Cardiovascular risk factors are well known to increase one’s risk of a stroke, and or vascular dementia. There is a lot one can do to prevent cardiovascular disease (CVD), stroke and maintain great heart health. I am sure you would like to know the evidence based risk factors for the aforementioned?
What are the risk factors for CVD and stroke?
In a recent paper published in the journal JAMA: Williamson et al used modifiable, evidence based risk factors in young adults (18-40 years) whom without any known evidence of cerebrovascular disease. To investigate using magnetic resonance imaging (MRI), if subjects brains were showing early signs of cerebrovascular disease. Cardiovascular risk factors that were measured ranged from: body mass index <25, cardiovascular fitness, alcohol consumption >8 drinks/week, non-smoker >6 months, blood pressure >130/80 mm Hg, cholesterol and fasting glucose.
What were the findings?
Each of the aforementioned risk factors were assigned a rating of 1, in a 8 point scale (8 separate risk factors). Scoring higher was inferred as having a low risk of cerebrovascular disease. Subjects that had more clinical risk factors (< 2 points), did show some early signs of cerebrovascular disease on MRI (1). Researchers found white matter hyperintensities, which are lesions contributing to demyelination of important neural fiber tracts in the central nervous system in subjects with <2 points. What does this mean? less connectivity = slower brain processes (executive functioning, working memory et cetera). For 18-40 year olds showing clinical signs this early- intervening with evidence based modalities would benefit the individual greatly.
So, how do I reduce the risk of developing cerebrovascular disease?
First of all- DON’T PANIC! although published in a reputable journal, the paper was a preliminary study, with further longitudinal studies required with a larger sample that is ethnically diverse. HOWEVER, all of the mentioned cardiovascular risk factors can be modifiable. The following 5 key points will get you in the right direction to good heart health!
Aerobic exercise: following the physical activity guidelines with 150 minutes of moderate aerobic activity per week. If you are sedentary >8 hours per day: aim for 75 minutes of accumulated physical activity per day.
High intensity interval training: 1-2 sessions per week, following an evidence based protocol, with guidance from your exercise physiologist and GP. Three 7-10 second sprints with a balanced work to rest ratio is suffice according to the literature.
Strength Training: 2-3 strength training sessions a week with accordance of the Exercise Sport Science Australia guidelines, with guidance from an accredited professional.
Sleep: although I am not a sleep physiologist, there is ample evidence relating poor sleep <6 hours/per night with CVD and insulin resistance. Sleeping 7-8 hours per night with optimal sleep hygiene is recommended by experts.
Nutrition: again, without being a nutritional expert: following evidence based guidelines (CSIRO), will ensure targeted bloods are met and there is less plaque build-up (atherosclerosis).
So there you go peeps! So many preventative ways you can keep your brain tissue myelinated! And your cardiovascular system in good “heart health”.
About the Author
- Williamson, W., Lewandowski, A., Forkert, N., Griffanti, L., Okell, T., Betts, J., Boardman, H., Siepmann, T., McKean, D., Huckstep, O., Francis, J., Neubauer, S., Phellan, R., Jenkinson, M., Doherty, A., Dawes, H., Frangou, E., Malamateniou, C., Foster, C. and Leeson, P. (2018). Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults. JAMA, 320(7), p.665.
Working with clients on a day to day basis, and of course also having multiple other conversations about health topics with other people, I get the privilege of hearing people’s beliefs about health and exercise. Experience over two decades as a health professional has given me multiple opportunities to see the link between our beliefs and health outcomes. I know this is nothing new, and I hope you don’t glaze over when I start talking about ‘beliefs’…! But I do wonder how often we stop and take stock of the things we believe… and about the actions we take, as these predispose the outcomes and results we see.
For example, consider comments like the ones outlined below, and lets consider the beliefs that may give raise to them, and then the results they may lead to in regards to changing and improving health:
- I get all the Exercise I need by walking
- I’m scared to lift weights because I’ll injure myself
- I was told Running is bad for my knees
- And there are many others, influenced by the latest diet fad or new exercise modality.
The issue with most of these beliefs, is that most of them are received from people who give advice with good motives, but often without the appropriate education, experience, or scientific rigour that extends beyond n=1.
This is exactly why we created iNform!! We could see that people are often influenced by multiple sources of information, and as we all well know, these are not always factual.
The Link between Beliefs and Health Outcomes
Why is this conversation important? Because your beliefs will determine your actions. And your actions will determine the outcomes and results you get!
If you are mathematically minded this looks something like BELIEFS x ACTIONS = OUTCOMES
Most of the health advice we read focuses on changing our actions to affect our outcomes/results. This is clearly an important part of the process, after all, the majority of people fail to create change because of lack of actual action! But for those that have the motivation to start, and even start to implement good behaviours (actions), why is it that for most those behaviours don’t last? I would suggest that it is because their behaviours are not married to their beliefs. If there is a disconnect between what you believe, and what you have been externally motivated to do, those behaviours are unlikely to last.
So the first step I would encourage you to take is to examine your beliefs. What do you actually believe about health and fitness? for example, do you believe the eating well is important to you? Do you believe that to create physical change, you are likely to have to ‘step up’ the activities you do? Do you believe that physical pain is something that you can actually change? I would suggest that to take the next step you actually spend some time writing these beliefs down.
Once you have outlined your beliefs, we should explore as to whether these beliefs are based on evidence, to ensure that they actually lead to the changes you are after!
So are your health beliefs actually factual?
What I mean by the question above, is, are they supported by scientific evidence? Are they provided by professionals trained to understand scientific evidence and provide such advice? And importantly, is that advice tailored to your particular needs? Part of the problem with the example beliefs I outlined above is not that they are totally wrong… in fact, in some circumstances they may be right… But the fact that they can be right doesn’t mean that they are always right! They may only be right because of a combination of a number of other confounding factors, that may or may not apply to you. This is exactly where an educated, qualified and experienced health professional comes in. We can help you discern whether there is scientific support for your beliefs, and help you see clearly through the fog of popular opinion and unsubstantiated fads. We can help you work through pre-existing experiences, concerns and fears, to enable you to start positive action towards the sort of outcomes that will help you live the life you want! We are always happy to sit with you to work through this process with you. Please do contact us (or post a question below) if you feel this applies to you!
About the Author
I’m writing this blog in light of an article I read recently on Daily Mail.com about exercise and pregnancy. It caught my attention because it was headlining that mothers should wait SIX MONTHS before running or doing strenuous exercise after child birth! Now, that is actually outrageous. For such a big media platform, this article is going to reach hundreds of thousands of people, and could very easily become an earnest belief for many pregnant women. Right in the middle of physical inactivity and health epidemic.
Why am I being told not to exercise?
The article stems from women’s health physiotherapists who often treat issues arising from high impact exercise done too soon after birth. Activities like running can play three times your body weight on your pelvic floor, which is in a vulnerable state after childbirth. If it’s not rehabilitated correctly (like when we experience any tissue damage), it can lead to a prolapse of the vagina, bladder and/or bowel. Women’s health physiotherapists have launched a campaign called ‘Pelvic Roar’ to raise awareness of pelvic health – which is the real issue here; awareness.
The exercise should change as you change, not stop
Our bodies don’t spring back from carrying a small human overnight. Our capacity to lift, contract, bend, stretch and even brace, will not be the same as it was before pregnancy. Hitting that pump class at the gym or bootcamp on Saturday morning’s probably isn’t a wise idea. Your body needs time to rehabilitate the muscles, tendons and ligaments that have all stretched to carry your little one. This takes specific and targeted exercises as everyone’s bodies will go through a different pregnancy journey, and will require different physical care. Exercises need to be modified and adapted as your body changes, and it’s hard to know how to do that on your own. It’s always a good idea to consult your doctor and when possible work with a clinically trained exercise professional.
Education of the effects, benefits and risks of exercise at all stages of pregnancy needs to be improved for all medical and health professionals who come into contact with new mothers. Hopefully then movement can be endorsed and embraced, with the emphasis on safety and individualisation.
5 reasons you SHOULD exercise while you’re pregnant:
If you like to consult the literature, like I do, and see what the science says; you will find a whole lot of positive evidence that supports doing exercise throughout and after your pregnancy. If you’re active before you fall pregnant it is safe to stay active during your pregnancy.
Engaging in light resistance training and aerobic exercise in the second and third trimester showed no negative effects on the risk of pre-term labour, mode of delivery, gestational age or newborn health. In fact, exercising during pregnancy had some positive effects by reducing prevalence of hypertensive and gestational diabetes and helped control excess weight gain throughout pregnancy. Potentially these factors combined with the strength, endurance and overall muscle health that is maintained during pregnancy, exercising is associated with a shorter first stage of labour. Pre- and post-natal depressive symptoms are significantly reduced with exercise,
What’s the next step?
Closer collaboration desperately needs to happen between healthcare professionals such as GPs, nurses, obstetricians, physios, exercise physiologists and fitness professionals. We need to encourage, empower and educate women who are trying to get pregnant, are pregnant or are recovering from pregnancy to exercise. But to exercise right!
If you’re currently pregnant, trying to get pregnant, know someone who is pregnant or have recently had your little one, please ask your health professionals about how you can safely make exercise work for you – or give us a call! Every pregnancy is different, it is important to seek advice from your doctor and to train with an appropriately qualified exercise professional, such as an exercise physiologist.
About the Author
What would you say if I told you that there’s a health component that is more important for healthy ageing than the COMBINED effects of smoking, obesity, and diabetes?? Yet, the average GP is unlikely to mention this to you, much less actually test it. Could they be missing one of the most important assessments they should be taking at your check up? and consequently, not giving you some of the best health advice you could be getting?? Ok, enough with the cryptic questions. This is going to be a short but powerful article, because I know you don’t have time to waste. The answer to these questions is aerobic fitness. That’s right, your aerobic fitness is your best health predictor and effector. Not sure how, or if, you should tackle this? Read on!
Aerobic Fitness is your best health predictor
The graph below shows the highly significant effect that cardio-respiratory fitness (CRF, or aerobic fitness) has on premature death, particularly with its effect compared to other more commonly discussed health issues. I am truly baffled that while this SHOULD be common knowledge to health and medical professionals, they rarely apply it as part of their assessment or targeted treatment!
Attributable fractions (%) for all cause deaths in over 53000 participants in the Aerobics Centre Longitudinal Study. This is an estimate of the number of deaths in a population that would have been avoided if a specific risk factor had been absent. That is, if all smokers were non-smokers or all inactive persons were
getting 30 minutes of walking on at least 5 days of the week.
Effect of increasing fitness
Sure, you have been advised by your health professional that you should exercise more… that you should get out for a walk or two during the week. The graph below shows us two critical things about this advice. First is the obvious difference in protective effect of general physical activity vs fitness. You are busy, and ‘exercise time’ is hard to schedule, so the last thing we want is for you to not get the best possible return on your time investment! This data show the multiplied protective effect that increasing your fitness has on your health compared to just ‘being active’. While your low level general incidental activity is important, having a focused and safe approach to improving your fitness will reap huge returns on your investment.
Second, if you don’t know where to start, this data show that just getting underway will give you great returns. In fact, as the graph shows, even if you shift the needle from being very inactive or unfit, to being just in the lowest quarter of either ‘active’ or ‘fit people’ you achieve the greatest return on your investment! For example if you are in the lowest 10% of either ‘active’ or ‘fit’ people, you get very little protective effect; but if you move to the 25th percentile in activity levels, you get about a 10% protective effect, but a whopping 40% protective effect for being in the 25th percentile in FITNESS levels!!
Estimated relative risk of cardiovascular disease by fitness and physical activity.
Williams, PT (2001) MSSE 33:754-761.
Let me summarise the point I’m trying to make: While being generally active (such as going for regular easy walks, etc) is good for your health, spending time getting FITTER will give you multiplied returns, in body composition, general capacity, and primarily in health, so you can get the most out of life for as long as possible! So if you are short on time, and have high expectations on your investments, then this makes a lot of sense. NOW, if you are concerned about increasing the intensity of your exercise due to health issues, or risk of injury, please get in touch with us. We have proven systems to improve your fitness in a safe and progressive manner.
I’d like to thank Associate Professor Lance Dalleck from Western State Colorado university for presenting to the iNform team and sharing his expertise on this topic.
About the Author
Exercise to improve mental health and well-being comes across as rhetorical. And to throw a pun in: it’s a no-brainer!
A recent study published in the American Journal of Psychiatry has found exercise can reduce depression globally by as much as 15%! Now, 15% does-not sound like much. However, with data collected worldwide – with a population cohort of 266,939, 15% starts to sound pretty darn good; or for you statistical nerds out there: a neat reliable confidence interval.
Take me through the interrogatives and detail James!
The authors didn’t elude how much physical activity is required to elicit an anti-depressant effect. If you read my last blog, you would know what the recommended physical activity guidelines are. What is more important, is the neuroprotective effect(s) exercise has. And from interpreting the paper: participants were followed longitudinally over six to eight years, which correlates nicely that exercise has a protective buffer to continuous stress. Depression is highly complex; interacting with genes the immune system and the environment. However the solution is simple: all one needs to do is-to huff and puff a little bit – from day to day, to statistically decrease depression!
Tips for using exercise to improve mental health:
Exercise needs to be enjoyable!
- A brisk walk on the beach..
- Kicking the footy with the lads/lasses..
- Or, hitting the gym for a workout or group-fitness class..
The list goes on..
When you choose the exercise that resonates with yourself the likelihood for adherence is higher. Enjoyable activity results in more brain regions becoming active – and neuromodulators releasing sweet beneficial chemicals, affecting your mood, motivation – and thus well-being!
So what are you waiting for? – Lets get moving together!
About the Author
Many people don’t eat enough fruit and vegetables, and at a population level we seem to score under par. However, I’ve noticed an interesting seasonal trend with some of my clients over summer. One where if they tend to be prone to metabolic issues like weight gain and blood sugar control these tend to spike; and the common thread is fruit.
This got me to investigate, how much fruit should you eat? Is there such thing as consuming too much, and if so, what is it?
How much fruit according to the Australian Dietary Guidelines
Now back in the 2000s there was a relatively successful campaign called “Go for 2 and 5” which educated us on the Australian Dietary Guidelines. This tells us how much fruit and vegetable we should be consuming. The evidence seems to show that as a population we should be aiming for 2 serves of fruit and 5 serves of vegetables per day.
We know that it was a successful campaign, as over the campaign period the awareness of these ads went from 20% to 70% of survey respondents (Department of Health & Ageing, 2007). Interesting though, while 94% of respondents were able to correctively give the fruit consumption guidelines of 2 or more serves per day, only 32% correctly gave the correct response of 5 or more serves of vegetables.
This got me thinking. Do we have a confirmation bias when it comes to fruit and vegetable consumption? By this I mean that we tend to hear the message that we should be eating more of the lovely sweet stuff. But ignore the message regarding boring old vegetables.
Perhaps we thought the message was go for 5 and 2 rather than 2 and 5?
So does excessive fruit consumption matter to our health?
At least if we look at the report published on the success of the Go for 2 and 5 campaign we see that people were already consuming the guidelines of two serves of fruit per day on average. While the average serves of vegetables scraped in at just over half of the guideline at 2.6 serves. Interestingly, while we already succeeded as a nation at consuming 2 serves of fruit 43% indicated that they planned on increasing their fruit consumption. Only 28% planned on increasing their vegetables.
Certainly this appears as though the message of eating more fruit was much more palatable to survey respondents.
So it doesn’t surprise me then when I see a dramatic spike in how much fruit some of my clients eat over summer. This amount for some was up to 5-10 serves per day. Now clinically we saw increases in 1-2 kg of weight and spikes in blood sugar levels, even though these clients were doing what they thought was best for their health. They have listened to part of the message (the part which is most palatable for us sweet tooths!) and simply didn’t consider that you might be able to have too much fruit!
In summer we tend to have an explosion of seasonal fruit to the market. Stone fruits, melons, and tropical fruits all tend to hit our grocery stores at a cheaper price. Interestingly, all of my clients who have drastically increased their consumption of fruits over summer had a stone fruit tree such as peaches and nectarines in their backyard.
So how much fruit should you eat per day?
Well that depends on what you may want to prevent health wise, but somewhere between 2-3 serves per day seems to be the “sweet spot”. If you want to know the science to this conclusion, and what fruits tend to work best for you, please read part two of this blog!
About the author