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