Decreased Dementia Associated with Midlife Cardiovascular Fitness

In a 44-year-long study involving women, high midlife cardiovascular fitness was related to a decreased risk in dementia.  The study found a dose-dependent relationship between fitness level and dementia risk.  Those with a high cardiovascular fitness level had only a 5% incidence of all-cause dementia by the end of the study, as compared with 25% for medium fitness, and 32% for low fitness.  Furthermore, for those who did develop dementia, the onset was an average of five years later in the high fitness group, than in the medium fitness group.  The average age of dementia was 11 years higher in women with a higher fitness level than those with a medium fitness level.

Cardiovascular fitness levels were measured at the start of the study using a stationary bicycle test that incrementally increased workload, in which participants cycled to exhaustion.  Dementia assessments were administered to the participants every 5-10 years thereafter.  The women who had the highest fitness levels also on average had higher wine consumption, their own income, and less hypertension compared with the medium or low fitness groups.  Although this study only involved women, similar conclusions can be extrapolated to men.  A Swedish study that tested cardiovascular fitness utilizing the bicycle test in 18-year-old men, found an increased risk in the onset of dementia occurring among medium fitness levels as compared with highly fit men, and further increased the risk in those with low fitness levels.  A very high dementia incidence was found particularly in participants who could not complete the bicycle test before reaching a submaximal load.

Although the findings were not causative, there is a definitive association between higher cardiovascular fitness and a lower risk for dementia.  Physiologically speaking, those who are the most fit, have a greater amount of oxygen circulating through their bodies.  Higher oxygenation to muscles increase endurance and performance.  Similarly, the same effect can be hypothesized to apply to brain function, as many associative studies have supported.  In short, increasing your cardiovascular fitness level will almost surely enhance your mental function.  Yet another pillar for the benefits of exercise.

by Rima Sidhu, Maze Health

Concussions: What You Need to Know

Concussions, also known as a Mild Traumatic Brain Injury (mTBI), occur when there is an impact to the head and the brain hits against the bone inside of the cranium and bounces and hits the other side. Berger asserts that the brain gets scraped against any bone irregulates on the inside of the cranial bones. The impact can stretch and tear tiny blood vessels and delicate nervous tissues. The scraping on the inside of the cranium can cause bleeding and bruising to the brain. Depending on the severity of the impact, it can lead to momentary alteration or loss of consciousness, or posttraumatic amnesia.

What you might have not been told is that post-concussion injuries can be accompanied by post-traumatic stress symptoms (PTSD). PTSD symptoms occur when we are exposed to an experience that overwhelms our instinctive ability to protect ourselves. When we either recall or re-experience the original traumatic event, the nervous system reacts as if we were reliving the upsetting episode. Highly charged emotions hijack our thinking as our nervous system remains stuck as implicit memory of the traumatic episode. Common PTSD symptoms are manifested in highly aroused anxiety, panic attacks, avoidance, flashbacks, loss of interest, social isolation or irritability. What is really important is that concussion and PTSD symptoms go hand-in-hand and both symptoms must be addressed to restore complete healing.

However, underreporting and/or the pressure to return to competition/class often cuts short the necessary time for the brain to rest. A May 2013 survey revealed 53 percent of high school students would continue to play even if they had a headache stemming from a head injury. Just 54 percent said they would “always or sometimes report symptoms of a concussion to their coach” as per Chris Nowinski, a former athlete himself and co-founder of Sports Legacy Institute.

If young athletes minimize headaches or pain symptoms, then what does this say about giving importance to the lingering emotional symptoms that remain unaddressed? The symptoms of mTBI of PTSD can mimic and overlap with one another and trigger each other. Non-trauma trained professionals may not even consider addressing PTSD symptoms at all. Hence, individuals may present PTSD symptoms and not necessarily associate them with the concussion.

It is precisely during resting time that athletes become restless. Driven by a mental toughness culture and/or the fear of losing out potential athletic scholarships, emotions like depression and anger are normally experienced. Research indicates that depression is about 8 times more common in the first year after Mtbi than in the general population. Likewise, studies are showing that ADHD symptoms may appear even 7 to 10 years after the concussion episode took place. Dr. Asarnow from UCLA indicates that these children may do relatively well when are less academically challenged, but as studying becomes more demanding, ADHD symptoms become more apparent.

A real concern is that teenage athletes are turning into alcohol as a way to “cure” emotional pain. However, drugs and use of alcohol will only worsen the depressive symptoms. Not only it reduces the effectiveness of anti-depressive medication, it can lead to a concerning addiction. Likewise, the recovery time to treat concussions will be prolonged as its symptoms stronger symptoms are typically experienced.

What you NOW know:

  • Concussions are accompanied by PTSD symptoms;
  • Underreporting emotional discomfort will only prolong healing process;
  • Anger, anxiety, and depression are normal emotional symptoms that need to be addressed or athlete may find unhealthy coping skills to alleviate such a pain;
  • The time to begin addressing emotional discomfort is during resting time as boredom may lead to cut short or underreport symptoms.

 

Alex Diaz, PhD

Sports Mental Edge

Older, but Not Weaker

Bone strength peaks by age 30 in humans. That is it…after that your bones get weaker. Muscle strength peaks at about 25 years old and plateaus until 35 years old. After that, you lose muscle strength. So what does that mean for the aging athlete?

Why do you need to maintain bone mass (strength)? Because weaker bones are more likely to break. The death rate after a hip fracture is14-58%. Studies show up 50% of people die within one year of breaking their hip. You don’t want to be one of these unfortunate victims of death by osteoporosis.

There are a few ways to maintain bone strength. First, it is important to reach your peak strength by developing good bones when you are young. You need to get adequate vitamin D and Calcium in your diet at all ages, but if you deprive your body of either of these at a younger age your bones will start out weak. Impact activities such as running or even walking build bone. Non-weight bearing activities like swimming do not build bone. Using weights and doing resistance exercises also helps build bone.

Similarly, building muscle is done through exercise and strength training. Each year after 35 years old, the average person loses 0.5-1% of their muscle mass. If you do not work out, you will get weaker. Even if you work-out, you will still lose strength but not as quickly.

For bones, the most important and common fractures are the hip and the wrist. Leg work-outs especially for the quads are key to maintaining the hip. I like squats, biking, walking and if able running. If any of these hurt, find out why and don’t do them. See your local orthopedist if you develop pain or swelling.

To strengthen your arms, biceps and triceps are important. If your forearms don’t get tired working out, add wrist flexions and extensions with light weights. Wrist fractures are very common in patients older than 65 years old and can be prevented in many people by strength training.

Unfortunately, a common consequence of weak bones is compression fractures of the spine. When older people say they are shrinking it is often due to collapse of the bones of the spine from osteoporosis. Core strengthening and impact exercises can help prevent these fractures.

At any age, you need to eat well and exercise. If you don’t do both, you will get older quicker. You will become frail and more likely to die at a younger age. This is up to you. If you develop pain, don’t give up but find out what the problem is. Have a good doctor you trust available to help you maintain your good health.

By Rick Weinstein, MD, MBA

Director Orthopedic Surgery Westchester Sport & Spine at White Plains Hospital

What is the Ketogenic Diet?

It seems like every year there is a new diet craze or a new way of eating. Many people are searching for the magic bullet for weight loss, and they go from diet to diet hoping that one works. The “new” craze is the ketogenic or keto diet. What is the ketogenic diet, and is it right for you?

The keto diet is based on scientific evidence and has been utilized for almost 90 years. It was originally created for patients with epilepsy since the keto diet mimics fasting, which has been shown to reduce the number of seizures for patients.  It is a very low carbohydrate diet which enables the body to use dietary fat and body fat storage as the primary fuel source for energy, rather than carbohydrates.  The body believes it is fasting because of the very low carbohydrate intake, and it starts to burn fat for energy. ”Ketosis” is a physiological mechanism that occurs in the body when adequate carbohydrates are not available to burn for energy, and instead, the body burns fat for energy, producing ketones as a by-product. When ketones rise in the body, it enters into ketosis, which is a fat-burning metabolic state that results in weight loss.

The diet works by severely limiting the number of carbohydrates that you consume to 10% of total calories. Carbs should come predominantly from leafy greens and non-starchy vegetables. For most people, this is about 30-50 net grams of carbohydrates, but some people get the best results on only 20g of carbohydrates. 20% of the diet should be from protein, especially fish high in omega-3s and grass fed and organic meats. All processed meat should be avoided. The remaining 70% should consist of healthy fats from avocados, nuts, seeds, coconuts, and medium-chain triglyceride oils. Dairy is allowed, but it should be limited. All sugar, grains, processed foods, and alcohol should be avoided.

In addition to weight loss, the keto diet has been shown to decrease the risk of type 2 diabetes and to improve blood sugar management. It also protects against cancer, decreases the risk of heart disease, and protects against Alzheimer’s and other neurological conditions. It may also increase mental focus and alertness as well as increase energy.

The keto diet has been shown to work for weight loss, but it can be difficult to adhere to. Additionally, some people, especially those who have difficulty metabolizing fats, will not do well on the ketogenic diet. Consult a health care practitioner before starting the keto diet and see if it is the best option for your weight loss and daily regimen.

Stay Safe on the Slopes

January is National Sports/Winter Sports TBI Awareness Month. TBI stands for Traumatic Brain Injury. This month is meant to shed light on concussions and other brain injuries sustained during sports, specifically that of winter sports. Traumatic brain injury occurs when a trauma, such as a fall, head injury, or car crash, causes damage to the way the brain functions. According to the American Physical Therapy Association, approximately 1.7 million TBIs occur each year in the US, resulting in 52,000 deaths and 275,000 hospitalizations. TBI is usually misdiagnosed which often causes complications or the death of the patient.

Football & hockey are most commonly associated with these types of injuries however skiing, snowboarding, ice skating, and snowmobiling also can cause significant damage. A 10-year study by the International Federation of Skiing documented 320 concussions sustained by athletes in the disciplines of alpine skiing, freestyle skiing, snowboarding, and ski jumping.

The National Ski Areas Association has provided the following tips for staying safe on the slopes this winter:

  • Always wear a helmet! Make sure that the helmet fits properly and that you fasten the chin strap. You want to be sure to have a proper winter activity helmet, not a bicycle helmet. Ski & snowboard helmets have specific features geared towards those activities
  • Wear the proper size skis. Larger skis may be harder to control. Speak to a professional in order to pick the appropriate size skis for your body type
  • Have proper bindings which keep your boots to the skis or snowboard. Binds should be able to release your foot but not too easily & should be adjusted by a professional
  • Boots should fit correctly, not too big or too tight. Your boots should also be warm and should be secured to the skis or snowboard
  • Like skis, poles should be of appropriate length and should have looped straps which go around your wrists

In the event that an injury does occur, be sure to seek medical attention immediately. Do not continue with the sport or activity until cleared by a medical professional. Rest is the best form of treatment when it comes to a concussion. This will allow the brain to better recover and prevent further damage. You may be advised to abstain from physical activity and even activities which require you to focus or learn new concepts. This may involve working less hours or shortening your school days. As symptoms begin to improve, you may gradually increase activity level as advised by your doctor. Keep in mind that repeated blows to the head can lead to Chronic Traumatic Encephalopathy. This is a progressive, degenerative disease that has been linked to memory loss, impaired judgment, insomnia, dementia, and severe depression. Follow the tips above & always err on the side of caution when participating in vigorous winter activities.

As with most sports & activities, you should get yourself in shape prior to hitting the slopes. You can’t ski your way into shape and you will enjoy it much more if you’re physically fit. Come to The Arena & train with our strength & conditioning coaches who can get you in great shape for the slopes & throughout the whole year.

By Gina Stallone CPT

Learn this Simple Lifesaving Technique

 

This is a true story that I hope inspires you to take action.

A few weeks ago I was at a friend’s birthday dinner with my family. A lady sitting at the far end of my table suddenly stood up holding her throat looking in distress. She began walking toward the bar. The lights were dim and the music loud. Most people in the crowded room didn’t seem to notice. Her friends sitting at the table did not follow her. Maybe they thought she wanted privacy? Earlier I had overheard her saying that she had many food allergies and was extremely sensitive. I initially thought she was having an allergic reaction to something she ate.

A member of the waitstaff followed her. I was concerned and followed her as well. My thoughts at that point were to ask her about and look for an EpiPen as she had known allergies. As I got closer she collapsed to her knees still holding her throat. At that point it seemed more like she was choking and all of a sudden those years of CPR training and recertification I had received, that I hoped I never had to use, kicked in. I yelled to the bartender to call 911 (which they were on their way to do anyway). In an emergency, always call 911 to get help on the way as quickly as possible.

I asked her if she was choking and wanted me to help her and she desperately nodded. Strange and obvious as this question may sound, this is part of the protocol. There were some waitstaff and bartenders around us and someone asked if I knew what to do. I said I had training in this, would do all I can to help and then got to work.

After performing two rounds of the abdominal thrust protocol also known as the Heimlich Maneuver, her airway cleared and she started coughing and breathing. I cannot describe the relief and gratitude I felt, and cannot even imagine what she must have felt at that moment.

What was most striking, and almost surreal, to me during this experience was the automatic response and calm control I felt. The reason being, every time I’ve taken CPR classes over the years, I’ve always dreaded actually being in a situation where the training was necessary. My fear was that I wouldn’t act effectively under pressure in the heat of the moment. But I felt surprisingly clear-minded, the procedure seemed to flow and thankfully was successful. The lady, although a little shaken, was ok.

Another thing that struck me was the fact that with so many people around, no one else followed her to see if she needed help as she walked away. Some people may not be able to recognize signs of distress, or maybe want to give privacy and not embarrass someone if they don’t realize the gravity of the situation. If you feel you are in distress, make it known that you need help. This is crucial.

My reason for sharing this story is to encourage you to get training in CPR or CPR/First Aid. You can make a huge difference in, and maybe even save someone’s life. Familiarize yourself with the basics because things really do happen at unexpected times. Then continue to be re-certified/trained as years go by. Practice and brush up on these skills once in a while. Repetition is what creates motor memory and will make a difference when there is real stress involved.

Some of us are required to have this training based on our careers. But even if it’s not a requirement, do it anyway. Sometimes professional help may be too far away when every second counts. So the more prepared we are to respond and take appropriate action when time is of the essence, the better our chances of successful outcomes.

There are lots of resources online for basic information and classes everywhere. Simply Google CPR classes in your area and you’ll easily find one.  Below are some links to help you get started.

 

Links:

http://www.redcross.org/flash/brr/English-html/conscious-choking.asp

http://henryheimlich.com/how-to-perform-the-heimlich-maneuver/

https://www.webmd.com/first-aid/choking-in-children#1

https://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240175_Pediatric_ready_reference.pdf

https://www.redcross.org/take-a-class/lp/cpr-first-aid-aed-certification-new-hero?utm=a&device=d&scode=PSG00000E017&gclid=EAIaIQobChMIyqem79HI2AIVB1gNCh3r8AciEAAYASAAEgLSE_D_BwE&gclsrc=aw.ds&dclid=CNOCm5fSyNgCFcQONwodYiUCTA

What Can We Learn from Top Athletes?

One of the quotes that better describes the mindset of successful athletes says, “Top athletes train as if they are the worst, yet compete as if they are the best.” I find it to be a humble, yet a powerful description of how an elite athlete goes about the mental preparation to succeed. Success is not consistently achieved by just showing up to compete and trying your best. Elite athletes clearly understand that the best predictor of success is a well-structured practice that pushes their physical, strategic, and mindset boundaries. Only when practices are used to their fullest potential, ideal performance are achieved.

Here are the best five habits shared by elite athletes that we can also implement:

Goal setting

Elite athletes plan their course of action by specifically setting out their goals under a reasonable time-table. Knowing exactly what they want to achieve pushes them to take action in direction toward constant improvement. Goals are broken down by identifying long-term objectives first and then working backwards by setting short term goals. One way to effectively stay on track on the achievement is by using a SMART chart. Eliud Keichogue, who ran 2nd in the 2016 London Marathon, kept track of all his progress, which helps him to remind himself of all his success and progress he was making to meet his goals.

 

 

Embrace mistakes as a learning experience

Elite athletes compete against themselves. All their focus is on improving their skills, mindset and performance. Missing the achievement of a goal is not a setback, but rather an opportunity to learn and improve for next time. Avoiding mistakes will only limit their achievements. Learning how to cope with setbacks will push them to achieve their goals. They see a big difference between obstacles versus challenges. The former places focus on the negative whereas the latter on the positive. Elite athletes are constantly learning from all their opportunities that are given and use that experience to feed more information and critical thinking to plan better for next time.

 

  • Sleep

Usain Bolt shared that his unnegotiable preparation routine is sleep. Sleeping is a time to recover and re-energize the body and mind. Make sure your room is free from electronics, a bit on the cooler side as it helps to rest the body quicker, and maintain a routine. Equally effective are power-naps. It provides time for the body to heal and, most importantly, for the mind to be fresh and ready to react and respond.

 

  • Imagery

The imagery of attaining goals is a powerful tool that feeds the brain with positive energy, optimism and motivation. Athletes visualize the achievement of their goal prior to starting each of their performances and practices.  There are two ways of doing imagery work: Internal Imagery: the athlete sees him/herself executing the ideal performance by bringing in as vivid an imagery as possible. The athlete “feels” the entire experience of the performance as if he/she is really doing it. The clearer and the more vivid the imagery is, the more the body will remember such an experience. External Imagery: the athlete sees him/herself competing as if he/she was on a canvas or screen of a movie theatre. In this case, there is an imaginary distance where the athlete “sees” him/herself successfully completing the entire performance rather than sensing it in his/her body.

  • Be happy

Katie Ledecky, a multiple time Olympic and World swimming champion, has learned to take competition in a happy, more relaxed manner. She shares that she places anxious moments at an arm’s length by bringing positive thoughts to any negative thoughts that start to creep into her mind. She finds that smiling and laughter brings relaxation and are natural remedies to alleviate stress.

Hope these tips used by elite athletes are equally incorporated in your routines. If it works from them, it can clearly work for us.

Alex Diaz, PhD

Sports Mental Edge

Getting in Shape Quicker in 2018

Every year we all make our lists of New Year Resolutions and promise ourselves to get in better shape. The truth is less than 7% of us will actually change anything. If you really want to change, then you have to push yourself out of your comfort zone and challenge yourself. Workout like you are 19 years old and willing to really sweat and be exhausted and sore. Figure out what motivates you and what kind of workout you enjoy. If you like running, do that. If you prefer elliptical or biking, do that. And if you prefer varying your work out, mix it up.

Nobody has enough time to work out the way they want to. I try to get an hour work out in before work; unfortunately, I can usually only do 30 minutes. We need to maximize the use of the minutes we have in the gym to be as efficient as possible. Interval training has been shown to have much more benefit than standard work outs. High Intensity Interval Training (HIIT) has been shown to be even better than interval training.

A standard workout is going on the elliptical for 20 minutes at one speed. Interval training would be varying the resistance/speed with peaks and valleys during the workout. An HIIT workout would involve making the peaks much higher pushing you where your body cannot supply enough oxygen to the working muscles. This could include not only your leg and arm muscles but also your heart muscle. The HIIT workout will require your body to recover for hours after your workout. Your metabolism will be increased and you will be burning more calories for several hours even after you are done with your training. Short but intense workout challenges are the key to HIIT.

I was caught up in my routine workout and getting bored doing the same regimen for years. Then 3 months ago I decided to go on a bike trip to South America with my 19-year-old son. I knew I had to step up my training to avoid embarrassment and so I would not feel old next to a much younger real athlete. I started biking outside and then started spin classes as the weather got colder. Also, I hired a personal trainer to kick my butt and help me do new workouts. The trainer was smart and goal-oriented helping design a legs and core workout to get me ready for the mountains of Chile. Over the next 6 weeks, I lost about 7 lbs. and dropped my waist size. I also felt better and more energetic during the day. I was well prepared and did great biking abroad.

I am competitive by nature, and this is part of what motivates me. When I am in spin class I won’t quit because I would not let the person next to me work harder. When my son passes me on the bike, I am pushing myself to keep up or even try to pass him. A lot of the work is mind over matter. Find what motivates you and use it.

Whatever physical activity you do, you need to push yourself. However, make sure your body can handle the challenge. As a physician, I advise you to know your body and realize that in doing too much you can hurt yourself. You need to know your limits and if you are uncertain talk to your own physician. It is a new year. Decide to be one of the 7% that actually change yourself for the better in 2018.

By Rick Weinstein, MD, MBA

Director Orthopedic Surgery Westchester Sport & Spine at White Plains Hospital

What is the Paleo Diet?

 

Many diet gurus, workout fiends, and nutrition specialists have been touting the benefits of the Paleo diet. A Paleo diet is named appropriately because it focuses on eating foods available only in the Paleolithic Age, when our ancestors were hunters and gatherers. This eliminates ALL processed foods, refined grains, cereals, and milk. Only fruits, vegetables, meats, nuts and seeds are allowed. The diet makes sense because evidence has shown that processed foods and sugars are responsible for many health issues. It increases the consumption of meats, fruits, and vegetables, which add nutrients and antioxidants to the diet.

Some of the health benefits of the Paleo diet include weight loss, reduced inflammation, increased satiety, regulated blood sugar levels, and corrected nutrient deficiencies. The diet is high in protein and fat, and since it’s all-natural, it is filled with nutrient rich foods.

Foods that should be avoided on the Paleo diet are refined sugars, refined oils, dairy, legumes (including peanuts, beans, and tofu), salt, potatoes, cereal grains, starches, and alcohol. Many Paleo experts allow grass-fed butter since it is more a fat than a dairy product, but that is a little controversial. Other controversial foods are pseudo-grains, such as quinoa. Quinoa is not strictly Paleo, but some people on Paleo diets eat it from time to time. It should be avoided if weight loss is the goal or if there are gut issues.

If your goal is weight loss, certain foods that are considered Paleo should be consumed in moderation. For example, butternut squash, acorn squash, yams, sweet potatoes, and beets are starchy vegetables. While technically allowed, their high starch content increases blood sugar levels and may promote weight gain, so they should be consumed in moderation. Additionally, processed meats and meat high in fat should be avoided since they provide more calories and fat. While fruits are Paleo-approved, they are also high in natural sugars, so consumption should be limited to once a day, with the focus on low glycemic fruits, such as berries and apples.

Some critics of the Paleo diet state that the diet may be too high in protein and difficult for many people to follow. Additionally, the diet is high in seafood. Many types of fish and shellfish are very high in toxins. However, in general, I believe the benefits of the diet far outweigh the negatives. In fact, if your goal is to lose weight in 2018, a version of the Paleo diet is a great way to start off the New Year!

 

By Denise Groothuis MS RD

For Men, Exercise is Key to Increasing Fertility

A comprehensive randomized control study that came out earlier this year suggests that engaging in moderate aerobic exercise can significantly increase male fertility rates in previously infertile men.  The study was conducted over a 24-week intervention period, with both exercise and non-exercise groups being physically similar in terms of body composition, semen quality, markers of inflammation and oxidative stress.

Throughout the course of the study, measurements were taken against baseline measurements, showing significant improvements in the exercise group in following areas:  Increase in Vo2 Max, which measures aerobic capacity, an increase in semen quality and decrease in sperm DNA damage, decreased markers of oxidative stress, and decreased pro-inflammatory markers.  Furthermore, during and post intervention, there were more total pregnancies and live births in the exercise group than in the control group, which reported 0% live births.

As the exercise subjects became more aerobically active, they experienced decreased body weight and body fat during the intervention.  The decrease in oxidative stress is attributed to an increase in exercise-induced antioxidant enzymes.  It was also reported that discontinuing exercise four weeks after the intervention period was not a long enough period have a significant adverse effect on fertility and pregnancy outcomes.

The take-away for men and couples hoping to increase their fertility, is that even a little goes a long way.  Try to incorporate moderate physical activity into your lifestyle, 3-4 days/week, for at least 25 minutes per bout.  Examples of moderate physical activity include:

  1. Brisk walk
  2. Light jog
  3. Heavy cleaning
  4. Mowing the lawn
  5. Light bicycling (10-12 miles/hour)
  6. Tennis- doubles
  7. Recreational badminton
  8. Hiking
  9. Recreational swimming
  10. Kayaking in calm water

By Rima Sidhu, MS