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Research released last week shows that thousands of knee operations may be no more effective than prescriptive knee exercises. Knee surgery (arthroscopy) is currently the most common operation used to try to fix knee problems for British people in middle age. This keyhole surgery is most commonly used to repair a torn meniscus – the cartilage between the knee joint – and it is used in 150,000 operations on middle aged knees each year.
In the operation, surgeons use an arthroscope, a tiny camera on the end of a tube, to enter the knee while they carry out the surgery through other small incisions. The process usually takes around an hour and patients can return home the same day. However, one of the problems is that the simplicity of the operation means that it has become an option for patients who wouldn’t have been considered for surgery in the past.
The study, undertaken by Oslo University Hospital and the University of Southern Denmark, compared patients who had undergone the operation compared with others who had done a 12 week strengthening programme helped by a trainer. After the 3 month trial period, the 140 patients were assessed, and the non-surgery group were found to be performing better and with lower levels of discomfort.
The authors of the study, published in the British Medical Journal noted that ‘Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term.’
A separate piece in the same journal claimed that there was growing evidence that surgeries are still being done despite new research showing exercise to be just as, if not more effective.
Teppo Jarvinen, from the University of Helsinki, and Gordon Guyatt, of McMaster University in Ontario, said: ‘What we should not do is allow the orthopaedic community … to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence.”
At Diets Don’t Work, having had first hand experience of a wide variety of age and sporting related injuries, we can also concur that surgery should only be considered once all other options – physical rehabilitation, training and treatment – have been throughly exhausted. Although it does have it’s place and can resolve some conditions that exercise and therapy cannot, in most cases a similar or better outcome can be had through exercise and rehabilitation.
Cycling in middle age can reduce diabetes chances by 20%, shows a new study. Those who started cycling regularly in their 50s and 60s had a lower risk than non cyclists and this risk decreased even further the more they cycled each week.
Martin Rasmussun from The University of Southern Denmark, who published the study, said that
“even when entering elderly age, it is not too late to take up cycling to lower one’s risk of chronic disease”.
Published in the online medical journal Plos, the study followed over 24,000 Danish men and 27,000 Danish women aged between 50 and 63 who did not suffer from diabetes or any other chronic disease. The subjects were then reassessed five years on when some 6,779 had ben diagnosed with diabetes. The study discovered that in the group who did no cycling there were 2,510 cases of type 2 diabetes, whereas in the cycling group only 703 were diagnosed. Those who cycled the most (only 5 hours a week!) also weighed less, had smaller waists, drank less and tended to have better diets. This may have also had an effect in the reduction of those diagnosed with adult onset type 2 diabetes, which is closely linked to poor nutrition, and in particular excessive consumption of processed carbohydrates and sugars. The healthier cycling group also drank more coffee, most likely the result of mid-cycle social coffee stops!
So to reduce diabetes chances in middle age – get cycling!
You may have heard people talk about a rotator cuff injury and rehabilitation; it’s one of the most common injuries to the shoulder for in both sport and everyday life. Here’s a look at what the rotator cuff actually is, how it works, how it gets injured and how to do a successful rehabilitation.
The definition of the rotator cuff is “A tough sheath of tendons and ligaments that supports the arm at the shoulder joint”. The shoulder is an amazing joint – it can swing a tennis racket, reach behind your back, get things down from shelves and help you to play the piano. It is very mobile and dextrous. But this mobility comes at a price – stability. Unlike the hip joint, which very stable and has a much more restricted range of movement – you can’t get your foot above your head, unless you’re an ice dancer- the shoulder sacrifices stability for mobility. It can do lots. But to allow for all this movement, the shoulder is very unstable. Step in the rotator cuff. Just like the name, these 4 muscles are a natural stabilising cuff that prevent the shoulder from dislocating. If we didn’t have one, when we threw a ball our shoulder would dislocate.
The rotator cuff is made up of four smaller muscles that attach to four points on the outside of the shoulder. They are the sub-scapularis, supraspinatus, infraspinatus and teres minor. Together they help to pull the shoulder in towards you so that it stays in place.
One of the most common causes of shoulder pain, rotator cuff injuries can be both sudden onset and also degenerative. Because of the complexity of the joint and the small spaces that the muscles have to go through, wear and tear over time can cause impingement (rubbing or wearing down) of muscle fibres. This is particularly common for people who do repetitive overhead movements of the arm. In these movements the rotator cuff has to go back on itself, rubbing and impinging on bone and tissue, causing injury.
Injuries can also be more sudden, especially in overhead weighted exercises like the shoulder press.
Rotator cuff injuries are quite easy to spot. symptoms include:
Pain and swelling on the front of the shoulder and side of the arm; this can be vague and hard to pinpoint
Pain on raising and lowering the arm
Stiffness and pain when sleeping
Pain when reaching overhead, e.g. to get something from a high cupboard
Pain when reaching behind you, e.g. putting on a seatbelt.
There are also some quite specific tests that a well qualified PT or physiotherapist can do to identify which part of the rotator cuff you have injured.
In any injury there are three phases; the inflammatory or acute phase, the proliferation phase and the chronic or remodelling phase. During the inflammatory phase (0-48 hours after injury) patient should RICED. That’s rest, ice, compression, elevation and drugs (like ibuprofen). In the remodelling phase (48 hours-21 days after injury) RICED can continue but it’s time to start rehab exercises. Massage can also help to ensure that scar tissue is broken down and new fibres are laid down in line with tensile stress. Otherwise this scar tissue will become a site of weakness. In the chronic stage the rehab exercises can become more challenging and complex. The exercises can now also challenge the muscles around and supporting the injury.
In some cases surgery may be required to remove any impingement to the rotator cuff. This is called a sub-acromial decompression (basically removal of debris and crud that is in the way of the rotator cuff). It os the most common shoulder operation in the UK.
In any rehab, exercise should follow the order of passive (someone moves the joint for you), active (you move the joint) and then resisted. It’s always better to start with a light resistance and more repetitions and then build up as you go.
A new review of studies shows that being skinny fat (thin in appearance, but fat on the in side) is more damaging for heath than being overweight. Exercising alone may not help you to lose weight – a combination of healthy eating, correct exercise and creation of an energy deficit is needed for that – but exercise will not only make you fitter but also your insides too.
Structured exercise for just two months cuts visceral fat that causes health problems like type 2 diabetes and cancer, a recent study has found. The study proves the myth that some people can be overweight but fit while others can be thin but unhealthy, or “skinny fat”.
Researchears from Liverpool’s John Moore University and Radboud University in the Netherlands looked at the results of 117 studies; they found that after a training regime, although weight loss was negligible internal fat had fallen by 6%. The subjects had also reduced waistlines, pointing to an increase in lean muscle mass which had increased their metabolic rates outside of exercise. The authors of the study also deduced that a further reduction of body fat by only 5% would lead to a reduction of internal fat by 21.3%.
Published in the journal Obesity, the study concluded that visceral fat may be a greater danger to health in the long term than being overweight on the outside; doctors shouldn’t think that just because exercise may not have reduced weight it has not improved health or longevity. The scientists added:
“incorrect conclusions can potentially lead to recommendations or suggestions that [an] exercise intervention was unsuccessful, despite the presence of a marked effect on body composition. These results clearly demonstrate that the positive effects of exercise training on your body composition cannot be detected by your weighing scale “.
Author of the study Dick Thiessen added “don’t let your weighing scale mislead you, when exercise training hasn’t made you lose weight – especially if you’ve ended up fitting better in your old jeans and markedly improved your health risks”.
In a similar study at the university of Arizona less alcohol, better nutrition and more exercise was found to slash the risk of cancer by a huge 60%.
Many studies have shown that listening to music improves performance and enjoyment levels. Using music in a workout is not only a chance for “you” time but also a chance to listen to music that you might not have time for in a hectic day. It can also help you to get through more and push harder, as well as preventing standing and gossiping! So here are our best bluetooth earphones for sport 2016.
Wires work well, but can tug at the ears in different types of exercise (especially rowing!), get tangled, catch on things and generally be a bit annoying. So we’d highly recommend setting yourself free and going wireless.
1 – Jaybirds Bluebuds
The second most expensive on the test here, we found that these had by far the best sound quality and great battery life, coming in at 8 hours of playback time. We really liked the fit too, as they are very secure and come with a selection of “wings” which support the buds on the ear. Turning them on and off can be a bit fiddly though. And don’t drop them on a playing field just before the tractor mower comes through. £100 on Amazon here.
2 – Jlab epic
Another quite expensive pair on the test but worth it in terms of sound and quality. They are very sturdy and look really sweat-proof, and are also super easy to pair and connect straight out of the box. Battery life is even better than the bluebirds at 12 hours, although we found that it usually came closer to 10. Still very good though and the best on test for value and quality. £85 on Amazon here.
3 – Plantronics backbeat fit.
A better value set, the Plantronics had the best battery life at this price point, as good as the most expensive on test. It has a hibernation mode that turns itself off when out of range of the source. They fit really well (better than the Jabra, below) and have a really easy to use and clearly labelled controller on both ear buds; one for phone, one for the music. These come top in the cool stakes too. £70 on Amazon.
4 – Jabra Sport Pulse
These are a bit pricey, but if you want the best then go for these. The wireless bluetooth headphones have a built-in heart rate monitor for tracking the intensity of your workouts; the simple ear hook design make them some of the most comfortable to wear both outdoors and in the gym.
The sound quality was the best in test by some way and the easy to use app that comes with it might just make your current running app redundant. £199 on Jabra.com
5 – Monster iSport Super Slim
These bluetooth earphones had the best noise isolation, so would be the best choice if you want to drown out the Taylor Swift that’s banging out of the gym speakers. Might not be best in heavy traffic though. Super waterproof and very stable in the ear, although the sound is a bit bassey. £129 from John Lewis
6 – AUKEY Bluetooth V4.1 sports headphones
Our best buy simply because of the price point. Even the best bluetooth sport earphones will, at some point, break. This is our experience in the real world of all-action sport, water and sweat. So our advice is to get the best you can for under £30 (you could even get 2 pairs at this price, one for backup). They sound good, stay put, and do the job. And you won’t be too heartbroken if (when) they break. £25.99 on Aukey.com
Patients who have been diagnosed with cancer should be advised to lose weight and begin an exercise regime immediately to double their chances of survival, world experts have said.
Dozens of studies presented to the American Society of Clinical Oncology at their conference in Chicago over the weekend showed that patients who were a healthy weight were 50% more likely to survive as those who were obese. Weight loss and exercise were not just shown to be key in cancer prevention, but also as important as drugs and chemotherapy in the treatment of the disease.
As the UK Institute for Health and care Excellence (NICE) promised a review into prescribed exercise for cancer patients, Doctors at the conference called for exercise and lifestyle change to be prescribed along medication.
One of the studies by Yale University, found that just 3 hours of walking a week led to a 46% reduction in mortality rates of the 300 women with breast cancer who took part. The conference was also told that a Mediterranean style diet high in unsaturated fats, oils, vegetables and fish could reduce the risk of recurring breast cancer.
Other researchers at Stanford and Harvard Universities found that overweight women with high blood pressure who were diagnosed with breast cancer were 69% more likely to die than those of a healthy weight who exercised. Their 10 year study also found that abdominal fat increased the risk of cancer death by a staggering 69%.
Melinda Irwin, who led some of the studies said
“after treatment, weight loss is the most powerful thing you can do. It’s the next best pill to treatment and it’s free and has no side-effects. Every woman when diagnosed with breast cancer should be counselled about weight loss and weight management and about the role of exercise.”
The University of Montreal went as far as recommending that cancer patients should be provided with personal trainers as a cost effective way of improving chances of survival. Fred Saad, consultant oncologist from the University said:
“exercise and weight loss increase survival rates, and high-intensity exercise — spurred on by a trainer — is more effective than exercising alone. We are seeing that intense structured exercise programmes, led by a trainer, have a better effect on the immune system than gentle movement”.
He is currently conducting a ground-breaking study on 1000 men with late-stage metastatic cancer to test the effect of higher intensity training on cancer survival rates. Dr Saad hopes that the study will be enough for National Health services to take exercise and diet as seriously as drugs in treatment.
More people than ever (and their children) seem to have allergies or intolerances, from hay fever to gluten to lactose intolerance. But what is lactose intolerance and how many people actually have it?
Lactose is a natural sugar that occurs in milk. Along with fats, protein, vitamins and minerals, it makes up everything that a baby needs to thrive in the early stages of life. However, in recent times dairy has been the victim of some bad press, from making us fat to making us react in a bad way, dairy seems to have a lot to answer for.
Lactose intolerance is the body’s inability to break down and digest the sugars found in milk and other dairy derivatives. Although yoghurts can be classed as dairy, the bacteria present in them makes the lactose easy to digest, so they are less likely to produce an adverse effect.
Those with lactose intolerance do not produce a specific enzyme in the gut that breaks it down. Any dairy produce consumed has to broken down instead by the digestive system, which can cause discomfort, gas, bloating and cramps. There are, however, various degrees of intolerance; one person may still have the necessary enzyme to break down lactose, but not in sufficient quantities. These people are more “maldigesters” than actually lactose intolerant. We are all born with the enzyme needed to break down our mother’s milk, so we all come into the world fully lactose tolerant. As we grow older some of us lose that enzyme and can become intolerant. However, it’s important to know the difference between lactose intolerance and an allergy to milk. An allergy is where the immune system reacts to a certain type of food and causes symptoms like itching, wheezing and itching.
Research in the 90s shows that this number is actually large; up to 70% of the world’s population lose their lactase enzymes (the ones needed for milk digestion) after weaning. So all those lactose intolerant people might not actually be faking it.
As well as getting a bad rap for causing tummy upsets, dairy has also been targeted by dieters who believe that its high fat content contributes to weight gain. This is unlikely to be the case though. The high fat and sugar in dairy is mitigated by its protein content, so it dosen’t have a huge effect on blood sugar levels. It’s glycaemic index is moderate at around 35. So in moderate quantities it won’t make you fat. It’s rather the low fat and 0% fat milk, cheese, yoghurt, and ice cream that are the culprit for the weight gain myth. In the wake of mixed messages about the dangers of saturated fats we’ve turned to these low fat options but they are often worse as as they’re loaded with sugar and salt.
There’s no treatment for lactose intolerance, so the only treatment is the avoidance of dairy products. This avoidance though means that you may be lacking some very important vitamins and minerals, so nutritional supplements like calcium and vitamin D are advisable.
Back by popular demand it’s our spring plank contest. It’s the great levelling exercise, where someone young can be out done by someone much older, where traditional fitness is less of an advantage.
The plank is a static, holding or isometric exercise where you hold yourself in a straight line propped only by your elbows and toes. It works not just the traditional muscles of the abdominal wall that you would exercise in crunches, but the whole of your core, from your back muscles to your “natural weight belt” the transverse abdoninus.
This spring we will be seeing who has the toughest core and also the toughest mind – the plank is very much a psychological challenge too. A minute is good, 2 even better. Last contest was won in a little over 11 minutes (men) and 7 minutes (ladies). The world record is over 4 hours!!
Running from the 1st May to the 31st May 2016, winning categories are:
Open ladies/Open men
Ladies and gents masters – over 70
A certificate of kudos and honour awaits winners of all categories, with trophies and a free PT session to the two best performers. Please note this may not necessarily be the open category winners, but those who we feel have pushed the boundaries furthest, allowing for age and context.
Rules – you must be timed by a DDW trainer, form must be correct, i.e. shoulders, hips and knees in a straight line. Please ensure you are fully warmed up before attempting.
Good luck! Winners will be announced here and on our Facebook page.
Is butter healthy, asked a new study released in the US this week? Butter and other saturated fats may not be as bad for us as previously thought; in fact, swapping them for unsaturated fats like olive oil and other plant oils may actually lead to an increase in life expectancy.
These are the surprising findings of a new study in the US that has re-analysed the data from a trial that was conducted 50 years ago, the results of which were never published in full. This data showed that although those who switched from saturated to unsaturated fats had lower levels of cholesterol, this did not translate into higher life expectancy through a reduced risk of heart disease.
In fact, the death rate was actually higher in those subjects with lower levels of cholesterol readings throughout the 5 year trial. Running from 1968 to 1973, the 40-year-old study known as the Minnesota Coronary Experiment was thought to prove the link between heart disease and coronary heart disease, but may only show a link to higher levels of cholesterol, not morbidity.
The Minnesota study, conducted from 1968 – 1973, involved some 9,000 people, mainly in a nursing home and mental hospitals. The patients’ diets were easily controlled and one group was fed foods high with saturated fats; another ate a diet with little saturated fat and replaced with lots of corn oil, an ingredient common in processed foods today.
Published in the British Medical Journal, the new analysis of the old data was done in the US by the national Institute for Health. The conclusion goes against much modern nutritional guidance:
“Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid (corn oil) effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes,” said the authors.
Although contentious, leading nutritionists and scientists in the US point to the subtleties in the findings, and the importance of what food was swapped for what. “For years now, we have been recommended to cut out animal fats and replace them with plant sources of fats,” said respected US dietician John Rickards. “But when you swap out bacon for a bagel in the morning – you essentially cut out fat and replace it with refined carbs – you run the risk for raising your triglycerides and lowering your HDL cholesterol – increasing your risk for heart disease.”
He added that fats should still be sourced from natural plant sources like nuts, seeds, avocados and coconut oils. The results of the study might not actually advocate lots of saturated animal fats, but rather that they should not be substituted for low fat/high sugar/high processed carbohydrate alternatives. The reinterpreted research does not claim saturated fats are good for you. It claims instead that eliminating them is not necessarily good for heart health. And that’s a crucial distinction. Remember also that many vitamins and minerals that we need are fat soluble, i.e. we need fat present to digest them. So the message is not to eliminate saturated fats, rather to include them in a healthy, whole food diet that also contains plant based fats, unrefined carbohydrates and clean sources of protein like fish and chicken. So is butter healthy? Yes, and no…like most foods.
The recent sugar tax announced in the latest budget comes not a moment too soon for a nation addicted to sugar; we eat an average of 238 teaspoons per person every week. We are on the verge of a type 2 diabetes epidemic, an obesity crisis and an explosion of other sugar related health problems. Despite knowing that sugar is bad and causes health problems, most of us still haven’t been given any advice on practical ways to reduce sugar in your diet.
That’s because it’s everywhere. Its hidden and carefully packaged in a way that is designed to keep it concealed from us. It’s hidden in a healthy looking soup. It’s packed into snack bars with the name “nature” on the front. It’s in many types of fruit (that, apart from the sugar, are really healthy to eat); it’s hidden in coffee drinks; it’s lurking in that healthy breakfast cereal.
Although cutting down is not easy, doing so has an immediate effect on health, especially in children. In a study at the University of California, 43 children, each with a chronic health problem like high blood pressure, were given foods low in sugar and had sugars replaced with starches. After only 9 days they showed improvements in cholesterol levels, blood pressure, improved blood glucose levels, lower insulin response (which causes type 2 over time) and improved liver function. The study definitively showed that sugar is bad for health not just in terms of weight gain but in a metabolic way.
So how do we go about removing it? Here are some key points:
1 – Don’t go overboard. You can’t remove all sugar from your diet. When training clients who want real definition or a 6 pack, we ask them to try and keep sugar to 30g a day or less. This is very hard. Sugar occurs naturally in many healthy foods, like vegetables and fruit. Instead focus on removing added and/or processed sugars and intense sweetness; these cause a dulling of the palette and sugar addiction. The less sugar you have, the faster and sooner your taste buds will re-adjust to normal levels, meaning that you will crave less sugar. It’s a healthy snowball effect.
2 – There’s no such thing as sugar addiction. Physiologically, you don’t need any sugar. Your body makes glucose to feed the brain and muscles from healthy carbohydrates, fats and proteins. You don’t need to add sugar. The premise that you need some sugar after or before exercise is a fallacy. It’s just marketing. Your body will make all the blood glucose it needs from other food sources.
3 – Check the label! Our advice is to avoid any food that contains more than 3g of sugar per 100g. Any liquid with any sugar in at all should be avoided. Why? Sugar in solid foods is mitigated by any fibre, protein and complex non sugary carbohydrate it contains, slowing its digestion. Liquid, however, just goes “straight in”.
4 – Some fruit is healthier than others. swap fruits high in sugar (grapes, cherries, oranges and bananas are the highest) for low sugar fruit. Anything with “berry” on the end will not only be low in sugar but will also be packed with vitamins and nutrients. In particular avoid fruit juice and smoothies. These have basically taken all the good things out and left behind a sugary fruit flavoured water.
5 – Avoid artificial sweeteners. Although there is no proof that these sweeteners cause blood sugar (and insulin) levels to go up, they do deaden the taste buds to excess sugar. Wean yourself off them and you will soon start to taste the natural sweetness in foods much more.
6 – Beware low fat foods. Fat doesn’t make us fat. We need fat. Sugar and processed carbohydrates make us fat. Translate “low fat” as “high sugar”. Avoid to reduce sugar in your diet.
7 – Use an app. Even if it’s just for a day, an app like weight loss resources or myfitnesspal can be uploaded to your smart phone and used to track calories (and sugar). At the end of the day have a look at the grams of sugar and where they came from.
8 – Be visual. take a food that you are about to eat. Look at the label. Work out how much sugar is in it. Then count out the equivalent amount of sugar onto a plate. For example, a pot of rachel’s organic yoghurt (healthy sounding, right?) contains 13g of sugar per 100g. There’s 500g in the pot. So Half a pot = 250g, or 2.5 times 13. That comes to 32.5. 1 teaspoon is 4g of sugar. Count 8 teaspoons onto a plate. Exactly. Shocking. The “healthy” bar pictured above contains 3 teaspoons of sugar. Yet it has the word “nature” on the front.
9 – Have treats, just reduce the sugar. Swap milk for dark chocolate. Swap sugary low fat diary for natural Greek yoghurt. Swap cereal for porridge. All these small changes will really add up. You will have more energy, avoid going through low blood glucose periods. These are pints in the day where you feel suddenly tired, hungry and in particular craving something sweet.
At first it might seem like you are depriving yourself, but after only a few days you will adjust and start feeling great.