Strong Medicine

Grains as carb source

2008-11-12T12:42:00.000-08:00

Found this little gem on information at the website of Dr. Loren Cordain, PhD from Colorado State University at http://www.thepaleodiet.com/index.shtml. Grains are often touted as the best source of carbohydrate intake, and this information compares grain intake for carb needs to the Paleo/Zone diet approach. Thanks to Robb Wolf (http://www.robbwolf.com/) for directing me to this information during his excellent nutrition seminar endorsed by the good folks at CrossFit (http://www.crossfit.com/).

Aren't whole grains good sources of fiber, minerals, and B vitamins? How can I get these nutrients if I cut down or eliminate grains from my diet?

On a calorie-by-calorie basis, whole grains are lousy sources of fiber, minerals, and B vitamins when compared to the lean meats, seafood, and fresh fruit and veggies that dominate The Paleo Diet. For example, a 1,000-calorie serving of fresh fruits and vegetables has between two and seven times as much fiber as does a comparable serving of whole grains. In fruits and veggies most of the fiber is heart-healthy, soluble fiber that lowers cholesterol levels -- the same cannot be said for the insoluble fiber that is predominant in most whole grains. A 1,000-calorie serving of whole grain cereal contains 15 times less calcium, three times less magnesium, 12 times less potassium, six times less iron, and two times less copper than a comparable serving of fresh vegetables. Moreover, whole grains contain a substance called phytate that almost entirely prevents the absorption of any calcium, iron, or zinc that is found in whole grains, whereas the type of iron, zinc, and copper found in lean meats and seafood is in a form that is highly absorbed.

Compared to fruits and veggies, cereal grains are B-vitamin lightweights. An average 1,000 calorie serving of mixed vegetables contain 19 times more folate, five times more vitamin B6, six times more vitamin B2 and two times more vitamin B1 than a comparable serving of eight mixed whole grains. On a calorie-by-calorie basis, the niacin content of lean meat and seafood is four times greater than that found in whole grains. Click here to read more about cereal grains.

Exercise is Medicine

2008-10-31T18:15:00.000-07:00

About a year ago, the American Medical Association (AMA) and the American College of SportsMedicine (ACSM) announced a new initiative: Exercise is Medicine. This initiative includes a web site (http://www.exerciseismedicine.org/) designed to help physicians promote exercise to patients, even recording physical activity as a vital sign during visits. This development occurred after an ACSM study found 65% of patients would be more interested in exercise if physicians advised them and provided resources, but only 41% of surveyed physicians endorsed exercise to patients, and very few were able to provide resources to implement that advice. To that end, the website holds a broad array of resources, both for physicians and the aspiring or current exerciser.
This initiative assumes that physicians are well equipped to advise their patients on selecting the proper exercises suited to the individual’s needs and interests. Certainly some physicians are well equipped to fill this need. However, our experience at Strong Medicine is that, with rare exception, physicians often turn to physical therapists when exercise programming is required, particularly with patients fresh from surgery, injury, or an exacerbation of a chronic condition. Extensive education in human movement, the ability to critically analyze peer reviewed medical and exercise science research and day in/day out manipulation of the human response to exercise are clear assets when it comes to exercise prescription.
We’ve taken it a step further, blending an understanding of conventional athletic sports performance enhancement methods from well established organizations such as the National Strength and Conditioning Association (NSCA) and USA Weightlifting alongside the more maverick, results oriented approach for extreme training developed by the folks at CrossFit. That kind of approach, set alongside a solid understanding of pathology and movement dysfunction, is Strong Medicine.
We salute the AMA and ACSM for the Exercise is Medicine initiative, but offer one editorial change. Exercise is medicine, yes, but in the right hands, it is more accurate to state that Exercise is Strong Medicine.

Weight Loss and Diet

2008-10-19T04:13:00.000-07:00

A recent New England Journal of Medicine article reported the results of a two year comparison of three approaches to diet on weight loss. Over 300 obese individuals were assigned to one of three diets: low-fat, restricted-calorie;Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie. This report is particularly interesting in that most studies of effectiveness and safety ofweight-loss diets are frequently limited by short follow-uptimes and high dropout rates, with neither concern being an issue here.

The highest mean weight loss occurred in the Mediterranean and low-carbohydrate groups at almost double the mean weight loss in the low-fat group. In addition, within the 36 subjectswith diabetes, changes in fasting plasma glucose and insulinlevels were more favorable among those assigned to the Mediterraneandiet than among those assigned to the low-fat diet.

What does this mean for you? Conventional advice to avoid dietary fats and instead substitute carbohydrates such as grains, pasta, and starches may not be the best approach to weight loss. Diets that advocate lowered carbohydrate intake and Mediterranean style foods, such as Adkins, Zone, Paleo or South Beach diets, seem to offer better potential for weight loss among obese individuals. While excessive intake of poor quality fats have been recognized as being counterproductive to a weight loss strategy, this new study supports the assertion that substituting high carbohydrate intake is also counterproductive to the same goals.

You can read the study yourself at http://content.nejm.org/cgi/content/full/359/3/229

A New Home

2008-10-14T16:38:00.000-07:00

Flagstaff, Arizona: 7,000 feet of altitude holds a funky, small college town attitude on the western edge of the largest Ponderosa Pine forest in the US. I get to live and work here now.

Summit Fitness is a modern, comprehensive "big box" gym with a physical therapy clinic and spa under roof. I'm a permanent part of this ownership group now, helping to redevelop training services and manage the facility. I'm also teaching part time at Northern Arizona University, both in the Physical Education and in the Physical Therapy program.

Yes, I dig it. More on Summit Fitness here: http://www.summithealthandfitnessllc.com/

Boot Camp Testing

2008-08-29T10:49:00.000-07:00

The Age Adjusted Physical Performance Test for Boot Camp attendees is a timed fitness test that utilizes body weight exercises (situps, pushups and squats) with conventional cardio training devices (treadmill or bike) to measure strength, power and endurance. It is a simple, objective and handy way to gauge gains in fitness. Reps for the first part of the test, like the previous post, is set at 100 minus age. Pushups, situps and squats are performed in series, finishing one exercise before another is started. After that, participants move immediately to the treadmill for a timed one mile run or stationary bike for timed 5 mile ride.

I ran these tests on boot camp attendees on 8/28, using Abmats for situps (designated as "AM" for Abmat), permitting either full or "from the knees" pushups, and designating "L" for long or "S" for short. Some folks transitioned from long to short, designated with "20L" for completing 20 long (full pushups) before moving to pushups from knees. The box height for squat depth is posted, labeled, for instance, as "14" for 14 inch box squats. The cardio section is timed and either T1 for Treadmill, one mile run or B5 for stationary bike, 5 mile ride. Remainder should be self explanatory. Click on the "Performance Log" button on the main page to see the results of that test.

Benchmark workout - age adjusted

2008-05-10T22:35:00.000-07:00

As time passes, work capacity will undoubtedly diminish at some level: a 70 year old who is both healthy and athletic is not expected to deliver the same performance as a healthy, athletic 20 year old. At 51, I'm in pretty good shape, but I'm kidding myself if I think I can reach the same capacity for performance that I had 20 years ago.

I cooked up this workout with some input from the folks at CrossFit Flagstaff and gave it a test drive today:

100-age reps of pushups

100-age reps of overhead squat with 45 lb. bar

(100-age)/2 reps of pullups

(100-age)/2 reps of touching knees to elbows while hanging on the pullup bar

1 mile run or 2K row or combo 800m run and 1KM row.

The math behind the rep calculation permits decreasing reps as you age, so that the 30 and 50 year old just might be on a similar level of stress/intensity.

This is an ugly workout, but one I can continue to do for the rest of my life to gauge how I compare with last year.

Strongest Man in the World?

2008-05-05T13:57:00.000-07:00

Different schools of weightlifting would name different shining stars that have lifted extraordinary amounts of weight using different kinds of events. If we look to the Olympic Games, two different competitive lifts are executed by world-class athletes in different weight classes. One lift, the snatch, requires the lifter to pull a weighted bar to a straight and locked arm, overhead position and then stand up under control just like this. The second lift, the clean and jerk, uses an explosive movement to pull up (or “clean”) the weighted bar into a crouching front squat position, stand, and then push the weight over the head to a straight arm, locked position just like this. Both movements require power, strength, flexibility and tremendous skill.

Athletes can lift more in the clean and jerk than the snatch – let’s look to the clean and jerk history for the answer to your question. The most weight successfully lifted in the clean and jerk is 266 kg (586.42 pounds) by Russian Leonid Taranenko in 1988. Taranenko in action in the video here. Keep in mind that this lift starts with the weight on the ground, and ends with well over a quarter ton held in place over the lifter’s head. It should come as no surprise that he also holds 26 world records – not too shabby for a man approaching 55 years old. But compared to Flagstaff talent, he’s just a pup.

Mel Katz is a weighlifter with Peaks Weightlifting Club here in Flagstaff, and he recently lifted 39 KG at the 2008 National Masters competition in the clean and jerk. Those of you with great math skill have already calculated that 39 KG is about 86 lbs. Yes, that is lighter than Leonid’s lift – but Taranenko was only 32 years old in 1988 when he lifted 266 KG. Mel is 86 years young this year, a WWII Purple Heart recipient and a cancer survivor to boot. He regularly trains at Summit Health and Fitness with other members of the Peaks Weightlifting Club.

So, who is the greatest weightlifter of all time? Leonid can come back in 30 years and show us his stuff. Until then, my money is on Flagstaff resident Mel Katz.

The math of weight loss

2008-04-13T19:56:00.000-07:00

When folks start to exercise with the hope of losing weight, they are understandably a bit disappointed to hear me tell them that exercise, without changes in eating habits, is probably an insufficient approach. It is compelling to hope that regular, consistent exercise alone would be enough to directly create weight loss. The reality of the situation is that changes to eating habits are also important for reliable weight loss, particularly a change in the volume of food intake as measured in calories.

Note: I'm going to use the term calorie instead of Kcal, Calorie, or large calorie to denote 1000 calories of energy, either from food intake or from exercise.

In an over-simplified response that looks at volume of food and exercise alone, weight loss can take place when your energy demands exceed your intake. For instance, if your diet consists of 1000 calories a day with a 2000 calorie a day energy demand, you will create a net loss of 1000 calories a day. Existing stores of energy in your body stored as fat will typically furnish a large part of those 1000 calories you need. That process of using more energy than your diet supplies results in weight loss. So, if your current diet furnishes less calories than your energy demands, you’ll lose weight. For most of the general population, our energy demands (excluding exercise) do not exceed our diet intake of calories. No surprise, just look around. Or take a look at any recently retired sports personality – same diet, less exercise, more personality to fill the wide screen.

An recent example that illustrates this approach one of the members at Summit Health and Fitness, where I work. Jim Hendron is a former Marine who understands the math for weight loss and has taken a typical “no holds barred” USMC approach to the process. Jim counts off 2000 calories on the treadmill every day by working out twice a day at least 5 days a week. On the intake side, he works very hard to keep his daily food intake to below 1000 calories. An estimated 1000 calorie intake with 2000 calorie demand creates an estimated 1000 calorie deficit every day. The result of his 12-week commitment to that diet/exercise approach has been an overall weight loss of over 50 lbs. Now, this is the Marine approach – take the objective regardless of the cost - it is not an approach I'd recommend for everyone or expect most folks would sustain, but it does illustrate the point well. It is aggressive and requires a rare level of exceptional discipline: not an approach that suits everyone. That being said…….Hoo-rah, Jim.

So, the advice here is that controlled portions, preferably of a balanced diet, can be used to keep your intake below your daily caloric demands. You can raise your caloric demands by increasing your activity levels – exercise being a great approach to that end. Sensible, controlled eating habits coupled with a good exercise program is a great way to sweat your butt off – literally. Even if you're not a Marine.

Six pack Abs & Core strength

2008-04-04T22:48:00.000-07:00

Six pack abs - doesn't everyone want them as a clear indicator of solid core strength? While it is common to think of lean and clearly “cut” abdominal muscles as the same thing, a “six pack” is not necessarily the best indicator of real core strength.

The firmly toned abdomen has that appearance for two reasons: lack of abdominal fat and selective training of a muscle called the rectus abdominus. This muscle runs vertically between the center of your chest and ribs down to your pelvis, and functions, when contracted, to draw your chest and pelvis closer in a curling motion (hence the “ab curl” exercise to train it). Three exercises work to create a six pack: situps, hanging knee curls, and table pushups. While the situp probably needs no explanation, the hanging knee up exercise is less common. This exercise starts hanging from a pullup bar, and the knees are drawn up to the elbows to target the lower abs. The table pushup is a weight loss strategy: firmly place both hands on the dinner table and push up before dessert arrives.

As for core strength, many self proclaimed experts, magazine article and books purport to have the latest and greatest approach, but one common element seems to be the concept of trunk stabilization. In normal life, trunk muscles (including abdominals) typically act as stabilizers for movement of the arms and legs. Think about movements such as walking, running, jumping, climbing stairs, lifting, reaching for an object, raising your hand, throwing, etc. Those movements require trunk stability while the arms or legs move. You best understand this when reaching for an object after a back injury – the injured back lets you know it is part of simply reaching with your arms.

If the goal is core strength, and the core functions to stabilize to allow movement of the arms and legs, then an exercise that requires trunk stability with movement of the arms and legs would fit the requirement. One example is the overhead press and lunge. Grab a dumbbell at about 10 percent of your body weight, press it straight over your head, and drop into a lunge position by stepping out on the opposite leg. Maintain the overhead press and step back to the original position, repeating the exercise for the other leg. Repeat until fatigue, rest a few minutes, and repeat two or three more times. If you can perform 50 reps on both arms, raise the dumbbell weight. The movement looks like this: Lunge Press video.

One more thing: you can't continue to assume that ingesting a six pack will help to create six pack abs. The old adage about "you are what you eat" doesn't necessarily apply here.

Picking a trainer

2008-03-28T08:06:00.000-07:00

So, you've decided to start the search for a qualified fitness specialist to help you with your training, but are not sure how to select a good one. What are some helpful guidelines?

It is really quite simple: find the person who has a shirt with “PERSONAL TRAINER” written on the back. Really big letters signify a much higher skill level.

Okay, maybe that’s not the best method. Here are a few tips to help you in your search.

Ask about the trainer’s qualifications. While the organizations that offer fitness training and certification seem to be an alphabet soup, two represent “gold standards” for the industry: the American College of Sports Medicine (ACSM) and the National Strength and Conditioning Association (NSCA). Individuals who have obtained certification from these two organizations have demonstrated a very good grasp of exercise science foundations for intelligent training of their clients. This does not mean these two certifying organizations are the only route to competence. They do indicate that the trainer has a commitment to both learning and communicating an understanding of good science principles for fitness training.
Ask about the trainer’s experience. While certifications represent a good understanding of the science behind training, it does not at all guarantee skill. It is critical to ask the trainer how long he/she has been doing this kind of work. As with any other area of expertise, practice makes perfect. Like a good certification, length of time in the business does not guarantee expertise, but it does indicate commitment to the process.
Speak with several people who have used the trainer’s services. The best predictor of success with you is a history of success with other clients like you. A good trainer will have fans enthusiastic about reaching their fitness goals under this person’s coaching. Be sure to speak with those that have achieved the kind of fitness you want to obtain. Do not assume, for instance, that a trainer with a long list of bodybuilding clients can help you with weight loss goals. Enthusiastic clients who have achieved their fitness goals represent the most important endorsement a trainer carries (even more than certification and experience). Hire someone with a track record of doing good work.
Is the trainer fit? Dismiss anyone who does not demonstrate a personal commitment to health. You would not hire a tour guide unfamiliar with the country you want to experience. Don't hire a trainer with a "do as I say, not as I do" attitude.
Do you have medical issues? Licensed healthcare providers (nurses and physical therapists, for instance) with fitness certification and training experience have a medical background that qualifies them to modify and scale training programs to address any special medical concerns. This is particularly true with older adults, who should also obtain medical clearance and guidelines from their physician before beginning a serious training program.
Is small group training available? While one to one coaching can be helpful in the beginning to spot and correct proper exercise form, avoid trainers who insist that one to one training is required until you reach your goals. A good trainer can spread the cost of services across a small group of like-minded clients without sacrificing training goals.

Think of a good trainer as a coach – you’ll still need to work hard, but the best ones will help you achieve the highest returns on your effort.

Wii Don't Fall

2008-03-23T16:49:00.000-07:00

The Nintendo Wii gaming system, popular with kids and adolescents, seems to be gaining a following with adults. Not the adult population that you'd first guess, either. It seems that the Wii, particularly the sports programs on the Wii, are being used in retirement communities with older adults as a means to improve function and prevent disability. I'm serious.

Here's a few links to stories about this growing trend:

1. Arizona residents of Pueblo Norte retirement center use Wii. http://www.azcentral.com/arizonarepublic/local/articles/0128wiiseniors0128.html

2. Wii-hab is the label for Wii use in rehabilitation settings, including with stroke patients.

http://wcco.com/health/nintendo.wii.therapy.2.373130.html, and also at

http://www.therapytimes.com/Rehab_Patients_Stay_Spry_with_Nintendo_Wii/content=0402J84C48968286406040441

Research published in 2006 hinted at this application of technology, stating that "Virtual reality has profound applications in the field of balance rehabilitation and training because of its relatively low cost." http://www.ncbi.nlm.nih.gov/pubmed/17946975?dopt=Abstract.

Here in Arizona, StrengthDoc has been asked to develop and manage a project that quantifies the effect of Nintendo Wii use on fall risk in seniors who reside in two retirement communities. Why? Simple - the sports programs that are available on the Wii (tennis, baseball, golf, bowling and boxing) seem to create a real workout for older adults in retirement facilities. The question before us is simple: is the workout that takes place when seniors participate in these games sufficient training to reduce the likelihood of falls? If the answer is "yes" - then a relatively inexpensive and novel approach to disabling falls has been identified. Researchers and graduate students at Northern Arizona University's doctoral program in physical therapy will assist with the study design and data collection for this project, beginning in April. The name of the project? Wii Don't Fall.

Wi'll keep you posted as the project proceeds.

Exercise is medicine

2008-03-21T22:28:00.000-07:00

An apple a day is prescribed in folklore as a way to avoid healthcare services. More evidence has just surfaced to support exercise as a way to stay out of the hospital, particularly with older adults. The benefits of exercise in disease prevention, particularly cardiovascular disease, are clearly supported in a wealth of studies in professional literature. However, one recent study compares health care costs of older adults who exercise to those who do not, finding less need for healthcare services in the exercising group.

Preventing Chronic Disease, a peer-reviewed journal published by the National Center for Chronic Disease Prevention and Health Promotion, is the source for a study entitled "Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults," funded by The Center for Disease Control and Prevention (CDC) and conducted by Group Health Cooperative and the University of Washington (UW). This study compared the health care costs of almost 5,000 individuals enrolled in a formal exercise program tailored to seniors to 9,000 individuals not taking part in the same exercise regimen over a 2-year period. The findings of the study support the assertion that exercise is not only good for your health, but also good for your wallet (and your insurance company’s payments for your healthcare).

The specific findings of the study demonstrate that:

· All exercise participants healthcare expenses were, on average, $500 lower than the non-exercisers.
· Exercisers who averaged at least two visits to the gym each week added an additional $1,252 healthcare cost savings in year 2 than did those who visited less than once per week on average. The savings were even higher for those who visited more than twice a week.
· Exercise participants had significantly less inpatient admissions than non-exercisers.
· Exercise participants had more preventative care visits, adding to the preventative benefit of exercising.

So what does all that mean? Older adults typically consume more health care than younger counterparts, so the study of the impact of exercise on healthcare utilization is significant, particularly if you are an older adult. If your employer or insurance company offers either reimbursement or payment for gym membership – take advantage of this benefit. Examples of this kind of program include either Silver Sneakers (whose members participated in the study mentioned above) or the Silver and Fit programs. Exercise is Medicine! In this case, exercise is medicine that prevents the need for additional medicine, and in many cases, costs you nothing but time and sweat.

Read the entire study here: (article link)

Pushups and bench press

2008-03-21T22:01:00.000-07:00

New York Times journalist Tara Parker-Pope recently wrote an interesting article about the value of pushups as part of your exercise routine. The article brings up several interesting points about the value of pushups and is located here: (article)

Pushups are often seen as archaic, “old school” exercises. You might think that a better approach to developing the same muscles would involve the bench press or some kind of machine, right? After all, almost any well equipped gym will offer the flat bench press, incline benches, decline benches, and even bench press machines that you use lying on your back or seated. High school, college and professional coaches and scouts are very interested in an athlete’s number on their bench press. However, if you analyze this motion, you’ll note that the body is supported and fixed in place while a load is being pushed away from the body. Now, if you have a bookcase knock you to the ground and pin you there, this is a useful skill: lay on the ground and push the weight away from you. However, this is not a pushup motion – in some respects, it is the opposite of that motion.

Pushup is the opposite of a bench press? Yes, unless you are Chuck Norris (more on that later). A pushup involves an unsupported, unfixed body being pushed away from a fixed surface, not an external object moving away from the body resting on a fixed surface. Let me state that a little differently: movement occurs as the body moves under control, not an external weight. In the pushup, your body is the load undergoing movement – and that requires a great deal of body control. Pushups do develop the arms, shoulders and chest, and in addition, also develop strength in the trunk, hips, knees and ankles. The pushup, in other words, engages more joints and muscles in the body and is, arguably, an important exercise for developing greater core control.

The Parker-Pope article suggests that pushups have an important protective role with older adults who are at risk of falls. The ability to react to a fall by taking body weight through the hands may not totally prevent injury, but helps to slow the impact of a “face plant.” Sounds pretty practical to me.

And what about Chuck Norris? Well, while the rest of us push our bodies away from the earth, Mr. Norris supposedly is the only human able to push the earth away from his body during pushups. At least that is what one former presidential candidate stated here: (video)

Weightlifting and Seniors

2008-03-20T06:09:00.000-07:00

Here's a question that comes up with individuals over 65 that train with me: When am I too old for weightlifting? While some medical conditions might support only walking for health, the good news is that those conditions are few and far between. The question really relates to a concept known as “exercise intensity.” Formerly, the general consensus was that higher intensity exercise (such as weightlifting) was too stressful for older adults. However, several respected studies clearly promote weightlifting to combat bone weakness, muscle loss, and the loss of regular function.

Dr Maria Fiatarone of Tufts University published a hallmark study tied to this question with nursing home residents over 90 years old. Ninety years old! Her 10 week, high intensity program created average strength gains of 174%, better walking speed and increased spontaneous activity. The authors concluded that “…high-resistance weight training leads to significant gains in musclestrength, size, and functional mobility among frail residents of nursinghomes up to 96 years of age.”

In another study (Morganti and colleagues), 39 women, average age of 60, underwent 1 year of resistance training. The study conclusion was “….high intensity strength training results in substantial, continual increases in strength in postmenopausal women for at least 12 months.”

Now you might think that these two studies are relatively new: you’d be wrong. Both studies are over 10 years old. Scores of studies since these two support the notion that weightlifting benefits older adults as well as younger.

In 2007, Puthoff and Nielsen’s study of the relationship of strength to function and disability in 30 older adults, average age of 77 years, concluded that: “Older adults should focus on increasingand maintaining lower-extremity strength and power across arange of intensities in order to decrease functional limitationsand disability.” An effective means to strength and power across a range of intensity? Weightlifting.

So, the message is clear – high intensity training, even (gasp) weightlifting, can be utilized by older adults! Best to seek the advice of an experienced physical therapist or fitness specialist for evaluation, program design and coaching - but then go get your dose. Exercise is medicine!

Summit Health and Fitness

2008-03-19T21:13:00.000-07:00

Strengthdoc is moving. High Country is calling.

Summit Health and Fitness (SHAF) is an expansive, well equipped and attractive gym with in-house physical therapy clinic in Flagstaff, Arizona. I've relocated to participate in an usual experiment that asks the question, "What would a fitness center look like if the owners were all healthcare providers?" I've been involved since early 2008, and so far the answer includes these kind of components:

1. Silver and Fit: A gym membership for older adults courtesy of their insurance company, Humana Gold, including special group exercise classes and limited personal training sessions to help make the new members feel at home in the gym.
2. Lose to Win: Educational and trial memberships for adults seeking to lose weight, a collaborative project with the local newspaper to publicly applaud participants who shed excess weight in a move toward better health.
3. Peaks Weightlifting Club chose to relocate from a long standing location to SHAF for club member training in Olympic weightlifting.
4. Center for High Altitude Training (CHAT), one of nine US Olympic Training Sites and official US Track and Field training center, utilizes SHAF facility and staff for resident and visiting athlete therapy and training.
5. Express boot camp classes and CrossFit training for small groups and individuals looking for an extra edge in strength, conditioning and physical performance.

Limited training, by appointment, is available in the Anthem community in the Spring months, before it gets hotter than blazes beginning Summer, 2008. Training services will eventually relocate to SHAF as demand dictates.

Other answers to the initial question currently go unanswered, but are in process and will be posted as they surface......

Strong Girls Rule!

2007-08-14T20:43:00.001-07:00

The last post mentioned a new class starting on Tues and Thurs mornings at 7am at Orthopedic Sports Rehab, a physical therapy clinic in Anthem. The class (OSR Team 7) has been composed of Crickett and Jill, who have not only faithfully made every session, but also have, to their credit, come ready to work hard. These training sessions take participants to the margin of their capacity in order to stretch performance limits, and they have willingly gone to that level of intensity each and every sesssion. It has been about 3 weeks since they started training and their improvements are already impressive.

One of CrossFit's hallmark workouts is named "Angie" and it involves 100 reps of pushups, pullups, situps and air squats for time. This workout, like all the others, can be scaled and modified to match the work to that individual's present abilities. For instance, with beginners the pushups can be performed with knees in contact with the ground, the pullups can involve a jumping move to get the chin above the bar, the squats can be "partial squats" to an elevated target and hands can assist the pull on the situp. Jill and Crickett employed some of these strategies on their first Angie workout on July 24. They repeated the same workout today, just 3 weeks later, and delivered impressive gains.

Crickett was able to complete the full 100 reps of all 4 exercises on July 24 in 20 mins and 6 secs. Today she did the same workout in 18 mins and 15 seconds, an almost 2 minute reduction in time. Her situps, in particular, have markedly improved in form and speed. Jill's initial time for 55 reps of all 4 exercises was 20 mins and 55 secs before she simply "ran out of gas." Her time today, for a full 100 reps of all 4 exercises, was 18 mins 55 secs - a big jump in her ability to both compress and sustain high intensity work. Both women are developing measurable improvements in power and endurance. They both are to be commended for the work that went into these results.

Crystal joins us today for her first session, bringing the same kind of determination as the other two "veterans." She completed 50 reps of all four exercises in an impressive 13 mins 30 secs, hinting that one more strong girl has joined up with OSR Team 7.

Congratulations to OSR Team 7 - and keep up the good work. I'll post a few pictures from today's session in the gallery.

New Classes

2007-07-19T13:54:00.000-07:00

Ah, the ebb and flow of the training world. The last post mentioned waning summer attendance, and this post announces new classes starting up.

Orthopedic Sports Rehab, Tuesday and Thursday mornings @ 7am. For all your morning exercise folk: training with a small group of like minded and breathless cohorts is available for a limited number in air conditioned comfort. Call me at 623.330.9136 to check for available slots in this class.

Ironwood Golf and Country Club, Tuesday and Thursday @ 10:30 beginning Sept 6. Limited to residents of the Anthem Country Club. Class size will be capped at 8 attendees for this introductory level CrossFit style class. Call Ironwood staff at 623.742.6200 or visit the website at http://www.anthemgolfclubaz.com/fitness.asp.

You can always check my website at http://www.strengthdoc.com/schedule.html for updates on class schedules and locations.

Summer training adjustments

2007-07-08T21:01:00.000-07:00

Summer has been brutal - yes, it is over 110 degrees on a pretty regular basis, but that's not what I mean. Maybe it is the heat, maybe it is vacation, maybe something else, but the burgeoning attendance from April and May has taken a nose dive.

Yes, many of you have stayed the course and for that I'm impressed with you. These workouts are tough, even tougher when it is hot, and I do understand how summer vacations throw a monkey wrench into schedules and routines. I've had thoughts of closing training down for the summer and starting back up in the Fall, but have decided against it. Here's the deal instead.

Effective July 1, I'm putting the workouts that were previously being held at Orthopedic Sports Rehab on hold until school starts. It doesn't make sense for me to continue to pay a rental fee to use the air conditioned space there when zero to no folks show for the workouts. So, group times for OSR are currently on hold, to be re-evaluated in the Fall.

Workouts in the Garage of Pain (GOP) in Anthem will continue with shade and the rolling evap cooler providing some measure of relief from the heat. Any other elements of discomfort in terms of temps falls under the category of training the body in "desert survival training." Consider it one more added benefit of training: conditioning to survive summers here. Gatorade and cold water are on hand in the garage 'frig as are freshly laundered towels. Monthly dues will continue to pay for training equipment for the GOP. Kettlebells and Concept II rower, like new with the fresh overhaul kit installed, are new additions. Next on the purchase wish list are fat bands for pullup assistance from JumpStretch Bands ( http://www.jumpstretch.com/ ).

Also, training on Monday evenings at 5:30 at Keven's Gym in the Arrowhead area will continue. New folks will be initially scheduled for 6:15, with the potential to move to 5:30 after an initial phase of training has been completed. This provides me the opportunity to keep a close eye on both form and symptoms during the early stages of adjustment to CrossFit's approach.

And for all you studs and studettes who have stayed the course: well done! CrossFit training is intense, and it doesn't fit the mold of what I've grown to call the image and beauty approach. As you've heard me say several times, these workouts are about creating functional athleticism, not Muscle and Fitness magazine models. The body changes seem to lag behind the actual strength and conditioning gains: CrossFit trained athletes, novice to expert, are more fit than they appear. My limited experience leads me to conclude that it takes 6 months of regular and sustained effort before body image starts to really reflect the fitness level. At that point, you won't only appear to be fit, you will look fit because you actually have created a real and measurable level of fitness. It takes time to reach that magic state of detraining that passes as healthy living. It makes sense that it would take time to reverse the trend, and create a level of fitness that is part and parcel to the intended design.

Six months of sustained training produces real reason to be encouraged as you achieve a surprising level of strength, power and endurance. Stay the course. After a year of training, you'll find yourself wondering what your limitations really are..............

What happens in Vegas.....

2007-06-30T07:00:00.000-07:00

In this case, what happens in Vegas will grow in Vegas. StrengthDoc has been asked to help The Merrill Companies (http://www.themerrillcompanies.com/) develop a new and unique approach to senior living. The Merrill Lifestyle Residence is a 50 story, 600 residence campus with upscale amenities near the Vegas Strip. An integral part of the Merrill campus offering will be on site physical therapy, fitness center and spa for residents.

Strength and conditioning is an important element of this project for a couple of reasons. First and foremost, physical fitness in the 65 and older crowd is not primarily tied to concerns about body image, but independence. The research literature, popular literature and widespread experience demonstrate a clear, positive relationship between strength and functional independence. See, for instance, the Tufts University Newsletter article at http://healthletter.tufts.edu/issues/2003-03/sarcopenia.html. Put bluntly, strength training can provide the difference between independence and frailty in seniors.

The second reason strength training is important to this project has to do with shared mutual benefit: both the resident and The Merrill Company win when residents remain healthy and strong. This relationship stands in contrast to a conventional health care facility model with provider and patient benefitting from a patient's dependence on the provider to furnish services based on a disability. This shared reliance on strength and independent function creates a unique partnership, as well as compelling, significant, fun work for the StrengthDoc. Stay tuned for updates.

More information at http://www.themerrillcompanies.com/currentdevelopments.asp

Trevor Win'E Fundraiser Update

2007-06-25T13:59:00.000-07:00

Funds were mailed to the Trevor Win'E Foundation with the goal of 12 cooling vests met! Overall, the CrossFit organization raised funds for over 200 vests.

Thanks to all who pledged and actually did the workout to raise the funds. Rest assured that a fair degree of suffering was experienced by those who volunteered for the workout. Three cases of severe DOMS (Delayed Onset Muscle Soreness) persisted well beyond the normal 48 to 72 hours with upper body swelling, particularly in the biceps region. Good news: We'll be integrating more pullups into the workouts to prevent that from occuring again! Bad news: We'l be integrating more pullups into the workout to prevent that from happening again.

Nice work, team.

Kipling on Fitness

2007-05-26T23:08:00.000-07:00

Rudyard Kipling weighs in on the importance of fitness:

"Nations have passed away and left no trace,
and history gives the naked cause of it--
one single, simple reason in all cases;
they fell because their people were not fit."

Memorial Day Fundraiser

2007-05-15T16:01:00.000-07:00

It gets hot in Iraq. Nasty Hot. On Memorial Day weekend, a small group of Anthem CrossFitters will conduct a fundraising event to provide a little relief from the heat for deployed U.S. troops. This event is tied to the Trevor Win'E Foundation (http://www.trevorwine.com/article.php).

Army SPC Trevor Win'E was killed in action by an IED (improvised explosive device) near Mosul, Iraq on May 1, 2004 shortly after his mother sent him one of her last gifts: a "Modular Combat Cooling System." When the manufacturer of the cooling vest contacted her shortly after the purchase, he learned she had buried Trevor a week earlier. Out of that conversation, a non profit organization was formed to send cooling vests to troops overseas, first to others in Trevor's unit, then to hundreds of other troops.

CrossFit Affiliates are partnering with this organization in a Memorial Day fundraiser with the goal of providing more cooling vests through the Trevor Win'E Foundation. Teams of 4 will complete a workout called "Trevor" that calls for a 4 person team to complete, collectively, 300 pullups, 400 pushups, 500 situps and 600 squats. The CrossFit team at Anthem will collect pledges toward this effort with the goal of furnishing 12 vests for distribution through the Foundation. We are asking for $40 pledges: the vests are made available to the Trevor Win'E Foundation at $160 each, discounted from the manufacturer's list price of $225. If you would like to see a video demonstration of the workout, it can be viewed at http://media.crossfit.com/cf-video/CrossFit_TrevorTeamWOD.mov. Please note that this demonstration comes to you compliments of some of the "CrossFit Stars" out of headquarters in Santa Cruz. We'll be taking a bit longer to complete the workout......but we will finish it.

If you'd like to contribute to this fundraiser, please contact me at jt57dpt05@gmail.com, or call me at 623.330.9136. Love to have you help with this effort. I'll post where and when we will conduct the workout for your viewing and cheering pleasure.

Another CrossFit convert from the healthcare ranks.....

2007-05-13T22:17:00.000-07:00

Heard from someone else more interested in promoting health than treating pathology.....this in my inbox today from Corey, who writes:

Dr. Tuitele: I am a chiropractic student in central New York and found your site thru Crossfit.com. I am very excited to see your perspective on health and function for your patients. I had started making plans for opening a practice in an approach different to those of my colleagues, utilizing that which makes for optimal health and balanced activity. I wanted to focus on getting my patients to be more active, and for those who already are, to keep them as safe and active as they can. Well 3 months ago I was turned onto CrossFit by a friend and have been blown away. I instantly saw the changes I had been able to make in my own life, reaching a level of fitness that I had long since thought was impossible without devoting my entire waking life to training. And, as you surely know, my thoughts quickly progressed to my practice and how application of the Crossfit principles and motivations fit precisely what I was looking to achieve with my patients. Beyond that, I have already taken my parents and gotten them on the path to greater fitness. My mother can currently perform 10 air squats and hang from a pull up bar for 12 seconds, two feats she never considered possible - this is after only 3 weeks of gentle training and progression of her skills. I get excited waiting for their calls with a new feat and gives me a great sense of hope for their lives, as well as the lives of my future patients.....

Old Guard

2007-05-11T08:19:00.000-07:00

At a physical therapy seminar this past weekend, a colleague asked "What are you doing these days, John?" I remarked that I was working on the prevention side of health, trying to keep people out of therapy, probably trying to run other physical therapists out of business. Her expression changed and as she walked away, she commented "That's not a good goal."

Interesting response: in my mind, the concept of fiduciary duty is central . Fiduciary is from the Latin fiducia, meaning "trust," a person (like a physician or physical therapist) who has the power and obligation to act for another under circumstances which require total trust, good faith and honesty. The public looks to physical therapists with an expectation that, first and foremost, the patient's (or client's) health is the central and dominant goal. Keeping people out of therapy, then, would be in line with fiduciary duty. That is not a great way to grow private practice business revenue, but that's the funny thing about healthcare: the practitioner is expected to be happiest when demand for his/her services are diminishing, not expanding.

At the same seminar, two days of instruction centered around treatment and prevention of knee injuries, particularly in young athletes. The instructor, Christopher Powers, PhD, PT is a USC professor who conducts research in biomechanics (in other words, he's a pretty smart guy). His comprehensive analysis of anatomy, biomechanical analysis, and treatment rationale had one important exercise as critical to prevention of knee pain and injuries. Suffice it to say that all of you who train with me will be doing more squats in the future.

First post

2007-05-04T23:25:00.000-07:00

Welcome to the new website. We're still under construction, but go ahead and browse around.

Go to "Why CrossFit makes Sense" for my take on the most effective strength and conditioning program I've encountered. If you are interested in my background, press the "Meet StrengthDoc" button. Locations and costs for training are covered in "Class Schedule/Locations" and "Invest in Yourself" links.

Across the next few weeks, the stock photos will be replaced with pics of athletes that train with me using CrossFit methods. Go to the Gallery now to see photos of some of the group I refer to affectionately as the "Temple Dogs."

I'll also be giving updates on two new projects outside of training athletes locally: design and startup of a fitness center/physical therapy department for a new retirement community and information on the "StandStronger" program, a strength and conditioning approach specifically designed to decrease falls in frail elderly. There is alot going on with StrengthDoc, and we're just getting started.

Be sure to visit www.crossfit.com - a great site committed to developing elite fitness. You also find my story of the program's benefit to me personally on CrossFit's message board at http://www.crossfit.com/discus/messages/29/40756.html.

Thanks for visiting.