Physical Activity For The Gold

Physical Activity For The Gold

With the Gold Coast Commonwealth Games starting this blog is a timely reminder to endorse the benefits of physical activity.

As the Australian public cheer on their favorite athletes from the comfort of her/his living room an oxymoron of sorts is this:

People are likely to be sitting on their glutes all day rather than getting out and using them! So while the Commonwealth Games is displaying the epitome of fitness, we are more likely to be sedentary and less physically active while we watch the athletes.

 

An evidence to practice gap in physical activity

A recent perspective paper in the Medical Journal of Australia discusses an “evidence-practice gap” of physicians. This means that while the evidence is strong in regards to the benefits of physical activity, there is an inadequacy in discussing and prescribing it to patients.

NOW, in no way am I slanting a bias towards exercise physiologist/scientists. However, physicians are typically the first line of contact for patient care, and thus, with physical inactivity being the fourth leading cause of morbidity/mortality worldwide (1) my premise is thus justified right?

The authors found that physicians who were themselves physically active, were more adept at discussing exercise over physicians who are physically inactive (3).

The benefits of physical activity are very well known (2). I am an evidence based analytical thinker, so when the evidence is very strong and robust – the likelihood for adherence is highly likely. Of course, there are “health professionals” and unfortunate reality television shows; that promote unhealthy physical activity.

Which is why I challenge the reader to ask her/his medical/health professional about the recommended physical activity guidelines. Do you know yourself? What the minimum physical activity guidelines are? What if your job entails eight hours of sitting a day… how much physical activity should one be achieving, based on evidence?

So many interrogatives!

 

So in summary, here’s some tips to help you increase your physical activity:

  • Query your medical and allied health team about the physical activity guidelines.
  • Ask your medical and allied health team – “am I safe to move”? 
  • Lastly, trust your source of information, including mine – by doing further research, while being mindful for confirmation biases.

 

Enjoy the games, and cheers to moving more!

James 👨🏼‍⚕️🏅

 

References:

  1. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219-229.
  2. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports2015; 25: 1-72.

About the Author

Hide & seek. Pain may not be hiding where you think it is…

Hide & seek. Pain may not be hiding where you think it is…

Following on from the great work from my colleague Dr. Nathan Harten’s last blog; I will continue educating you on the latest neuroscience on persistent pain.

You may have been allluded to our brains wonderful capacity to protect to a ‘perceived’ threat.

Perceived you say?

Lets delve into this further…

There needs to be credible evidence of danger over safety for a pain experience (1).

Let’s pause and reflect on that for a moment…

Danger or safety in pain circumstances

It is advantageous to have fast acting danger messages to make us pull our hand away from a hot pan right? Danger over safety is highly relevant here. What about an ankle that had been sprained ten months ago? That ankle is still hurting to load, difficult to localize the pain, and you have exhausted Google & the pharmacist for an answer. Not advantageous at all is it?

Pain is not a true marker of tissue damage…

Let’s pause and reflect again on this statement…

Pain is an output constructed by the brain (1), by many contextuals. Contextuals ranging from:

Is this pain going to interrupt my job?

Is this what an ankle sprain feels like?

Can I still play in the football grand final?

How long am I going to be out for?

Should I just rest?

All of these constructs add to a pain experience (3); storing memories, emotions and motor patterns in a highly organised network, AKA your central nervous system. Even your immune cells (microglia) and endocrine system (HPA axis) are activated! (3) plus more!

Persistent pain is more than just where it hurts

So you see pain isn’t all just about where it hurts. Especially persistent, chronic pain (1). Somehow, your brain is still warning you. It still wants to protect you from a perceived threat and make you hurt.

This may sound like a rhetorical question, but is this protection advantageous at all?

Please take the time to reflect on your own experiences of pain…

Maybe the threat of losing your job is adding to a pain experience?

What if you are a professional athlete, trying to protect your pain from the coaching staff, perhaps because your contract is up at the end of the year?

Are you still blaming the driver who hit the back of your car?

All of the highlighted words are ‘threats’, and thus the brain will scrutinise all of the aforementioned and will decide whether it’s important or not to let you know; and to make you hurt.

Becoming aware of perceived threats and dangers are so important to understanding your pain (1, 3).

I hope now you think of pain as a biopsychosocial paradigm (Bio meaning the biological tissues, psycho meaning thoughts, feelings and beliefs; social meaning the environment) and not just about the tissue that hurts (2).

So I challenge you to challenge your beliefs on pain. This may be a line in the sand that you are willing to make.

Address what threats are in your life (work, financial). Learn how your stress system works. All of this is great at assisting you in the short term, but it can get a bit much if it’s 24/7 (think of having to listen to your car alarm all day!). However this is a topic for another day and another blog!

Feel free to seek help from someone else! Know that you are safe to move when you are experiencing chronic pain (even better with an exercise physiologist!).

Finally, know that we are neuroplastic and bioplastic… meaning that you can heal!

 

References

  1. 1. Butler, DS & Moseley, GL 2013, Explain pain, 2nd edn, Noigroup Publications, Adelaide, South Australia.
  2. 2. Gatchel, RJ, Peng, YB, Peters, ML, Fuchs, PN & Turk, DC 2007, ‘The biopsychosocial approach to chronic pain: scientific advances and future directions’, Psychological bulletin, volume 133(4), pp. 581-634.
  3. 3. Moseley, GL & Butler, DS 2015, ‘Fifteen Years of Explaining Pain: The Past, Present and Future’, The Journal of Pain, vol16, no. 9, (pp. 807-813).
Movement Revolution: Exercise effect on knee pain

Movement Revolution: Exercise effect on knee pain

Now as a disclaimer of sorts, I am going to straight out say that the following is purely qualitative & subjective. One is sure The New England Journal of Medicine won’t be calling to publish the following…

We are born to move!

Lets begin,

Neuroscientists have hypothesized for years that we humans are prediction machines, we are born to move! Movement can even be seen in the early stages of gestation. The child learns by observing the mother’s facial expression(s) & fine motor cues, and learns from making errors.

But still, movement is regularly neglected as a first line agent for pain & even metabolic conditions. Often replaced with pharmacological interventions. Now, one can understand that a hypertension patient would be prescribed a angiotensin converting enzyme. But, we know MORE can be done!

Motivation for this blog is due to seeing more knee pathologies, and especially how correctives have been neglected for surgery as a frontline intervention. Now, I am not trying to put your ACL into excessive anterior translation (get it?).  And I don’t need to discuss any sham stories.

Let me explain… Check out the schematic below

Without needing to be Wilder Penfield, you can see the highlighted blue & green regions in the cerebral cortex. This is your motor and sensory regions in your brain! Now, it doesn’t seem like your motor & sensory areas represent a huge amount of your cortex. But if you knew (or you may already know!) that the gyri & sulci (plural) are densely packed with neuronal cell bodies, millions in fact! And if I direct you to the tonotopic organization of the motor & sensory cortex; you can see how much dedication and richness there is to regions such as the hands & lips et cetera.

So, now you have brushed over some neuroanatomy…

What’s the big deal?

My argument is that are motor & sensory cortices are highly neglected as a conjunctive therapy to other modalities. One can manipulate another’s motor & sensory system to drastically improve pain, especially if there is maladaptation which is oftenly seen in chronic pain, but somehow neglected.

Don’t get me wrong, touch (which is somatosensory) is fundamental for the healing, learning process.

However, as humans, we are prediction machines. We hypothesize, use our narratives to justify our cognitive biases, plan, make executive decisions.

Sprinkle a little dopamine in the Ventral Tegmental Area and 3..2..1..GO!

 

I am really pushing a movement revolution!

Trepidation: Should we be using more than just medicine to help treat depression?

Trepidation: Should we be using more than just medicine to help treat depression?

I attended an insightful evening at SAHMRI on depression. I don’t want to sound all melancholic at the start of this blog. However, quantitatively speaking, Australia is the unhappiest country in the world (per capita). We also have the highest prescription rate/use of antidepressants in the world (per capita).

Now I am really sounding melancholic.

Why do we have high rates of depression?

I was really saddened that Australia, a wonderful, optimistic, culturally diverse nation is so depressed. Are we trying to put a band-aid on by taking an antidepressant with the notion that quote un-quote “she’ll be right mate”? Are we ill-informed by our health & medical team? Or does one think or feel that a pill is the only way to remission? Or are we literally still stuck in time?

Maybe my past tense reference was justified…

Here’s the problem…

Depression is so much more complex than the first hypothesis from the 50s, which brought us the discovery of the first antidepressant, Fluoxetine (Prozac). The problem is that all that has changed in the last forty years is that we now have ten or more antidepressants rather than just one. The reason I am so passionate about the right co-care and management is because of the side effects of these medicines. For example, the growth factors in antidepressants can contribute to obesity, another morbidity that inundates our health care system.

So what can we do to help treat depression?

Recent advances have shown that our genes can be switched off by our environment, sedentary lifestyles and psychologically stressful events.  This includes our BDNF (brain derived neurotrophic factor) genes, which are the fertilisers for our brain. They help protect and grow our neurons.  However, positively, we can also switch this gene on by exercising and meditating. Therefore our actions and choices can potentially lead to melancholy or greater health.

I guess this is more of a personal release than an education problem solving blog. Please pardon the lack of clarity/direction. But it many ways I feel this is the current position we are in.

It all starts with the little things:

  • Move more…
  • Find space, breathe, form boundaries and find silence/solitude…
  • Hug more…
  • Connect more (interpersonally)…
  • Connect with nature…
  • Nourish your body… (remember where amino acids are derived from… FOOD. And what do amino acids make? Neurotransmitters!)
International Women’s Day 2017

International Women’s Day 2017

Wednesday the 8th of March marks International Women’s Day. A day to recognize all the wonders of the female phenotype that spreads one’s estrogen and oxytocin around the universe!
Although I am a lover of the classics of Greek philosophy. Aristotle was all to wrong to postulate that women had no place in the metaphysical realm of thought… Inspirational women such as Rosalind Franklin, through her genius bold work on  X-ray crystallography helped solve the mystery of the double helix; and all of those 20,000 and so A, T, C G’S we know as DNA. Now, to not suggest one to be naive.
One may not know that, although Watson & Crick have taken all the glory for the discovery of the double helix (which also won them both a Noble Prize in 1962). It was Franklin in fact, who; through her work in X-ray crystallography took the first photo to postulate that DNA was in the shape of a double helix.
AND! with two unsuccessful attempts by Watson & Crick to  develop a successful model (which was berated by Franklin) left them both desperate to finish first. Leaked information of Franklin’s discovery fell nicely into the hands of the two scientist… and the rest is history. Sadly Franklin died at the tender age of 38 (potentially to over exposure of radiation), and thus could not defend herself for her discovery. One will never know what more discoveries Franklin could have made in her precious time…
I used Rosalind Franklin as an example to help celebrate International Women’s Day. With the struggle it has been for female scientist and the like (not helped by egotistic males) to really flourish in one’s craft. And how wonderful it is to see; that women are being recognized all around the world; and not just for their cooking abilities (I just went there..).
Perhaps, Donald Trump can write this blog next year….
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