scheduled hour they come strolling in asking to be forgiven for running late. O.k., things happen. The question is do things happen 2 weeks out of 4. My advice? Get a new trainer.
2. Neglect to keep charts on their clients. How in the world is a trainer supposed to keep a mental note of all the particulars surrounding a clients health, contact information, goals, workout weights, injury areas, to name a few. Boggles my mind how many trainers simply write nothing down. They truly must have amazing memories.
3. Eating while training a client. Hey, I get hungry too and I also work a long day. It would be unimaginable for me to eat in front of a client unless we went out for a meal. Frankly it does not matter if it is a power bar, a peanut butter sandwich or a bag of trail mix. I pay you to work me out, eat on your own time.
4. Talking to other trainers, or familiar clients, while working me out. Here's a novel thought: my health and safety for that one hour is in your hands, your complete attention is required. It does not matter to me if your best friend from grade school that you have not seen in 10 years just walked in. Your attention is on your client for one hour.
5. Children do not belong in the gym. Not the client's kids or the trainer's. Last thing I want is to hear or see is kids when I am trying to concentrate on touching a cone while balancing on half a foam roller with a 20 pound jacket on my body. Don't get me wrong, I like children. I don't like children at the gym.
6. Talking on cell phones, or texting, while working out a client. This one might have been a contender for the number one position. As if the invasion of cell phones in not pervasive enough it has now entered the gym. Picture this: client is doing a deep lunge exercise down a lane at the gym. Following behind offering no words of encouragement, but "spotting" her is trainer on cell phone. Unbelievable. Unbelievable that the trainer is on the phone and equally nuts that the client does not care. Important caveat: clients are guilty too. Recently I witnessed a client doing step ups on to a platform while speaking on the phone. It was her husband who "always calls me when we hear this song". Could you just wretch?
7. Lack of creativity in workouts. Worse is the trainer who you know is making up the routine as we go along. Getting to the gym takes a certain amount of motivation for most clients. Help us out and add some variety to the exercise routine.
The last item is for the gym owners in the reading audience: stop being cheap and make sure the carpets are cleaned, the equipment is updated and in good working condition, the amenities in the locker room are clean and control your employees or contractors. At $50 to $75 per hourly session these are reasonable requests.

If you are shopping for a personal trainer, use this list to size up the trainer and the facility you are contemplating using. Know too that there a many, many simply excellent, diligent, qualified trainers that fit none of the faults mentioned above. In fact this article is a result of observations made while either warming up for, or working out with, my trainer who cannot be faulted for any of the issues sited."
R. Adam Shore - www.physicalfitnessarticles.net

Wednesday, June 13

Health And Fitness For People Above 50 *

Most aging adults don't get enough physical activity. Exercise, though, can improve health impairments and prevent some diseases. It can also improve mood and emotional well being. The keys, though, to a sensible senior workout are to take it slowly and keep it up. Older people need to find a realistic mild to moderate enjoyable program.

Let me give you 8 important reasons why You should work out.

1. Sleeping Aid for Seniors

Because exercise effects the body is so many positive ways, it is clearly the most natural option for helping address sleep related issues. Regular exercise will first of all help tire the body physically, ensuring a natural form of fatigue that the body will address with a
need to get appropriate rest.

2. Strength Training = Strong Bones

A critical aspect of aging is the general weakening of both muscle tissue and our bones themselves. One of the surest ways to reduce the stress on our weakening bones is to increase our muscles mass through strength training. Strength training has repeatedly been shown to be a safe and effective method of reversing muscle loss in the elderly

3. Strong Heart

People who exercise vigorously and often will reduce the risk of heart disease the greatest, but studies also show that any exercise can be beneficial. Studies have found that moderate exercise is also beneficial for those people with existing heart disease. *

Health And Fitness For People Above 50 - II *

4. Arthritis Help

Arthritis is defined as the inflammation of a joint, but it can certainly seem more painful than that. It can cause searing pain that leaves the body feeling weak for days. As people age, arthritis tends to develop from the extended every day uses of the body.

Exercise, though, can assist with arthritis by strengthening the muscles near the joint which helps reduce joint stress. While exercise is necessary for everyone, it is essential for those with arthritis

5. 58% lower risk for Type 2 diabetes

A study reported a 58% lower risk for Type 2 diabetes in adults who exercise for as little as 2.5 hours a week, even if the exercise was of a moderate level.

People with diabetes are at high risk for heart disease, so the protective effects of aerobic exercise on the heart are very important for people with Type 2 diabetes. Initial indications are that strength training to increase muscle mass and reduce patient fat is also helpful for people with diabetes.

6. Increased Overall Fitness

Being physically active appears to stimulate immune cells that target many viruses and infections. Though exercise appears to stimulate such cells, that stimulation appears to last only a few hours. However, regular exercise appears to lower the overall risk of being susceptible to the flu, colds, and other viruses.

7. Increased Stamina and Slowing the Aging clock

Physical fitness allows the body to perform to its full capacity. Fitness helps us appear, feel, and act to our full potential. Exercise is essentially the capability to complete everyday responsibilities energetically and actively, with energy remaining at the end of the day for appreciation of other activities.

8. No Brain Drain

How many times do you hear yourself or other seniors say, "Sorry, I'm just having another senior moment? Many seniors are making exercise more of a habit so their sharp and educated minds don't suffer. Studies across the country are showing that seniors who exercise their bodies have the least trouble exercising their minds. *