Metabolic Inflexibility Literature Review

Below is a shorter literature review I did as part of my PhD research. It can be on the dry side, but the take away is that as your body gets closer to a Metabolically INflexible state (e.g. diabetes) you have a much harder time process any food and turning it into a good fuel sources.

If you are very Metabolically Flexible, you can adapt to virtually any fuel source (e.g. various foods). Now this is not an argument for going crazy and eating Ho Hos and Krispy Kremes, there are limits!

The point is that every is different and perhaps there is a way to quantify how metabolically efficient each person's body is without subjecting them to IVs and sticks in the arm for hours at a time.

Any questions, let me know and I will be happy to discuss. Big thank you to my advisor Dr. Don Dengel and Dr. George Biltz for the ideas, background, and all the support.

Enjoy

Mike N

METABOLIC INFLEXIBILITY

It is no secret that in the United States, the rate of obesity in children is on the rise. In fact, childhood obesity in the US has tripled over the last 40 years and doubled in the past 15 years

(32). About 40% of adolescents seen in the University of West Virginia pediatric clinic have body mass index (BMI) greater than 85% for gender and age (44). Body fat and its distribution is related to cardiovascular disease, hypertension and type 2 diabetes, all diseases that are considered to have an “incubation period” during childhood and adolescence (51). In 2003-2004 17.1% of US children and adolescents (age 2 to 19) were overweight (defined as at or above the 95^th percentile of the sex specific BMI for age growth charts) (29). If the current epidemic of child and adolescent obesity continues at the same rate, life expectancy could be shortened by two to five years in the coming decades(30) and it will be the first time in recent history that life

expectancy has decreased.

LITERATURE REVIEW

Metabolic Flexibility

Due to possible discontinuities in both the supply and demand for energy, humans need a “clear capacity to utilize lipid and carbohydrate fuels and have the ability to transition between them.” (18). This capacity is a healthy state and termed “Metabolic Flexibility”. It is hypothesized that metabolic inflexibility may play a role in various disease processes such as the metabolic syndrome that may even start in childhood (3, 27, 28, 46). Location of body fat may affect

disease risk also and data from prospective studies using waist to hip ratio or waist circumference confirmed that abdominal obesity is more closely associated with disease risk than total body fatness(6, 7, 22).

A key to understanding metabolic flexibility is the vital role of insulin. In humans, insulin is a regulatory hormone synthesized in the pancreas within the beta cells (β-cells) of the islets of Langerhans. Insulin can be characterized by two phases an initial (cephalic phase) driven by the nervous system and a sustained secondary phase (1). Some data indicated that variations in prestimulatory glucose can secondarily affect the magnitude and pattern of subsequent glucose-induced insulin secretions (13). Humans in a healthy state with normal insulin

metabolism have the ability to effectively switch from primarily a fat metabolism to a carbohydrate metabolism. Also, in human subjects that reach a stage in the metabolic syndrome characterized by insulin resistance and glucose intolerance bordering on frank diabetes, there is still considerable beta-cell capacity demonstrating a clear absence of the normal initial peak of insulin secretion (5, 45). Skeletal muscle is a major player in energy balance due to its metabolic activity, storage capacity for both glycogen and lipids, and its effects on insulin sensitivity (9-11). Obesity/visceral fat, transient state of puberty, ethnicity, genetic factors, and physical inactivity all may lead to insulin resistance (2).

Elevated lipid content and intramuscular triglyceride (IMTG) are both linked to insulin

resistance (20)and thus compromise efficient lipid utilization. Perseghin et al. (31) used magnetic resonance spectroscopy (MRS) to report that lipids contained within muscle fibers were strongly correlated with the severity of insulin resistance. In metabolically inflexible subject, lipid oxidation may fail to increase with fasting and fail to suppress with hormonal insulin elevation. Lowered post-absorptive fatty acid oxidation leads to excess accumulation of IMTGs and begins a downward spiral. Interestingly, endurance trained athletes also have an increased IMTG level, but remain insulin sensitivity (perhaps from increased turnover rate) (9).

Kelley et al. (17) (as shown in Figure 1 below) showed that under basal fasting conditions glucose uptake and oxidation are normal or even increased in obese subjects compared with lean subjects. Fatty acid uptake is also normal, but fatty acid oxidation is lower and its storage is elevated in the obese group which may explain why they have a higher body fat as they are more apt to store fat.

During a hyperinsulinaemic euglycaemic clamp condition the differences between lean and obese are quite different. In lean subjects, glucose uptake increased 10 fold with both oxidation and storage primarily contributing while fatty acid uptake decreased equally dramatically. In

obese subjects however, glucose uptake, oxidation and storage are reduced; which is quite a different response from the lean group.

Figure 1 (47) shows the contributions of lipid and glucose oxidation to resting energy expenditure of the leg. Obese subjects derived relatively less energy from lipid oxidation during basal conditions; showing a blunted fat burning response. During insulin-stimulated conditions, lean subjects show a greater suppression of lipid oxidation compared to the obese group under

the same conditions.

Figure 1 from Kelley et al. 1999

In summary, Kelley et al. (17) presented data from subjects with type 2 diabetes showing metabolic inflexibility as obese subjects derived relatively less energy from lipid oxidation during basal conditions (P<0.01). Lean subjects showed a greater suppression of lipid oxidation during insulin-stimulated conditions (p<0.01). As shown in Figure 2 below, lean subjects have a different response compared to obese and diabetic's subjects as carbohydrate oxidation is increased (19).

Figure 2 from Kelley et al. (19)

Assessment of Metabolic Inflexibility

One way to assess metabolic flexibility is by the infusion of drugs (insulin, glucose, etc) to alter the metabolic environment. The downside is that this is more difficult to use in a clinic, requires more specialized training, and is not generally an option for children due to its invasive nature. Metabolic inflexibility is also dynamic in nature and the data collected are normally for acute settings and brief time periods only. An ideal method of assessment would be non invasive and able to collect dynamic data.

HRV

A noninvasive measure of a dynamic system is done currently by the collection of cardiac data via heart rate variability (HRV) (40). HRV analysis has been used extensively to assess autonomic control of the heart under various physiologic conditions. Most often linear analysis is done in both the time and frequency domain.

There are some data to suggest a difference in HRV for obese and non-obese individuals (25). It is well know that the autonomic nervous system ANS) plays an important role in regulating energy expenditure and body fat content, but to what extent is not exactly clear. Nagai, et al. (25) studied 42 non-obese and obese healthy school children where both groups were matched for age, gender, and height. ANS activity was assessed by HRV power spectral analysis. The results showed that the obese children had reduced sympathetic as well as parasympathetic nerve activity which could be a factor in preventing and treating obesity.

Activity is also known to affect HRV (26). Nagai et al. (26) presented data that lean active children demonstrated a lower resting heart rate (HR) as well as higher total power (TP), low frequency (LF), and high frequency (HF). LF reflects mixed sympathetic (SNS) and parasympathetic (PNS) activity, HF reflects PNS activity and TP evaluating the overall ANS activity. In contrast, obese-inactive group showed significantly lower TP, LF and HF. These data suggest obese children have reduced sympathetic and parasympathetic nervous activities as compared to lean children with similar physical activity levels. This autonomic reduction that is associated with the amount of body fat in inactive state may be an important factor for the onset or development of childhood obesity. The good news is that regular physical activity could contribute to enhance the ANS activity in both lean and obese children (26).

There are some data to suggest alterations in HRV in young patients with diabetes (14). Autonomic neuropathy is a common complication of diabetes mellitus (DM) and the aim of the study was to assess HRV changes during prolonged (40 minute) supine rest in 17 young patients with DM compared to an aged matched healthy control group. HRV analysis consisted of time/frequency domains, Poincare and sequence plots and sample entropy. The study found that HRV was able to distinguish cardiac dysregulation in young patients with DM from a control group. However, it did not find any significant difference in sample entropy between the groups, perhaps due to the subtle nature of the cardiovascular impairment in young DM patients (14). Data from Porta et al. (41) used SampEn and ApEn to analyze HRV during a head-up tilt test and concluded that with short duration data SampEn was significantly more reliable at producing accurate entropy scores.

HRV provides a non invasive method that is able to capture data in a dynamic fashion, but to date it has very limited data regarding its relation to metabolic inflexibility.

Sample Entropy

Entropy, in the original context of thermodynamics is a measure of system disorder and randomness. Approximate entropy was first coined by Pincus et al. (36) in 1991 as a way to quantify the dynamic control of a system (such as HR control) and possibly analyze many other “random” sequences (34). The promise of approximate entropy (ApEn) is that it can classify complex systems with only 100 data values in diverse setting that include both deterministic chaotic and stochastic processes (34). To date, ApEn has been used in the analysis of medical data (37), cardiology (16, 43) and neurohormonal responses (15, 35, 38, 49, 50).

The ApEn algorithm counts each sequence as matching itself to avoid the occurrence of ln (0) in the calculations. ApEn is heavily dependent on the record length and is uniformly lower than expected on short records (42). It is also lacking in relative consistency meaning that if ApEn for one data set is higher than another, it should but does not remain higher for all conditions tested (33).

Sample entropy (SampEn) was developed to reduce the bias of ApEn as it does not count self-matches. Richman et al. (42) defines SampleEn as “precisely the negative natural logarithm of the conditional probability that two sequences similar for m points remain similar at the next point, where self-matches are not included in calculating probability.” So a lower value of SampEn indicates more self-similarity (and thus less variability). SampEn is defined in terms (m,r, N) where m is the length of sequences to be compared, r is the tolerance for accepting matches and N is the length of the time series. Another benefit of SampEn is that it does not use a template-wise approach when estimating conditional probabilities as it is in essence an event-counting statistic (42). In a study by Richman et al. (42) SampEn agreed much better than ApEn statistics with theory for random numbers with known probabilistic character over a broad range of operating conditions and it has successful been used to calculate HRV on very short ECG mV recordings (10 to 60 seconds); so it does not appear to require long periods of data collection (4). HRV calculated by SampEn has been used in studies on recovery post exercise training (12, 24) and alterations due to disease and aging (39). Lake et al. (21)performed a sample entropy analysis of neonatal HRV in an attempt to predict sepsis and found that entropy falls before clinical signs of neonatal sepsis and also that missing data points were well tolerated.

RER

The RER is the ratio of the volume of CO2 to O2 and can be measured with a metabolic cart to collect expired gases. The RER at steady state is displayed as a ratio between 0 .7 to 1.0 where 0.7 corresponds to 100% fat metabolism, 0.85 corresponds to 50% fat and 50% carbohydrate metabolism and 1 corresponds to 100% carbohydrate metabolism.

RER has been found to be reproducible during exercise under standardized conditions (23), but factors such as age, gender, dietary substrate intake, insulin, and plasma free fatty can influence the selection of substrates during exercise and hence alter RER(8, 48).

IMPLICATIONS

With the rise in obesity, it will be imperative to have a method to determine which children are on the fast track to further metabolic damage. Current methods such as insulin clamps may be effective, but they require more training on the clinician side, more difficult to obtain IRB approval and many times will not be used children due to their invasive nature. Future studies may be conducted on newer non-invassive methods to determine metabolic inflexibility and potentially investigate the effects of various forms of exercise and nutrition methods to combat obesity in children and target those in high risk groups.

References

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2. Amiel S. A., S. Caprio, R. S. Sherwin, G. Plewe, M. W. Haymond, W. V. Tamborlane. Insulin resistance of puberty: a defect restricted to peripheral glucose metabolism. J Clin Endocrinol Metab. 72(2):277-282, 1991.

3. Arslanian S., C. Suprasongsin. Insulin sensitivity, lipids, and body composition in childhood: is "syndrome X" present? J Clin Endocrinol Metab. 81(3):1058-1062, 1996.

4. Bornas X., J. Llabres, M. Noguera, A. Pez. Sample entropy of ECG time series of fearful flyers: preliminary results. Nonlinear Dynamics Psychol Life Sci. 10(3):301-318, 2006.

5. Bruce D. G., D. J. Chisholm, L. H. Storlien, E. W. Kraegen. Physiological importance of deficiency in early prandial insulin secretion in non-insulin-dependent diabetes. Diabetes. 37(6):736-744, 1988.

6. Donahue R. P., R. D. Abbott. Central obesity and coronary heart disease in men. Lancet. 2(8569):1215, 1987.

7. Ducimetiere P., J. Richard, F. Cambien. The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study. Int J Obes. 10(3):229-240, 1986.

8. Goedecke J. H., A. St Clair Gibson, L. Grobler, M. Collins, T. D. Noakes, E. V. Lambert. Determinants of the variability in respiratory exchange ratio at rest and during exercise in trained athletes. Am J Physiol Endocrinol Metab. 279(6):E1325-34, 2000.

9. Goodpaster B. H., J. He, S. Watkins, D. E. Kelley. Skeletal muscle lipid content and insulin resistance: evidence for a paradox in endurance-trained athletes. J Clin Endocrinol Metab. 86(12):5755-5761, 2001.

10. Goodpaster B. H., D. E. Kelley. Skeletal muscle triglyceride: marker or mediator of obesity-induced insulin resistance in type 2 diabetes mellitus? Curr Diab Rep. 2(3):216-222, 2002.

11. Goodpaster B. H., S. Krishnaswami, H. Resnick, et al. Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women. Diabetes Care. 26(2):372-379, 2003.

12. Heffernan K. S., C. A. Fahs, K. K. Shinsako, S. Y. Jae, B. Fernhall. Heart rate recovery and heart rate complexity following resistance exercise training and detraining in young men. Am J Physiol Heart Circ Physiol. 293(5):H3180-6, 2007.

13. Henquin J. C., M. Nenquin, P. Stiernet, B. Ahren. In vivo and in vitro glucose-induced biphasic insulin secretion in the mouse: pattern and role of cytoplasmic Ca2+ and amplification signals in beta-cells. Diabetes. 55(2):441-451, 2006.

14. Javorka M., J. Javorkova, I. Tonhajzerova, A. Calkovska, K. Javorka. Heart rate variability in young patients with diabetes mellitus and healthy subjects explored by Poincare and sequence plots. Clin Physiol Funct Imaging. 25(2):119-127, 2005.

15. Juhl C. B., O. Schmitz, S. Pincus, J. J. Holst, J. Veldhuis, N. Porksen. Short-term treatment with GLP-1 increases pulsatile insulin secretion in Type II diabetes with no effect on orderliness. Diabetologia. 43(5):583-588, 2000.

16. Kaplan D. T., M. I. Furman, S. M. Pincus, S. M. Ryan, L. A. Lipsitz, A. L. Goldberger. Aging and the complexity of cardiovascular dynamics. Biophys J. 59(4):945-949, 1991.

17. Kelley D. E., B. H. Goodpaster. Skeletal muscle triglyceride. An aspect of regional adiposity and insulin resistance. Diabetes Care. 24(5):933-941, 2001.

18. Kelley D. E., J. He, E. V. Menshikova, V. B. Ritov. Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes. Diabetes. 51(10):2944-2950, 2002.

19. Kelley D. E., L. J. Mandarino. Fuel selection in human skeletal muscle in insulin resistance: a reexamination. Diabetes. 49(5):677-683, 2000.

20. Kelley D. E., F. L. Thaete, F. Troost, T. Huwe, B. H. Goodpaster. Subdivisions of subcutaneous abdominal adipose tissue and insulin resistance. Am J Physiol Endocrinol Metab. 278(5):E941-8, 2000.

21. Lake D. E., J. S. Richman, M. P. Griffin, J. R. Moorman. Sample entropy analysis of neonatal heart rate variability. Am J Physiol Regul Integr Comp Physiol. 283(3):R789-97, 2002.

22. Lapidus L., C. Bengtsson, B. Larsson, K. Pennert, E. Rybo, L. Sjostrom. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed). 289(6454):1257-1261, 1984.

23. Laplaud D., R. Menier. Reproducibility of the instant of equality of pulmonary gas exchange and its physiological significance. J Sports Med Phys Fitness. 43(4):437-443, 2003.

24. Lewis M. J., A. L. Short. Sample entropy of electrocardiographic RR and QT time-series data during rest and exercise. Physiol Meas. 28(6):731-744, 2007.

25. Nagai N., T. Matsumoto, H. Kita, T. Moritani. Autonomic nervous system activity and the state and development of obesity in Japanese school children. Obes Res. 11(1):25-32, 2003.

26. Nagai N., T. Moritani. Effect of physical activity on autonomic nervous system function in lean and obese children. Int J Obes Relat Metab Disord. 28(1):27-33, 2004.

27. Nistala R., C. S. Stump. Skeletal muscle insulin resistance is fundamental to the cardiometabolic syndrome. J Cardiometab Syndr. 1(1):47-52, 2006.

28. Oakes N. D., P. Thalen, E. Aasum, et al. Cardiac metabolism in mice: tracer method developments and in vivo application revealing profound metabolic inflexibility in diabetes. Am J Physiol Endocrinol Metab. 290(5):E870-81, 2006.

29. Ogden C. L., M. D. Carroll, L. R. Curtin, M. A. McDowell, C. J. Tabak, K. M. Flegal. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 295(13):1549-1555, 2006.

30. Olshansky S. J., D. J. Passaro, R. C. Hershow, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 352(11):1138-1145, 2005.

31. Perseghin G., P. Scifo, F. De Cobelli, et al. Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans: a 1H-13C nuclear magnetic resonance spectroscopy assessment in offspring of type 2 diabetic parents. Diabetes. 48(8):1600-1606, 1999.

32. Pietrobelli A., M. S. Faith, D. B. Allison, D. Gallagher, G. Chiumello, S. B. Heymsfield. Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr. 132(2):204-210, 1998.

33. Pincus S. Approximate entropy (ApEn) as a complexity measure. Chaos. 5(1):110-117, 1995.

34. Pincus S., R. E. Kalman. Not all (possibly) "random" sequences are created equal. Proc Natl Acad Sci U S A. 94(8):3513-3518, 1997.

35. Pincus S. M. Orderliness of hormone release. Novartis Found Symp. 227:82-96; discussion 96-104, 2000.

36. Pincus S. M. Approximate entropy as a measure of system complexity. Proc Natl Acad Sci U S A. 88(6):2297-2301, 1991.

37. Pincus S. M., I. M. Gladstone, R. A. Ehrenkranz. A regularity statistic for medical data analysis. J Clin Monit. 7(4):335-345, 1991.

38. Pincus S. M., J. D. Veldhuis, A. D. Rogol. Longitudinal changes in growth hormone secretory process irregularity assessed transpubertally in healthy boys. Am J Physiol Endocrinol Metab. 279(2):E417-24, 2000.

39. Platisa M. M., V. Gal. Dependence of heart rate variability on heart period in disease and aging. Physiol Meas. 27(10):989-998, 2006.

40. Platisa M. M., V. Gal. Reflection of heart rate regulation on linear and nonlinear heart rate variability measures. Physiol Meas. 27(2):145-154, 2006.

41. Porta A., T. Gnecchi-Ruscone, E. Tobaldini, S. Guzzetti, R. Furlan, N. Montano. Progressive decrease of heart period variability entropy-based complexity during graded head-up tilt. J Appl Physiol. 103(4):1143-1149, 2007.

42. Richman J. S., J. R. Moorman. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 278(6):H2039-49, 2000.

43. Ryan S. M., A. L. Goldberger, S. M. Pincus, J. Mietus, L. A. Lipsitz. Gender- and age-related differences in heart rate dynamics: are women more complex than men? J Am Coll Cardiol. 24(7):1700-1707, 1994.

44. Someshwar J., S. Someshwar, K. C. Perkins. The obese adolescent. Pediatr Ann. 35(3):180-186, 2006.

45. Storlien L., N. D. Oakes, D. E. Kelley. Metabolic flexibility. Proc Nutr Soc. 63(2):363-368, 2004.

46. Stump C. S., E. J. Henriksen, Y. Wei, J. R. Sowers. The metabolic syndrome: role of skeletal muscle metabolism. Ann Med. 38(6):389-402, 2006.

47. Takarada Y., H. Takazawa, N. Ishii. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc. 32(12):2035-2039, 2000.

48. Toubro S., T. I. Sorensen, C. Hindsberger, N. J. Christensen, A. Astrup. Twenty-four-hour respiratory quotient: the role of diet and familial resemblance. J Clin Endocrinol Metab. 83(8):2758-2764, 1998.

49. Veldhuis J. D., M. L. Johnson, O. L. Veldhuis, M. Straume, S. M. Pincus. Impact of pulsatility on the ensemble orderliness (approximate entropy) of neurohormone secretion. Am J Physiol Regul Integr Comp Physiol. 281(6):R1975-85, 2001.

50. Veldman R. G., M. Frolich, S. M. Pincus, J. D. Veldhuis, F. Roelfsema. Growth hormone and prolactin are secreted more irregularly in patients with Cushing's disease. Clin Endocrinol (Oxf). 52(5):625-632, 2000.

51. Wells J. C., M. S. Fewtrell. Is body composition important for paediatricians? Arch Dis Child. , 2007.

Merry Christmas and Z Health Story

Merry Christmas (Happy Holidays to those that celebrate something else other than Christmas) to everyone! Thanks again for the precious time that you take to read my ramblings, as it is much appreciated. I feel so privileged to be doing something that I truly love and anything that I can do to help provide some good info in the process is great.

I look forward to even more excellent interactions coming up in 2008! Tons of great stuff coming up.

Z Health Story
The athlete that I have been working with for the past year about 2-3 times a week showed up last week with major "upset stomach" and progressively got worse on all movements. His stomach was quite bloated and hurt with mild pressure. We did the Z Health Neuro Warm up 1 and it did not help. I tried some hands on work around the abdominal area in different directions, pressure, etc with no luck. I did a visual test (PREP) and he tested positive with eyes down and closed (lately he has been testing clear), so I had him do an Egyptian (Z Health drill where you move your head side to side like in that old 80s horrible video from a certain nameless band, hehehe) with his eyes closed and down.

After walking around for a bit he started to feel better and about 10 minutes later we were able to do some push ups and lighter body weight movements and his movement dramatically improved from earlier in the session.

The amazing part was that by the time he left he felt relatively good (not great) and the distention in his abdominal area had reduced quite a bit. Pretty amazing and behold the power of the nervous system!

I honestly am not entirely sure of the reason for the result. Maybe it was related to some cranial tension, particular eye movement, perhaps just more neuro input, or opposite joints between the neck and pelvis; but it worked and he left better than when he came in---so I met my goal.

Rock on!
Mike N

Stress, Holidays, Pain and Chili Peppers?

It is the Holiday season and stress levels are on the rise! Just remember that for all you gym rats, that ANY stress has an effect on the body and it is not just the added stress on your body from the gym. The term eustress and distress defined by Webster’s dictionary as

eustress (noun) : Stress that affects your body in a positive fashion.

Distress is the opposite.

Distress (noun): pain or suffering affecting the body, a bodily part, or the mind

In training, it may not be beneficial to have every session perceived as distress, but without the principal of overload the body has no reason to adapt; so it is a fine balancing act. It was rumored that trees planted in the first Biosphere experiment did not grow straight up since there was no wind!

Take Away
Monitor your training progress based on if it was a eustress or distress session and see how it goes. I would be interested in your feedback. Special thanks to Zachariah Salazar for the "new to me" definition of stress.

I am a Kiteboarding Adict!
I just got back from another kiteboarding session in S Padre TX this past Sunday through Wensday and it was great! Only one day out of 3 with nice wind, but that day of riding made the entire trip worthwhile! I even caught some air for about 3-4 seconds on purpose this time. Wow, that is an amazing feeling of being lifted up off the water as everything goes dead quiet and if you do it right, you can even land softly (or in my case cannonball into the water 6o% of the time). If you have not checked out the book "The Four Hour Workweek" by Tim Ferris, I highly highly recommend it. I have no plans to ever really retire, so I might as well enjoy everything to its fullest extent now and not put it off.

Super Geek Alert: Study on Pain Physiology
I have tons of cool studies coming up, but I need to get through my finals first and only 8 more days to go. Whoo ha. The of this quarter is drawing near.

From some work published in Nautre (1), scientist are working on combining two compounds to elicit a very cool effect on reduction of pain! Most agents used for acute pain reduction like lidocaine (think of the dentist if you have ever had any work done there), result in numbness and a general lack of feeling including a loss of motor control--try drinking that crappy Kool Aid they give you after you get your wisdom teeth pulled. I think the dentist just does it for entertainment as I know I spilled mine all over myself.

In the experiment (1), they combined the effects of capsician (that stuff that turns your mouth to fire from hot chili peppers) with a local anesthetic (QX-314 which is in the lidocaine family). This worked to shut up (technical term) the local pain sensations (nociception) without affecting the motor control qualities (hey, I can sill move).

Capsaicin binds to TRPV1 and causes the protein to open a gate leading to a small channel in the nerve cell's membrane. So researchers scratched their heads and thought maybe injecting capsaicin followed by QX-314 would allow the chili pepper compound to open the doors of pain-sensing neurons, clearing the way for the anesthetic to enter and shut down the cells; and it did! (2)

For all the geeks out there, capsaicin, as a member of the vanilloid family, binds to a receptor called the vanilloid receptor subtype 1 (VR1). When the neuron is stimulated it sends a signal to the brain (remember, that is where pain lives). Anything that binds to the VR1 receptor can produce the same sensation that excessive heat or abrasive damage would cause, thus explaining why the spiciness of capsaicin is described as a burning sensation.

Why You Might Care
Alexander M. Binshtok et al (1), stated “Long-lasting decreases in pain sensitivity were also seen with regional injection of QX-314 and capsaicin near the sciatic nerve; however, in contrast to the effect of lidocaine, the application of QX-314 and capsaicin together was not accompanied by motor or tactile deficits.” Translation—the pain signal was shut down, but there were no other deleterious (bad) effects!

References

1. Binshtok A. M., B. P. Bean, C. J. Woolf. Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers. Nature. 449(7162):607-610, 2007.

2. www.sciam.com

Go with your gut and Oct RKC pics

Go with your gut
As you know from my last blog, I just got back from kiteboarding in S Padre Texas. For those of you who do not know what kiteboarding is, imagine attaching yourself via 100 foot long, razor sharp lines to a kite that can range from a small 8m (so about 24 feet across) up to 16M (about 50 feet across) or even larger. These are not your typical Charlie Brown kites and can create enough power to rip you across the water or up into the air. Amazingly, they have extremely fine control since the lines connect into a control bar that allows you to harness the power of the kite. The mainpower of the kite attaches into a harness at your hips to keep some stress off of your arms. All of this makes for a unique learning experience, but incredibly fun and extremely addictive too after just a few sessions.

The weather in S Padre TX is normally beautiful this time of year. Each Fall there is a big crew from Minnesota (and other locations) that heads down. This past Wed everyone was riding in sunny 87 F days with a nice 15-20+ mph wind. Perfect. The weather while I was there--not so perfect. Cold, overcast and rain as I arrived late Wed night.

The first day out I froze and I was the only nut out there kiteboarding at that time. The wind was super strong and it was a good session. I was frozen by the time I got out. Who would have ever thought that I needed a dry suit for S Padre!

The next day it was cold and raining again. Drat. We sat around and could not take it anymore and drove out to see if anyone was kiteboarding at the nearby beach. Honestly, the though of going back out was not sounding great to me since it was blowing at about 20-25 mph and the air temp alone was 47F. Brrrrrrrrrrrrr. Pretty cold for a 3/2 light wetsuit that I just bought the day before. But we came to kiteboard, so back home to get our gear and we were back out there.

Whether it's the best of times or the worst of times, it's the only time we've got. -Art Buchwald

I was having a hard time keeping my fingers working inflating a "new to me" kite, but finally got it up. I was nervous since this was the first time I have ever flown this kite or this design (Cabrinaha X bow 2006 12 M). I got a launch from my buddy and was promptly dragged down the beach before I could get control of it. Yikes! There was no one in the line of the kite, so I knew I could always pull the safety to kill the power in the kite with no problems or fear of hitting anyone. Now that I had control of the kite, I picked up my board and back out in the water I went. .....and it was freezing cold. That first drop in was very very cold as a wetsuit keep you warm by circulating a layer of warmer water next to your body. The thicker the wetsuit neoprene, the less exchange there is of this warm water layer next to your body with the colder outside water. The bugger is that during that first drop in, the water has not been warned by your body yet (hindsight would have told me to flood my westuit with warm water BEFORE going in, but I saved warm water for after I got out). So now I was really starting to think again that this was going to be a disaster, but figured I went through this much effort I might as well try to ride a bit.

The kite had tons of power and I got ripped off my board as I depowered the kite and it slammed into the water as I promptly supermanned through the air onto my stomach. Ouch. Crap. Tried again and this time I was up and riding. Wow, the wind was extremely strong and I had the kite on depower as much as I could. I dug my heals in on my board and off I shot upwind. Whoooooooooo ha. This was actually fun now and after a few rides I was really loving the kite and getting used to it. 2 hours passed by and even though I was cold I still did not want to come in. I was getting some very nice transitions and I was riding fully extending with my butt and shoulders only a few inches off the water. Whoooo ha!!! Even though it was super windy, the surrounding land masses block most of the waves, so the water is relatively flat.

I noticed all the cars parked on the beach had backed way up and I saw our rental car now parked way back on higher ground. My buddy was flagging me in, so I called it a day after riding for 2 hours and headed back in. As I undid my kite I was starting to get really cold. The water was now up to about 3 inches on the car and still rising and we were out of dry land. We made it out there via some mud bogging in a small Chevy 4 door compact car (if you are the rental car company reading this, the car is just fine and don't worry). Back at the condo I took the best hot "waterfall style" shower of my life.

Why you may care
So sometimes when you don't want to do something, you need to listen to your gut feeling. I knew in my gut that I wanted to go ride, even though I thought of every possible reason why I should not go. The conditions were safe, but far far from ideal. I trusted my gut and it turned into one of the best sessions I have ever head kiteboarding as everything felt just right.

The moral of this story is to trust your gut feelings and test it. If after a few rides I felt unsafe or it was not right, I could just bail and go back home with no regrets and the satisfaction that I tried. Sometimes it turns into much more.

Congrats in order
A huge congratulations to Brett Jones and Andrea DuCane on becoming Master Instructors and to Jeff O'Conner, Geoff Neupert and David Whitley on becoming Senior RKCs. Way to go everyone!

October RKC pictures
Better late than never!

2 "Jeffs" Brett Jones and Sandy

It's me

Brad "Top Notch" working hard

The cops were even on hand to make sure it did not get too unruly!

Qualitative Study on Exercise and Cancer Fatigue Perception

Happy Thanksgiving to all USA readers and happy Tues to everyone else around the world.
Thanks for all the comments and everyone who takes time to read this blog. It is much appreciated!!

I am off to celebrate Thanksgiving in S Padre by doing some kiteboarding. I leave in a few hours and I can't wait. Whooooo ha.

This week I have a summary/critique I did of a study looking at the perception of fatigue in cancer patients before and after an exercise program. Pretty amazing study to see how their perception of fatigue was altered by exercise.

This is a qualitative study, so you most of you in the hard core science world are use to reading quantitative studies (think lots of numbers, highly controlled). The bad part is that not all of life fits so neatly in that box, so qualitative studies can be extremely useful. A different question many times needs a different method. Enjoy!

Summary
The object of this study (Adamsen et al., 2004) was to explore the nature of fatigue in advanced stage cancer patients undergoing chemotherapy and also participating in an exercise program. The exercise program lasted 6 weeks with multidimensional exercise consisting of physical exercise (1.5 hours three times weekly), relaxation (0.5 hours four times weekly), massage (0.5 hours twice weekly), and body-awareness training (1.5 hours once weekly. A qualitative process using interviews that were conducting at three different times (start, during, and termination) of the program. 23 patients (age 18 to 65 years old) participated. The type of cancer, stage of progression and treatment all varied. They concluded that patients experienced exercise-induced fatigue which they related to a new sense of increased strength, improvement in overall energy and physical well being instead of a negative, flu-like induced chemotherapy fatigue. The transformation of fatigue supports the theory that exercise is a beneficial strategy in the treatment of cancer related fatigue (Adamsen et al., 2004).

Critique/analysis
Research Design
The theoretical perspective was appropriate since it works to answer their question about the impact of exercise on changing perceptions of fatigue. There are a few studies on the impact of exercise and cancer, one by Markes, Brockow, and Resch (2006) stated, “Exercise during adjuvant treatment for breast cancer can be regarded as a supportive self-care intervention which results in improved physical fitness and thus the capacity for performing activities of daily life, which may otherwise be impaired due to inactivity during treatment. Improvements in fatigue were ambiguous and there was a lack of evidence for improvement with exercise for other treatment-related side effects.” (Markes, Brockow, & Resch, 2006)

69 total interviews of 23 participants were conducted. The interviews were conducted at three different time points during the study: prior to (as a baseline), 6 weeks into the exercise program and at the completion of the intervention. Three weeks should have been enough time for the participants to judge the change in their fatigue levels due to the exercise intervention. Adamsen L et al. (2006) stated, “Clinical controlled trials and more follow-up studies are needed to establish the optimal program length and content for sustained exercise adherence in cancer patients.” (Midtgaard, Tveteras, Rorth, Stelter, & Adamsen, 2006) There was not a control group, so you can’t rule out the added attention that the participants received as altering their feelings of fatigue, especially since they were receiving custom exercise, massage, relaxation treatments for many hours a week.

The researchers role in the study was design and analysis, but they did not conduct the interviews themselves, stating “Interviewing was chosen as the research method in order to ensure that the physical exercise was performed at lowest risk by using the patients’ information as the basis for making adjustments to the program and subsequently evaluating the program.” (Adamsen et al., 2004) This helps to remove the bias that the research may add during the interview process. Investigator triangulation was also applied to further reduce bias (Ramprogus, 2005).

There is little to no background on the authors described in the text. A simple literature search under the main author Adamsen L. reveals many studies in relation to exercise and cancer, so it would be great to see this highlighted more in this study.

Sampling
According to literature by Endacott and Botti (2005), calculating sample size in qualitative research depends on a number of factors. These include: 1) research design 2) sampling method 3) the degree of precision required 4) the variability of the factors being investigated 5) the incidence of a particular variable in the population (Endacott & Botti, 2005). Twenty-seven patients gave their consent, but two withdrew and twenty-five completed the 6-week intervention; so a small number were in the study and 6-weeks is short for an exercise study. To the researcher’s credit, they were not looking at a functional outcome from the study, but at how the participants viewed fatigue. The authors also acknowledge the small population as a study limitation and there was not a previous study looking at the changing perception of fatigue with exercise in cancer patients, so a smaller sample size may be appropriate for this study (although a larger number is always nice to see).

Participants were attracted by posters and pamphlets at the outpatient clinic or in the ward; so not all patients were notified of the study in a systematic fashion. The participants were also categorized as highly motivated, relatively young and physically active pre illness. This is the type of group you would expect to attract from this type of study, so it is skewed towards an active, motivated population that may obtain different results than an unmotivated, less active group.

The participants were not alike in many ways such as age, sex, diagnosis, treatment, etc. Other studies of cancer and exercise (Barnard, Leung, Aronson, Cohen, & Golding, 2007; Heim, v d Malsburg, & Niklas, 2007; Markes et al., 2006; Monga et al., 2007) normally focus on one particular type of cancer, but even that research is limited in volume. The biggest flaw of this study is lumping all types of cancer and treatment methods into one big group.Practical

Applications

This study shows that an intervention of an exercise program may alter cancer patients perception of fatigue. This could have a great impact in future cancer treatments programs to help patients deal with the sense of flu like fatigue that normally accompanies chemotherapy treatment causing the patients to move even less and continue to have their health spiral downward. While there is little know about the mind/body connection and its ramifications, it can be argued that if patients feel better about themselves and maintain a more positive outlook, they may have a better prognosis.

Conclusion
The object of this study (Adamsen et al., 2004) was to explore the nature of fatigue in advanced stage cancer patients undergoing chemotherapy and also participating in an exercise program. The exercise program lasted 6 weeks using multidimensional exercise. A qualitative process (interview method) was conducting with 23 patients (age 18 to 65 years old). The type of cancer, stage of progression and treatment all varied. Despite this, they concluded that patients experienced exercise-induced fatigue which they related to a new sense of increased strength, improvement in overall energy and physical well being instead of a negative, flu-like induced chemotherapy fatigue. The transformation of fatigue supports the theory that exercise is a beneficial strategy in the treatment of cancer related fatigue (Adamsen et al., 2004) and may have further implications for including an exercise program in cancer treatment programs.

References

Adamsen, L., Midtgaard, J., Andersen, C., Quist, M., Moeller, T., & Roerth, M. (2004). Transforming the nature of fatigue through exercise: Qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy. European journal of cancer care, 13(4), 362-370.

Barnard, R. J., Leung, P. S., Aronson, W. J., Cohen, P., & Golding, L. A. (2007). A mechanism to explain how regular exercise might reduce the risk for clinical prostate cancer. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP), 16(5), 415-421.

Endacott, R., & Botti, M. (2005). Clinical research 3: Sample selection. Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses, 21(1), 51-55.

Heim, M. E., v d Malsburg, M. L., & Niklas, A. (2007). Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Onkologie, 30(8-9), 429-434.

Markes, M., Brockow, T., & Resch, K. L. (2006). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane database of systematic reviews (Online), (4)(4), CD005001.

Midtgaard, J., Tveteras, A., Rorth, M., Stelter, R., & Adamsen, L. (2006). The impact of supervised exercise intervention on short-term postprogram leisure time physical activity level in cancer patients undergoing chemotherapy: 1- and 3-month follow-up on the body & cancer project. Palliative & supportive care, 4(1), 25-35.

Monga, U., Garber, S. L., Thornby, J., Vallbona, C., Kerrigan, A. J., Monga, T. N., et al. (2007). Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Archives of Physical Medicine and Rehabilitation, 88(11), 1416-1422.

Ramprogus, V. (2005). Triangulation. Nurse researcher, 12(4), 4-6.

Z Health Level 4 Wrap Up and Good vs Bad Calories

Greetings! Thanks for taking the time to read to read my blog as it is much appreciated.

I submitted my abstract to the American College of Sports Medicine (ACSM) last Thurs, so we will wait and see if they want me to do a poster or slide presentation at the ACSM conference in May 2008. Special thanks to all that made it possible--Dr. George Biltz, Dr. Don Dengel and Dr. Richard Winsley. Once I get the green light to discuss the data, I will have a write up here.

As promised, here is the Z Health Level 4 Wrap Up translation and download.

First off, I want to send a special thanks to Kathy, Shannon and Dr. Cobb at Z Health for all the work they put into it and everything they do. Each level is top notch all the way. Special thanks to all that attended as it was great to see old friends again and meet new ones. Everyone there was exceptional. If there is a Z Health trainer in your area, I highly recommend a visit to one. Click here to find out. I can personally vouch for all those at Level 4 and I would have zero hesitations sending anyone I know to them.

Here are what I consider the main points. Some of these will look familiar as they are covered in R Phase and I Phase also to some degree:

"All the body all the time"--Dr. Cobb
If I have one main complaint it's that I don't see enough people respecting this aspect. The standard therapy for a chronic shoulder issue is to only look at the shoulder. A vast majority of the time, that is not the SOURCE of the issue; it is only an indicator that there is an issue. I seem to get more shoulder complaints than any other complaint and I have yet to find an improvement by only doing shoulder work. Most of the time it is the opposite foot, ankle, hip, same side wrist or thoracic area; but since it is all the body all the time then anything can cause anything. This was really shown in level 4 where we were working on scars on other locations on the body and seeing some dramatic improvements in what would seem like an unrelated area.


ANY THREAT can be interpreted as pain and pain and poor performance are the same thing.
This completely changes the way we look at pain and poor performance. We need to ensure that when we are training an athlete, that we keep this in mind. It will be counter productive to do things that are always perceived as a threat to the body. So yes, sets, reps, exercise, volume, etc---all of those things are good to record, but I would add a threat level and RPE (rating of perceived effort) to your training journal. I hear more trainers talking about training off of only RPE recently and I think that is a great idea, but the next step is to log a threat level also. Using a simple 1-10 scale is fine. You should not be training at a high threat level day in and day out. Most training should be as Dan John says "punch the clock sessions." You get your work done in the correct fashion and it may not be your best session ever, but you got it done. Day in and day out this will add up fast!

Pain lives in the brain
The older thinking about pain believed that there was a pain center in the brain, but newer research has shown this not to be true. If it was true, we could target that pain center and relieve tons of pain issues with ablation (think of high energy to zap tissue) and designer drugs. Again, physiology is messy and it is not that simple. The newer thinking is along the lines of the pain neuromatrix developed by Melzack (and Wall). I knew the Matrix was involved in this Z stuff some how!

Breath retraining
I predict that this will be a huge area of topic among top trainers/coaches in the near future. Many already realized this years ago. For those at the recent RKC, Brett Jones had us do some breathing drills while not lifting to see if we were breathing into our stomachs or chest area. Gray Cook has talked about this a fair amount lately also. Be sure to check out "The Secrets of the Shoulder" DVD by Gary Cook and Brett Jones here. In the interest of full disclosure, I have not picked up yet, but it is first on my list come December when my schedules slows up a bit. Anything from both of those guys is well worth owning.

For all you linear thinkers, think of an athlete that comes to you with say a left shoulder issue. One thing to add to your list in to check their breathing. A normal breath should have the stomach going out on inhale and coming in on exhale. Most of the time the reverse happens (paradoxical breathing). When you breath in with the chest area, it is using the accessory muscles to help lift the ribcage. These accessory muscles (like the upper traps, scalenes, etc) have a huge effect on shoulder function. The shoulder is allowed to move by a virtual symphony of muscle movements around the joint. Imagine the drummer in a world class symphony playing on the wrong beat. What do you get? A crappy song, that's what! If your breathing is off, you can messs up the shoulder muscles and get a crappy shoulder (among other potential issues). Is it always that simple? Nope, but if you have tried tons of other work and the shoulder is still an issue, investigate how the athlete is breathing. It is amazing to me that I took a whole physiology class on Advanced Pulmonary Mechanics, but they failed to mention just how common poor breathing is in general.

All details matter
Either you believe in the SAID (Specific Adaptation to Imposed Demand) principal or you don't. Sorry, no fence riders on this one. So if you believe in it, then pay attentions to the details when lifting. What is your posture? Do you feel better after each lift, set, rep or worse? Is your performance/movement getting better or not?

Z Health is about creating SUPERIOR athletes.
I don't have much expeirence with other "systems" out there for performance enhancement so I can't comment much on how Z compares to them, but I can say that Z leaves virtually no stone un turned in regards to superior performance based on physiology/neurology. Z Health helps you achieve better performance, no matter what your goal!

The 9S model for an athlete--Speed, Strength, Skill, Sustenance, Suppleness, Stamina, Structure, Spirit, Style and Sprint. Most people only work with athletes in 2-3 areas and you need all 9 depending on the state of the athlete on the day you are working with him/her. Expand your areas.

Stay out of pain!
If you are in pain, get out of it. Yes that is easier said than done, but I see athletes all the time moving into pain when they should know better. Unless you are a professional athlete that gets paid to perform, find something else to do that is not painful. If you are a pro athlete, you still need to get out of pain as it is hindering your performance. Each rep you perform is either taking your closer to your goal or farther away. If you are pushing through pain, it is taking you farther from your goal. Yes, this includes all your machos on the foam rollers!

Take Away points you can use:
Record a threat and RPE in your training journal. A simple 1-10 scale works
An RPE of 1 is just barely awake and a 10 is a level that you can not sustain anymore despite your best effort.
A threat level of 1 would be virtually nothing, and a 10 would be running from an angry bear.

Check your breathing--is it in the chest or stomach area. Breath awareness is key

All details matter to keep an eye on your training sessions and when you are not training. How do you feel? How is your movement? How is it connected?

Stay out of pain!

Z Health is about creating superior athletes
If you are interested in pain reduction and performance enhancement, click on here for more information.

Good Calorie, Bad Calorie debate
Gary Taube's book "Good Calorie, Bad Calorie" seems to be creating quite a stir lately.

I've added it to my amazon wish list, but I have not picked it up yet, so I can't comment on it directly. It revolves around the low carb debate which can be multiple blog entries on its own, but below is an excerpt from Gary, alternative medicine guru Dr. Andrew Weil and also Dr. Oz. Very interesting debate!

I really like Andrew Weil's books and highly recommend them. "Healthy Aging" was just superb.

Post your comments on it below. If people are interested I will post more of my thoughts on it in the future. Any Z Health questions/comments are always welcome too.



Rock on
Mike N

Z Health Level 4 Update Day 3 completed

Just another quick rapid fire update before I head off to the last day. sniff sniff

As stated the other day, ANY THREAT can be interpreted as pain and pain and poor performance are the same thing. I just realized this AM that one of the reasons I love David Allen's system of organization (called "Getting Things Done") is that it allows me to take tasks and put them into a system and get them off my mind and I believe it also reduces the threat level. I am sure all of us reach point where it feels like there is WAY more things going than we can do, which is a threat and at min leads to increased stress.

Wrist mobility can be huge for shoulder ROM and we learned some super fast drills to assess it.

Strength can be viewed as a threat. You are strong enough to lift it already but your brain/nervous system won't let you. Two great examples of this are Roger Bannister breaking the 4 minute mile and Fred Hatfield squatting over 1,000 lbs. Both were feats that people said could not be done, but they did not believe them and did it. Soon after, there were many more in a few weeks to months that did the same thing. Their beliefs were shattered.

Stress is only a stimulus--disstress vs eustress

The primary area of threat to the body is the head and esp the eyes (vision). This will have huge ramifications for sports performance and pain reduction. I don't see enough people in the training/performance enhancement field addressing this at all. A running back with great vision will have a HUGE advantage. Why do you think top athlete always talk about "seeing the game" etc. Now some of that goes beyond just vision, but vision is a great start.

Example, I have been doing some visual work (eye muscle work too) and it has made a huge difference. I had my private session with Dr. Cobb and we worked on more visual items. I had a "lazy eye" as a kid and they patched my good eye at that time to force my other eye to work more. So today my eyes track together (for the most part), but I am suppressing the signal from my other eye; so I am only using one eye. Dr. Cobb had me do some drills to get both of my eyes "back online" and the difference in gait and posture was crazy. I had neurally chunked my current posture (and basically everything) to my vision of only using one eye so once I get my other eye back online I will have binocular vision, and that is going to absolutely huge.

Visceral pain and referred pain and what to do about it. Yes, it may not be your shoulder that is the true source of the issue. I watched a private session and saw that it was the liver on an athlete here that was affecting his shoulder pain and range of motion. Yes it sounds insane, but look up "Head's zones" if you are interested. Again, ALL DETAILS MATTER. Dr Fernando Cervero has some good stuff on visceral pain too.

Breath retraining. Think of how many breaths you take a day--about 20 to 26,000 EACH day. If this is messed up, it is not good. Since it is controlled by muscles and the nervous system it can be retrained. If you are breathing with only chest and not your belly you will need to check this out (contact me with any questions of course).

For all you cardio bunnies, efficiency is HUGE! Breathing is a huge part of this and with some simple drills can shave time of your best times very quickly.

Neurodynamics--what is it and how to test for it.

Nerve glide testing for all the majors nerves in the body

Cranial Sacral--what is it and does it work? The cranium is extremely important (remember it holds that thing we call a brain). The lines (sutures) are NOT fused. There is current research to back this up. The first time I heard that I thought it was bull crap, but it is true.

There is a connection between the top of the spine (C2) and the coverings of the skull/brain; so you can affect it by very precise mobility work with the head and upper spine.

There was more but my ride is on the way.
Rock on
Mike N

Z Health Level 4 Update

Greetings from sunny AZ! I am here doing the Z Health Level 4 Cert.

This cert is a little different as it is more therapy based (T Phase). Again, like all Z Health work it is based on ACTIVE mobility work, so it is in essences guided exercise.

Rapid fire, here a just a few things that were covered in the past 2 days. And there are still 2 more days to go!

ALL DETAILS MATTER--this is one thing that I love about Z as it respects how complicated each individual really is. This does not mean that the exercises to fix something are complicated however---big difference.

Your state of inflammation determines the "gain level" your body is set at in response to a stimulus.

"All the body all the time"-Dr. Cobb. This is so true!

It is not just simply joint mobility. When you work on the joints you are affecting things on multiple layers--joint space, blood supply, lymph supply, nerve tension, etc

Z Health is about creating SUPERIOR athletes. If you want average, go somewhere else

The 9S model for an athlete--Speed, Strength, Skill, Sustenance, Suppleness, Stamina, Structure, Spirit, Style and Sprint. This is the basis for Z Health S Phase. The point is that most people only work with athletes in 2-3 areas and you need all 9.

Pain lives in the brain. Pain is a perception of an event

Adrenal fatigue can affect the skin appearance

NEURAL TONE, NEURAL TONE, NEURAL TONE, NEURAL TONE!!

There are basically 3 layers to work in 1) skin 2) superficial 3) deep ---NONE of these require pressure that is remotely painful. Remember that pain has all sorts of bad effects on the nervous system.

Soft tissue work is an ASSESSMENT with the end goal being an increase in function--so you may need soft tissue work, you may need mobility work,etc---end goal is the same

Pain and poor performance are the same thing.

How you breath is of huge importance for shoulder health, body mechanics, on down the line

Endurance athletes are pain management specialists.

Future of pain relief is inflammation and mind/body connection (pain neuro matrix)

Pain is an ACTION SIGNAL

ANY THREAT can be interpreted as pain--from stepping on a nail to your boss, your job etc

Pain does NOT equal injury all the time

Fascia is not that complicated--get over it. It never moves unless other things move. Yes, fascia is EVERYWHERE in the body and very complex, but on a practical level it is still connected to the nervous system

I always wondered why I never saw a trigger point on a cadaver--nervous system is dead.

You have 3L of lymph in your body--this may be important!

Where athletes have swelling can tell you a lot of information

Know your anatomy and main nerves to muscles and how to fix it.

My ride is on the way, so gotta run. Any questions, please post them in the comments.

Rock on
Mike N

RKC Wrap Up

Update
I've been buried in analysis and proposal writing this past week, hence the delays. If all goes well I will be presenting an abstract at ACSM (American College of Sports Medicine) this May; so keep those fingers crossed. If anyone else is going to be there (talk about planning ahead) please drop me a line and we can talk "shop".

I am off to Z Heath Level 4 in AZ this coming Wed for some more Z Kool Aid. Whooo ha! Can't wait. I am looking forward to seeing everyone there again and learning some great new information.

RKC Wrap Up
Overall, the RKC was awesome!

Honestly, I went into it knowing that I would learn a lot, but figure some of it may go against what I believed (it is good to challenge beliefs). The main reason I signed up was that ALL of the RKCs I have met were top notch and excellent people in all respects; so I knew it must be good! I also have been reading Pavel's work for a long time and I always learned something new from him every time.

I was pleasantly surprised to find that I agreed with almost all of it, and the parts I am still trying to piece together in my mind I will be thinking, experimenting long and hard on for awhile.

From the outside, it would appear that Z Health and RKC are polar opposite, but I don't believe so and I found both of the systems discussing the same thing! Now, since I just did the RKC my experience with the RKC system is extremely limited at this point, but I found the similarities were

both talk about APPROPRIATE tension
relaxation when not lifting
breathing techniques (anatomical vs biomechanical match)
strength is a skill that must be practiced
long spine and proper alignment
the nervous system holds the keys to all of it!

I used to think that RKC was always about high tension and no relaxation, which is not true. Think of tension as a big dial. The closer you are to a 1 RM (rep max), the more tension you will need to lift the weight in a safe manner. Powerlifters are on this end of the spectrum, since the entire goal is to lift as much weight as possible within the confines of the rules. Now if you are doing an exercise with 50% of your max, you will need less tension. Yes, this is an over simplificiation. I think most people would be better off practicing BOTH ends of the spectrum and everything in between. If you lift in a commercial gym, you will know what I mean. Most there (none of the readers of this blog though of course) use too much tension with horrible alignment. Again, it is all about APPROPRIATE tension.

I want to give a shout out to the team leader of our group Brett Jones as he did an amazing job and it was great to be on his team. The assistants for our group Sandy and Brian were outstanding also. Everyone there was highly motivated from the team leaders and everyone participating. A special shout out to all team Jones members and each one of them gave it their all during the entire weekend. It was a grueling weekend with tons of work. I did more KB work in 3 days than I think I've done in the past month. The graduation training session was brutal, but it was nice to know it was the last one!

I highly recommend the RKC system to anyone that is interested.

Please post any comments below about Z and RKC as I think that would be an interesting discussion. I know Geoff Neupert had a few entries on his blog on this topic also. I believe both are talking about the same thing, but how they go about an end result is different.

Rock on
Mike N

RKC Completed!

Just a quick note that I passed the RKC (Russian Kettlebell Certification)! Whoooo ha! Thanks to all for their encouragement.

It was a crazy and grueling 3 days, but overall it was an excellent experience and EVERYONE there was top notch all the way.

Special thanks to Brett Jones our group's RKC Team Leader and his assistants Brian and Sandy--excellent job!

I will post the full details soon! And look, another blog post from me without references (don't get too used to it though).

Rock on
Mike N

RKC Day 1 Completed

I made it through day 1 of the RKC here in MN and getting ready for day 2 right now.

I was so excited that I passed the snatch test and got 74 reps with the 24 kg with one hand switch. I did not keep the best long spine, but I still passed.

Day 1 had us working on swings and TGUs primarily. It was very good and I learned tons of new stuff and met lots of great people.

Full wrap up coming next week. Off to day 2 and then the final day 3.

Rock on
Mike N

RKC in Minnesota coming right up!

This one will be super short this week since I am off to the RKC here in MN starting with the meet and greet Thurs night and then the pain starts Friday through Sunday. Unfortunately I got blasted with a horrible cold starting about a week ago so training as been not the best to say the least. Before that, my best in training for the 24kg snatch RKC style was 66 reps with one arm switch only. For the RKC I need 76 total reps with the 24kg with only one arm switch. I figure I should be able to add 10% with an all out performance when it counts, so I will be close. I did my last training session last night, so tonight will be some very light work (if at all), some Z Health and attempt to get some more sleep for a change. Extra sessions wil only hurt me at this point, so it is time to rest up and show up heathly and then anything is possible. My plan is to pass the snatch test on day 1 in the AM so I can concentrate on all the other tasks at hand without having to worry about it. Wish me luck!

I am super excited to meet everyone, so if you will be here in MN for the RKC please introduce yourself. I should be easy to find--look for the 6'3" blond guy!

I will have more updates after the RKC on the experience.

Blog updates will be shorter until after Z Health Level 4 in AZ in early Nov due to class, labs, possible abstract due to ACSM (if the results looks good), research funding proposal and pilot research study protocol all due before the Goblins come on Halloween. Tons of great stuff though!

Rock on
Mike N

Stop looking at averages, it's not that simple!

I've often said that physiology is messy (click here for an older post on it). I am sure I am not the first person to say that and I can't even remember who I stole it from.

I was having a conversation with Dr. Biltz at the U of the MN the other day (the really cool part about hanging out there is that I can pick the brains of super smart people) about the "thingification" of physiology. Open any text book and even in exercise physiology--which I tell people is basically physiology "in motion" (at rest it is pretty boring anyway), the descriptions still make it sounds like it is at rest. Sure, they say it is not at a steady state, but the quantities they use and words make it seem "fixed'

Dr. Biltz argues that ALL of it is in motion and prefers to think of it in terms of "different flow rates' which makes perfect sense to me since my primary background the first 8 years in college and beyond was engineering (I actually switched from the PhD program in Biomedical Engineering here to Kinesiology when I only had 2 more biomed classes left to take--ugh!) In engineering, we use rate calcs all the time, although I still think Newton invented Calculus just to torture students.

We should also stop looking at the means of data. We are past gaining a ton of new info that way and who the heck is "normal" anyway? (Sure as heck it's not me!) As I've stated before (check out the link here), physiology is associated with every "bad" engineering word--non linear, anisotropic, dynamic, highly variable, etc.

There are more data emerging within the last few years that is not only using the means/averages. One area is Heart Rate Variability (HRV) that uses the variability of the HR on a super small scale to get at the ratio of sympathetic to parasympathetic stimulation.

Analogy time. Think of sympathetic stimulation as an accelerator and parasympathetic as a brake. If you pull out a heart and let it beat on its own (click here to see the post about the visible heart experiments where they did just that), it will go to a rate of 100 beats per minute.

So under most conditions the heart is mainly under parasympathetic stimulation (aka braking) to DECREASE the heart rate (HR). When you start to exercise, the body with start to WITHDRAW parasympathetic stimulation up to about a rate of 100. Now, it is really never all parasympathetic or sympathetic and HRV can be used as tool to look at the percentage of each one at any given rate. This gives us clues as to how the nervous system maintains control.

Even new implantable defibrillators will give you a picture of HRV! See the picture at the top here.

This non linear, dynamic analysis can be applied to many areas! Here is a link to a study looking at GH levels. Many times you will see the word "entropy" or a newer method is "sample entropy" which appears to be better (I will save you the math but if you want to know how to calculate sample entropy see the list below for some good late night reading if you can't sleep).


Rant over and off my soapbox I go.
Rock on
Mike N

General references on the topics above

1. Bornas X., J. Llabres, M. Noguera, A. Pez. Sample entropy of ECG time series of fearful flyers: preliminary results. Nonlinear Dynamics Psychol Life Sci. 10(3):301-318, 2006.

2. Cao H., D. E. Lake, M. P. Griffin, J. R. Moorman. Increased nonstationarity of neonatal heart rate before the clinical diagnosis of sepsis. Ann Biomed Eng. 32(2):233-244, 2004.

3. Javorka M., J. Javorkova, I. Tonhajzerova, A. Calkovska, K. Javorka. Heart rate variability in young patients with diabetes mellitus and healthy subjects explored by Poincare and sequence plots. Clin Physiol Funct Imaging. 25(2):119-127, 2005.

4. Kaplan D. T., M. I. Furman, S. M. Pincus, S. M. Ryan, L. A. Lipsitz, A. L. Goldberger. Aging and the complexity of cardiovascular dynamics. Biophys J. 59(4):945-949, 1991.

5. Maestri R., G. D. Pinna, A. Porta, et al. Assessing nonlinear properties of heart rate variability from short-term recordings: are these measurements reliable? Physiol Meas. 28(9):1067-1077, 2007.

6. Nagai N., T. Matsumoto, H. Kita, T. Moritani. Autonomic nervous system activity and the state and development of obesity in Japanese school children. Obes Res. 11(1):25-32, 2003.

7. Nagai N., T. Moritani. Effect of physical activity on autonomic nervous system function in lean and obese children. Int J Obes Relat Metab Disord. 28(1):27-33, 2004.

8. Pincus S. Approximate entropy (ApEn) as a complexity measure. Chaos. 5(1):110-117, 1995.

9. Pincus S., R. E. Kalman. Not all (possibly) "random" sequences are created equal. Proc Natl Acad Sci U S A. 94(8):3513-3518, 1997.

10. Pincus S. M. Orderliness of hormone release. Novartis Found Symp. 227:82-96; discussion 96-104, 2000.

11. Pincus S. M., J. D. Veldhuis, A. D. Rogol. Longitudinal changes in growth hormone secretory process irregularity assessed transpubertally in healthy boys. Am J Physiol Endocrinol Metab. 279(2):E417-24, 2000.

12. Platisa M. M., V. Gal. Reflection of heart rate regulation on linear and nonlinear heart rate variability measures. Physiol Meas. 27(2):145-154, 2006.

13. Richman J. S., J. R. Moorman. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 278(6):H2039-49, 2000.

14. Ryan S. M., A. L. Goldberger, S. M. Pincus, J. Mietus, L. A. Lipsitz. Gender- and age-related differences in heart rate dynamics: are women more complex than men? J Am Coll Cardiol. 24(7):1700-1707, 1994.

15. Tulppo M. P., T. H. Makikallio, T. E. Takala, T. Seppanen, H. V. Huikuri. Quantitative beat-to-beat analysis of heart rate dynamics during exercise. Am J Physiol. 271(1 Pt 2):H244-52, 1996.

16. Veldhuis J. D., M. L. Johnson, O. L. Veldhuis, M. Straume, S. M. Pincus. Impact of pulsatility on the ensemble orderliness (approximate entropy) of neurohormone secretion. Am J Physiol Regul Integr Comp Physiol. 281(6):R1975-85, 2001.

17. Veldman R. G., M. Frolich, S. M. Pincus, J. D. Veldhuis, F. Roelfsema. Growth hormone and prolactin are secreted more irregularly in patients with Cushing's disease. Clin Endocrinol (Oxf). 52(5):625-632, 2000.