misc.fitness.aerobic FAQ Part I

Misc.fitness.aerobic, was formed in June 1995 for those
interested in discussing or questioning various aspects of
a total aerobic fitness program. Topics welcome for
discussion include any aerobic activity such as aerobic dance,
step training, use of aerobic machines (e.g.stairclimbers,
NordicTrak, rowing machines, etc.), jazzercise, walking,
jogging, running or any other activity pursued for the purpose
of increasing aerobic fitness.

The group will also address other aspects of a good
aerobic program such as proper nutrition, muscle training,
aerobic exercise for weight loss, flexibility, aerobic
exercise videos, tapes, literature and aerobic instructor
certification procedures and certifying organizations.

1. ORIGIN OF FAQ

The misc.fitness.aerobic FAQ is being maintained by the
group’s founder, Bobbie Rivere. It has been formulated by
using the most frequently asked questions from the people
who read misc.fitness.aerobic. Any suggestions or revisions
should be sent to bobbie@panix.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

2. DISCLAIMER

The questions and answers below represent our best
effort to provide general information. They are not to be
read as gospel. Individual people have different needs and
abilities, and all exercise routines suggested should be
adjusted to suit the specific situation. It is best to
consult a doctor before beginning any lifestyle change
involving exercise, particularly if you have been sedentary,
are very overweight or overfat, or have or suspect any sort
of medical condition which might be exacerbated by exercise.

3. RELEVANT FAQS

alt.food.fat-free FAQ
alt.food.low-fat FAQ
alt.support.diet FAQ
misc.fitness FAQ
Stretching and Flexibility FAQ
The Abdominal Training FAQ

4. AEROBIC EXERCISE

4.1 What is aerobic exercise?

The word aerobic literally means “with oxygen” or “in the
presence of oxygen.” Aerobic exercise is any activity that
uses large muscle groups, can be maintained continuously for
a long period of time and is rhythmic in nature. Aerobic activity
trains the heart, lungs and cardiovascular system to process and
deliver oxygen more quickly and efficiently to every part of the
body. As the heart muscle becomes stronger and more efficient, a
larger amount of blood can be pumped with each stroke.
Fewer strokes are then required to rapidly transport oxygen
to all parts of the body. An aerobically fit individual can
work longer, more vigorously and achieve a quicker recovery
at the end of the aerobic session.

4.2 What are some examples of aerobic activity? (Some
of these activities can be anaerobic if you are not
moving continuously)

(from Ron Hogan < ronh@lion.sr.hp.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it >)

Aerobic dance, aerobic machines, backpacking, ballroom
dance, basketball, belly dancing, boxing, broomball,
calisthenics, canoeing, cycling, fencing, frisbee, golf,
gymnastics, handball, hiking, hockey, ice skating,
jazzercise, jogging, judo, jumping rope, karate,
kayaking, mountaineering, racquetball, rock climbing,
roller skating, rope climbing, rowing, running,
skateboarding, skiing, skin diving, spelunking, square
dancing, squash, step aerobics, swimming, walking, water
skiing or any other activity that meets the criteria in
section 4.1.

5. AEROBIC TRAINING

5.1 What factors affect aerobic training?

Frequency, duration and intensity. Frequency refers to
how often you perform aerobic activity, duration refers to
the time spent at each session, and intensity refers to the
percentage of your maximum heartrate or heartate reserve at
which you work.

5.2 How often should I train? How hard? For how long?

Most experts believe that 3-5 times per week for a
duration of 20-60 minutes at 60-90% of age-specific maximal
heartrate or 50-85% of VO2max (heart rate reserve).

6. WORKOUT INTENSITY

6.1 How do I determine my target heartrate?

The general formula for the average person is 220-agex60%
andx90% of HRmax. For example, a 30-year old would calculate
his target zone using the above formula: 220-30=190.
190x.60=114 and 190x.90=171. This individual would try to
keep his heartrate between 114 (low end) and 171 (high end)
beats per minute.

(from Evelyn Mitchell < efm@tummy.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it >)

The Karvonen Formula calculates your heartrate reserve
range. To calculate it, take your pulse for one minute on
three successive mornings upon waking up. (We will be using
the case of a 30-year old male whose resting pulse was 69,70
and 71 for an average of 70 over the 3 days.)
Calculate target heartrate by subtracting your age from
220 (220-30=190).
Subtract your average resting heart rate from target
heartrate (190-70=120).
The lower boundary of the percentage range is 50% of this
plus your resting heart rate [(120 x .5) + 70 = 130]. The
higher boundary is 85% plus your RHR [(120 x .85) + 70
=178]. Using the Karvonen Formula for percentage of heartrate
reserve, this 30-year old man should be working between 130
and 178 BPM.
Like the maximum heartrate formula, the Karvonen formula
can vary from individual to individual. Not every
individual is “average”, and there can be large differences
among people. Therefore heartrate alone may not be the best
indicator of how hard or how well you are working.

It is important to note that the deviation in both the
age-specific formula and the Karvonen formula is due to the
estimation of HRmax. If you have an actual HRmax from a
graded exercise test, it will be more accurate. ACSM lists
two formulas for estimating HRmax, each one with
a standard deviation of +/- 10-12 BPM:

HRmax = 220 – age (low estimate)
HRmax = 210 – (0.5 * age) (high estimate)

HR = exercise intensity * HRmax * 1.15

Source, ACSM’s Guidelines for Exercise Testing and
Prescription, 5th Edition, p. 274, Williams and Wilkins
(publishers)

6.2 What are some other methods for judging my workout
intensity?

The Borg scale of perceived exertion is another way of
determining how hard you are working. Using your own
subjective Rate of Perceived Exertion (RPE) on a scale of
6-20 or a scale of O-10, you determine how hard you *feel*
you are working. A rating of 12-16 (“somewhat hard” to
“hard” on the 12-20 scale) or a rating of 4-6 (“somewhat
strong” to “very strong”) on the 0-10 scale
reflects a heartrate of 60-90% of maximum and should be the
target area for which to strive.

Original Scale Revised Scale

6 0 Nothing at all
7 Very, very light 0.5 Very, very weak
8 1 Very weak
9 Very light 2 Weak
10 3 Moderate
11 Fairly light 4 Somewhat strong
12 5 Strong
13 Somewhat hard 6
14 7 Very strong
15 Hard 8
16 9
17 Very hard 10 Very, very strong
18 * Maximal
19 Very, very hard
20

Source: ACSM’s Guidelines for Exercise Testing and
Prescription, 5th Edition, p. 68, Williams and Wilkins
(publishers).

The talk test is another measure of intensity. You
should be able to talk without gasping for air
while working at optimal intensity. If you cannot, you
should scale down. On the other hand, if you can sing an
aria from Madame Butterfly, then you need to work harder.

7. SPOT REDUCTION

7.1 I do lots of outer thigh (tummy, buns, etc.) work.
Will that part of my body slim down first?

No. When we’re working a muscle or group of muscles to
burn fat, we have no control over what part of the body we
burn fat from. There is no such thing as “spot reducing”.
Fat generally is used up in pretty much the reverse order
it was put on, (LIFO – Last In First Out). When you are
exercising, the blood is carrying fat from all over the body
to provide the energy. The muscles which are being worked
will improve, of course, so when the layers of fat finally
do get worked off, you’ll have some nice lean tissue to show
for all your efforts.

(from Michael G. Kurilla < mkg2r@uva.pcmail.virginia.edu This e-mail address is being protected from spambots. You need JavaScript enabled to view it >)

Another aspect to this question is the fact that muscle
growth underneath a fat deposit can give the appearance of
spot reduction. This is because the overlying fat is stretched
over a greater surface and appears thinner, although the total
amount of fat is the same. A good analogy is with a balloon.
As the air is increased, the skin on the balloon gets thinner,
but the amount of balloon material stays the same. I think that
this may be how the spot reduction myth originated. By working
the muscles below the fat, people think they are actually making
the fat go away.

8. FAT BURNING

8.1 How do I know when I’m exercising hard enough to
burn fat?

Actually, you’re *almost* always burning fat at one rate
or another, but you burn most when your body is in its aerobic
range. A good rule of thumb is that after 20 minutes in your
aerobic zone, you will be burning more fat than carbos. Covert
Bailey, in “Smart Exercise”, states that you will be burning
fat after only twelve minutes of aerobic exercise. If you
can increase your aerobic activity to 30 minutes or longer,
you will be burning a larger percentage of calories from fat.
There is still some disagreement as to which is better – longer
duration at lower intensity, or shorter duration at higher
intensity. If you are limited in time, then the higher intensity
will maximize your aerobic benefits in a shorter amount of time.
If you can work for a longer duration at a lower intensity, you
will decrease your chance of injury. The object is to burn more
calories than you take in. 3,500 calories equals l pound of fat.
Your muscles will continue to burn fat after both aerobic and
anaerobic (muscle training) exercise.

(from Michael G. Korilla [mgk2r@uva.pcmail. virginia.edu])

This is perhaps the most common question raised by individuals
exercising for the purpose of either weight loss or simply
weight control. This stems from the recognition that aerobic
exercise is a significant adjunct to any weight loss program,
that is diet plus aerobic exercise produces more weight loss
than diet alone. In addition, the weight lost with exercise
tends to be a higher percentage of fat.

Exercise can be grouped into three broad levels of intensity,
mild, moderate, and high. Mild intensity is a comfortable walking
pace and can be sustained almost indefinitely, moderate intensity
is equal to an average cardiovascular conditioning workout (able
to talk, but not sing) and can be sustained (in a trained individual)
for upwards of 3 – 4 hours, and high intensity is not
able to talk and can only be sustained for 30 – 45 minutes.

Based on recent and very detailed research studies, in terms of
absolute fat burning, a moderate intensity workout burns the most
fat. At a heart rate equal to about 75% of max, fat burning will
approach 0.5 grams – 1.0 grams of fat per minute. There is a weight
dependence with the lower end referring to a 100 pound individual
and the upper end to a 200 pound person. As the durationa continues
(greater than 1 hour), fat burning can increase slightly (another
10%).

At a mild intensity, the majority of calories expended (85 – 90%)
are fat calories, but the absolute level is only about 60% of the
moderate intensity. At high intensity levels, fat burning declines
to a level of about 65% of the moderate pace, as sugar burning
supplies the rest. The high rate of sugar burning exhausts the
limited sugar supply in muscles and causes muscular failure.

The only caveats for the above burn rates are that these numbers
are derived from individuals who were already aerobically trained
and were conducted in the AM before breakfast. Less fit individuals
are known to burn less fat and more sugar (part of aerobic conditioning
is greater reliance on fat burningfor energy). Exercising after a
meal will tend to promote more sugar burning. Consumption of sugar
during an exercise session will also tend to retard fat burning in
favor of the sugar. These numbers were derived from cycling and so
the absolute numbers can be increased if exercises that involve more
muscle groups are utilized (running, rowing, etc.). From peak energy
production rates for various exercises, rowers might reach about 40%
higher.

9. EXERCISE DURATION

9.1 Is it better to break my exercise sessions up, or
exercise for a longer period?

(from Ken Raich < raichk@ix.netcom.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it >)

There are TWO distinct thoughts on this issue: Both
present fairly reasonable arguments.

First, It takes 15-20 minutes to get your metabolism into
the fat burning zone many people desire for an aerobic
workout. Once you havereached this level, your body tends to
obtain more of its energy from fat than carbohydrates. Using
this argument, a single 90-minute workout will allow you to
exercise in this “fat burning” zone for at least 70 minutes
while two 45-minute sessions would allow you to be in this
zone for at least 50 minutes (2 x 25). This logic supports
a single, longer workout.

Second, For 6 or so hours after a workout your body
remains in “afterburn” mode, burning more calories at rest
than it would have if you had not worked out. Using this
logic, two sessions would produce two afterburn periods and
result in more fat being burned than would be
for a single workout session.

The real bottom line is that if you exercise for 90
minutes a day,you’re interested in more than just
fitness(don’t get me wrong, this is perfectly OK). To stay
in reasonable cardio-vascular shape, you need to perform
aerobically for 20-30 minutes at least 3 times a week. If
you wish to be in better than “the minimum acceptable”
shape, remember that the returns are not geometric (you
won’t be in twice as good shape if you workout for twice as
long). Therefore, if you’re going to workout for 90 minutes
a day, splitting the time between one or two sessions
probably doesn’t make a significant fitness-level
difference.

10. WEIGHT AND BODYFAT PERCENTAGE

10.1 How much should I weigh?

What you weigh is not as important as the percentage of bodyfat to lean
tissue. You can be overweight without being overfat and vice versa. Since
muscle weighs more than fat, and you want to have firm muscles throughout
your body, you may weigh more than you thought was average for your height
and build. There is still much controversy over what is “ideal”
bodyweight. While some body fat is essential to sustain life, it is
generally thought that a healthy bodyfat percentage for males is 8-20% and
for females is 13-25%.

Source: ACE Instructor Manual, 1993, p.178

10.2 What’s the best way to determine Body Fat
Percentage?

(from <chuckg@arnet.comSun>)

Weighing in water (hydrostatic) is generally considered
the best method.But, the real answer is that a single
measurement, no matter how accurate, doesn’t tell you much.
What’s really important is, are you gaining or losing fat?
The best way to answer this question is to take a reading
every few weeks and graph the results. The absolute
accuracy of these readings isn’t really important as long as
you use consistent technique so that the error is about the
same every time. The two methods that work best for
at-home measurements are skin-fold calipers and bicep IR
units. Treat the numbers not as “body fat percentage” but
as a “body fat index.” If, after several readings, your
body fat index is clearly trending up, you may want to
reconsider your diet and exercise programs. It’s like the
gas gauge in your car – it doesn’t tell you how many gallons
you have, but it gives you a relative indication.

11. MUSCLE TRAINING

11.1 Should I train my muscles as well as do aerobic activity?

Definitely. Muscle training is an integral part of any
aerobic program. After muscle training, our bodies continue
to burn fat for many hours. The combination of aerobic
exercise, muscle training, proper diet and stretching is an
excellent program for getting fit and staying healthy.

11.2 Which is better for muscle training: Weights or
ExerTube (DynaBand)?

Neither is actually “better”. All exercise accessories
have their uses. Weights require more muscles in use to
maintain proper form, while the bands and tubes are easier
to use in targetting specific muscles. Bands and tubes also
have the advantage of being somewhat adjustable in
resistance just by changing length. To change weights in
dumbbells, you either need another set of dumbbells, or extra
plates for those which use plates. Dumbbells, however, do offer
a much greater range of available weights, particularly at the high
end, making them more useful in strength training. Bands
and tubes are generally used in resistance training exercises.

12. WARM-UP AND COOL-DOWN

12.1 What is a warm-up, and how important is it in
aerobic activity?

A warm-up helps your body prepare itself for exercise and
reduces the chance of injury. The warm-up should be a
combination of rhythmic exercise which begins to raise the
heartrate and raise muscle temperature, and static
stretching through a full range of motion. The rhythmic
exercise may be a slower version of the aerobic activity to
come. For example, you might want to walk before you jog,
or do some aerobic dance movements before an aerobic
or step class. The stretches in the warm-up should be
non-ballistic and cover all of the major muscle groups.
Always stretch the lower back before doing any lateral
movement of the upper torso such as side bends.

12.2 What is a cool-down, and how important is it in
aerobic activity?

After any aerobic activity, the blood is pooled in the
extremities, and the heartrate is elevated. The purpose of
the cool-down is to bring the heartrate down to near-normal
and to get the blood circulating freely back to the heart.
Stopping abruptly could result in fainting or place undue
stress on the heart. The cool-down should also include
stretching to help relax the muscles which worked so hard
during the activity. The cool-down stretches also increase
flexibility, and might help to prevent DOMS (Delayed Onset Muscle
Soreness) although this has not been proven.

13. HEAT AFTER WORKOUT

13.1 Should I use a steam, sauna or hot tub right after
a workout?

Since the blood tends to pool in your extremities after
a vigorous workout, and steams, saunas, hot tubs and even
hot showers tend to dilate your blood vessels, it is really
not the best thing to do as it will be more difficult for
the blood to reach the heart and brain. However, if you’ve
done a thorough aerobic cool-down, and you wait a reasonable
amount of time to return to almost normal, you might go into
one of these “fun” things. But if you feel any sign of
weakness or dizziness, get out immediately.

14. HOW TO BEGIN AN EXERCISE PROGRAM

14.1 I have never exercised before. Where do I begin?

It is a good idea to start slowly and build up to a full
program. Walking is the easiest way to begin a program.
Start with a stroll for a mile or so and build up to walking
3-4 miles per hour. As you become proficient at walking,
you might want to try another activity such as jogging,
running or even aerobic or step classes. The best aerobic
program is the one you enjoy and will stick to. Remember,
the journey of 1000 miles begins with but a single step.

15. STEP AEROBICS

15.1. What is step aerobics?

Step aerobics is a form of aerobic activity which is
performed on a platform that usually ranges from 4″ to 10″
in height. Step training was developed to provide a low-impact
activity that is both challenging and interesting. People who
may not like certain aspects of aerobic dance find that step is
a very good alternative. Each participant works within his or her
own space. There is no traveling across a room. When done properly,
step training is an efficient means of improving aerobic fitness.

15.2 What is proper stepping technique?

Your body should remain in good alignment. Your head should be
up, shoulders down and back, chest up, abdominals and buttocks tight.
When stepping up, lean from the ankles and not the waist to avoid
placing excessive stress on the lumbar spine. Contact the platform
with the entire foot. To avoid Achilles tendon injury, make sure
your heel is down, and your foot is in the center of the platform.
When stepping down, step close to the platform and allow the heels
to contact the floor to help absorb the shock. (toe, ball, heel).
When doing lunges or repeater steps, however, the heel should be
up, and the weight should be on the forefoot of the working leg.
You should not use hand or leg weights when you are stepping as the
risk of injury outweighs any added benefit you might get from using
weights. It is important to note, that anyone with a history of knee
problems should consult a physician before beginning step training.

15.3 How high should my step be?

Step height depends on several things – fitness level, current
stepping skill, and the degree of knee flexion when the knee is
fully loaded while stepping up. At no time should the knee joint of
the first leg to step up flex beyond a 90% angle. Reebok is now saying
that 60% is even better. Deconditioned individuals or beginners
should begin on a 4″ platform. As you improve, you may add risers
to increase the step height making sure not to exceed the 90 degrees
of knee flexion. The most popular step heights are 6″ and 8″.

15.4 How can I increase intensity.

There are several ways to increase intensity. Increase your step
height, use longer lever arms or add propulsion moves (where both
feet are off the step at the same time). If you are going to add
propulsion, or power as it is known today, make sure not to do these
moves for more than one minute at a time as these moves result in
higher vertical impact. All power moves should be done as you go
up onto the platform. Always step down without power. Power moves
are considered advanced, and should not be attempted by beginners.

15.5 How fast should the music be?

According to Step Reebok guidelines, music should be played at
a speed of 118-122 BPM. Technique and safety are seriously compromised
when the music is too fast. It is also impossible to get the full
range of motion that can be achieved at slower tempos.

16. EXERCISE GADGETS

16.1 How good is (insert your favorite exer-gadget shown on TV)?

The fitness industry changes all the time, and along with these
changes come trends and fads in the types of exercise people prefer
to do and the machines and equipment they use to do it. Some of
these items are good, and some are junk.

As pointed out by Ken < soulhuntre@pobox.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it ), nobody
is able to test every piece of equipment on the market. Before
you buy any new gadget, ask the experienced fitness folks in the
misc.fitness.aerobic newsgroup for their opinions, and also ask
yourself the following questions.

– What does the device claim to do?

– How will it accomplish the goal?

– If the device claims to train specific muscles,
does it use motions similar to those I might use without
the device such as gravity or other less expensive forms
of resistance.

– Does the device encourage me to train my other muscles as
well? Does the device provide a balanced program for
training my other muscles?

– Is this device putting other parts of me at risk (such as my
low back or joints)?

– Does the device make claims that it can produce seemingly
impossible results in very short periods of time?

If you are still convinced that the device is for you, and you
buy it, please write a review in misc.fitness.aerobic so others can
learn from your experience.

17. EXERCISE INJURIES, REACTIONS AND ENVIRONMENT

17.0.0 The following section describes a number of injuries
and syndromes that can befall the exerciser. While
this information can be useful in determining appropriate
first aid or symptomatic relief methods, it is important
to be aware of the distinction between first aid and
relief of symptoms vs. diagnosis and treatment.

As will become evident in the sections ahead, a single
symptom (such as knee pain) can have a variety of causes,
many of which are not immediately obvious and require
the diagnosis of a physician, who can prescribe treatment.

Individuals are strongly encouraged not to use the information
below to “self-diagnose”, but merely as guidelines for
appropriate first aid/symptomatic relief and when to see
a physician.

17.0.1 Legal Issues for the Exercise Professional

Exercise professionals are *strongly* encouraged to refrain
from the process of diagnosis and/or prescription of treatment
or rehabilitative exercise. Our scope of practice is limited
to encouraging rest, RICE, and a visit to the doctor.

Statements such as “that sounds like chondromalacia – why don’t
you try and strengthen the medial quad to help out” or “you’ve got
low back syndrome” involve a judgement by the exercise professional
that can be construed in a court of law as a diagnosis and/or
prescription of rehabilitative exercise.

If such advice causes the individual to sue at a later date,
the charges can be much more serious than mere negligence – the
exercise professional can find themselves in the position of
being charged with practicing medicine without a license.

Exercise professionals are best advised to speak in general
terms without reference to an individual’s condition, to focus
on general preventive behavior, and to refer individuals
to a physician when a diagnosis needs to be made or an
injury does not respond to first aid/symptomatic relief (such as RICE).

An appropriate example: “well, there are a number of causes
for the shin pain you’re experiencing. You can apply RICE
to relieve the symptoms, but if it doesn’t feel better within
a day or two you should consult with your physician.” Here we
sidestep the issue of diagnosis, stress sympomatic relief, and
incorporate a physician referral in one sentence.

Or: “Now we’re going to do some exercises for the back. It is
believed that strengthening the low back can help prevent low back
pain.” In this case, only a general discussion on preventive
(not rehabilitative) exercise is provided.

17.1 What should I do for an acute injury?

If you feel that you have “pulled a muscle” or have an
inexplicable pain after exercising, the *immediate*
treatment is RICE (rest, ice, compression, elevation).
Icing for 48 hours, every 2 hours for about 10-15 minutes,
*should* help the injured area. However, if you’ve got an
injury that doesn’t respond to RICE in a
couple of days, you should see your physician.

17.2 What should I do for a chronic injury?

It is important to remember that the people here on
misc.fitness.aerobic have varied backgrounds, but are
primarily fitness professionals. As such, we’re really not
qualified to give out rehabilitative exercise. You must see
your physician or other qualified person to find out what
you should do if an injury persists.

17.3 What are some common exercise injuries?

17.3.1 Overuse Injuries

The heading of overuse injuries is a broad one, into which
the vast majority of exercise-related injuries fall. Generally
overuse injuries are chronic ones, meaning that no single event
causes them (as with a sprained ankle or a broken leg), but a long
series of events over weeks, months, or years of training gradually
weaken or irritate the area in question until exercise
becomes difficult or impossible, or other symptoms appear.

The vast majority of overuse injuries can be avoided by proper
attention to form and technique, appropriate rest, proper equipment
(especially footwear), and gradual increase of exercise frequency,
intensity, or duration.

The best cures for an overuse injury are rest followed by a
gradual returnto activity coupled with an awareness of the problem
activity, and appropriate corrective measures (be they more gradual
return to exercise, appropriate strengthening, or avoidance of
certain forms of activity).

17.3.2 Patellofemoral Syndrome (“Runner’s Knee”) / Chondromalacia

Chondromalacia literally refers to the wearing away of the
cartilage on the back surface of the kneecap, which might be
first exhibited as a “clicking” or “grating” sound, and knee
pain under the patella (kneecap).

Chondromalacia refers to the condition, and not a specific
disease state, as a great many possible causes exists for
damage to the cartilage.

Patellofemoral syndrome, likewise, refers to generalized
knee pain, often associated with runners, but not limited to
runners alone. In this context, the cause is usually improper
running mechanics over a period of time, though in many cases
the cause is unknown.

Once chondromalacia has occurred, the process is irreversible,
and attention is paid to achieving the maximal amount of pain-free
activity, and avoiding activities which will cause further damage
to the joint.

Note that patellofemoral pain is of a more general nature,
and may or may not be due to the pathological condition of
chondromalacia.

It is best to consult a physician or a physical therapist
when any sort of knee pain is encountered.

17.3.3 Plantar Fasciitis and Neuromas

Plantar fasciitis is literally an inflammation of the
plantar fascia, a web of tough, fibrous connective tissue on
the bottom of the foot. Neuromas are irritated nerve endings,
but can cause pain in the foot (or other places, depending on
the nerve in question).

Either condition should be examined by a physician. While
both are commonly caused by overuse, the question of whether
the condition is due to poor technique, simple overuse, or an
orthopedic problem should be explored.

In the case of the latter, orthotics (inserts for shoes designed
to help maintain proper impact cushioning and support for the foot)
can play a major role in the prevention of future episodes.

17.3.4 Lateral Epicondylitis (“Tennis elbow”) and the
More general Tendonitis/Arthritis/Bursitis

Any “-itis” condition refers to inflammation or irritation.
In the cases of tendonitis, arthritis, and bursitis, the sites of
inflammation are the tendons, joints, and bursae (fluid-filled
sacs provided cushioning between tendons and bones), respectively.

Again, any of these conditions should involve a physician
referral. Tendonitis and bursitis are common overuse injuries,
and rehabilitation will generally involve rest, and enhancing
flexibility and strength of all muscles surrounding the joints
near the area in question.

Arthritis can be caused by two distinct disease processes –
osteoarthritis is essentially “wear and tear” on joints, in which
the cartilege covering the articulating surfaces of the bones
becomes worn, and the joint reacts, often by swelling and
filling with fluid. It can become quite tender, and
motion can become difficult.

Rheumatoid arthritis is an autoimmune disorder in which the
body launches an attack on its own joint tissues. While much
less common than osteoarthritis, it can be severely dehabilitating.

Rehabilitation for arthritis generally involves activities
that are low-impact in nature, and strengthening exercises.
Activities are carried out through a “pain-free range of motion”
(ROM limited by the onset of discomfort), and no activity is
recommended during periods of active inflammation.

17.3.5 Shin Splints and Compartment Syndromes

Shin splints are a common name for pain felt in the anterior
portion of the calf, which can be due to a variety of causes, from
muscle imbalances to something as serious as a compartment syndrome.

Generally, treatment for shin splints involves RICE, strengthening
exercises for all of the muscles surrounding the ankle joint, and
flexibility exercises.

Compartment syndromes are a much less common, but more serious
problem, where one of the compartments between muscles which
contains blood vessels and/or nerves becomes swollen, compressing
the blood vessels and/or nerves. This can lead to pain, swelling,
and discomfort, and in severe situations can be an emergency
situation requiring surgical intervention.

17.4 What are some common exercise reactions?

Some number of people experience reactions to exercise,
ranging from uticaria, a harmless red blotchiness on the neck,
face, or arms, to exercise induced asthma or bronchospasm,
to anaphylaxis.

Exercise-induced asthma (EIA) is most likely to strike
individuals exercising in cold, dusty, or excessively humid
environments, and can range in severity from mild coughing to
severe discomfort. Individuals who suspect that they
have exercise-induced asthma are encouraged to seek medical
attention to rule out other possibilities, and to ensure the
best possible treatment for their condition.

General recommendations for persons with EIA include an extended
warm-up, avoidance of cold, dusty, or extremely humid environments
for exercise, pursed-lip breathing, and keeping an inhaler handy
for use during exercise (if recommended by physician).

While very rare, it is possible for someone to have an allergic
reaction to exercise, called exercise-induced anaphylaxis. This is
a life-threatening situation, and requires immediate medical
attention. People prone to EIA can, at the advice of their
physician, carry a bee-sting kit to use in such situations.
Any person suspecting that they are prone to EIA should consult
with their physician before resuming exercise.

17.5 What are some common environmental concerns?

Extremes of temperature and humidity pose special problems
for the exerciser. In hot weather, care must be taken to wear
clothing that is light, breathes well, and allows for the
evaporation of sweat.

“Sauna suits”, “tummy wraps”, and other products designed
to encourage quick weight loss through sweat are particularly
dangerous – the body can reach dangerous (or even fatal) core
temperatures in very short periods of time. Weight lost by
these methods will be regained as soon as water is ingested
again, and so the risk does not outweigh the “benefit”.

On extremely humid days care must be taken to exercise at
an appropriately lowered intensity, out of the high heat/humidity,
or even to postpone exercise until the heat/humidity diminish.
As exercise intensity increases and more heat must be dissipated,
evaporation of sweat becomes the principal means by which cooling
occurs. In a high-humidity environment, evaporation
becomes less effective at cooling, and the risk of heat-related
injury is greater.

Adequate hydration is also key to safe exercise in the heat,
as the body will produce large quantities of sweat. 1-2 cups
of water before exercise and 1/2-1 cup of water during exercise
are recommended, though more can be ingested.

It is important to remember that the thirst mechanism lags
behind the body’s need for fluid – by the time one is thirsty
one is already substantially dehydrated. Even small amounts of
dehydration can affect performance, and severe dehydration can be
life-threatening.

Contrary to popular belief, water consumed during exercise will
not contribute to cramping, so “swish and spit” should be avoided in
favor of consuming small amounts of water steadily during the exercise
session, especially during periods of prolonged exercise.

In the cold, care must be taken as well. It is best to dress in
layers that will wick sweat away from the body – many of the “high-tech”
fabrics that are now available will do this admirably. Outer
layers can be used to keep the body warm during warm-up, and
removed as exercise progresses to allow the body to cool itself,
and then be replaced during the cool-down to avoid an excessive chill.

Garments made of fabrics like wool, which will insulate even
when wet, are superior to garments made of materials like cotton,
which will contain sweat and can contribute to heat lost by evaporation
and conduction as the activity level decreases.

17.5.1 Heat-Related Problems and Inuries

(from Jennifer Robles (Neefer) < oaktree@aimnet.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .>)

17.5.1.1 Who is at risk for heat-related illness?

People at risk for heat-related illnesses include those who
work or exercise outdoors, elderly people, young children, and
people with health problems. Also at risk are thos who have
had a heat-related illness in the past, those with medical
conditions that cause poor blood circulation, and those who take
medications to get rid of water (diuretics).

People usually try to get out of extreme heat before they begin
to feel ill. However, some people do not or cannot. Athletes
and those who work outdoors often keep working even after they begin
to feel ill. Those living in poorly ventilated or poorly insulated
or poorly heated buildings are at risk of heat emergencies Many
times, they might not even recognize that they are in danger of
becoming ill.

17.5.1.2 What are heat related illnesses?

Heat cramps, heat exhaustion, and heat stroke are conditions caused
by overexposure to heat. Heat cramps are the least severe, and
often are the first signals that the body is having trouble with the
heat. Heat cramps are painful muscle spasms. The usually occur in
the legs and abdomen. Think of them as a warning of a possible heat-
related emergency.

HEAT EXHAUSTION is a more severe condition than heat cramps. It
often affects athletes, fire fighters, construction workers, and
factory workers, as well as those who wear heavy clothing in hot,
humid environments. Its signals include cool, moist, pale or flushed
skin, headache, nausea, dizziness, weakness, and exhaustion.

HEAT STROKE is the least common but most severe heat emergency. It
most often occurs wehn people ignore the signals of heat exhaustion.
HEAT STROKE develops when the body systems are overwhelmed by heat
and begin to stop functioning. HEAT STROKE is a SERIOUS medical
emergency. The signals of heat strok include red, hot, dry skin;
changes in consciousness; rapid, weak pulse; and rapid, shallow
breathing.

17.5.1.3 How do you treat heat cramps?

To care for HEAT CRAMPS, have the victim rest in a cool place.
Give them cool water or a commercial sports drink. Usually, rest and
fluids are all the person needs to recover. Lightly stretch and gently
massage the area. The victim should NOT take salt tablets or salt
water. The can make the situation worse.

When the cramps stop, the person can usually start activity again
if there are no other signals of illness. She should keep drinking
plenty of fluids. Watch the victim carefully for futher signals of
heat-related illness.

17.5.1.4 How do you treat other heat-related illnesses ?

When you recognize heat-related illness in its early stages,
you can usually reverse it. Get the victim out of the heat. Loosen
any tight clothing and apply cool, wet cloths. If the victim is
conscious, give cool water to drink.

Do NOT let the conscious victim drink too quickly. Give about one
glass (4 ounces) of water every 15 minutes. Let the victim rest in a
comfortable position and watch carefully for changes in her condition.
The victim should not resume normal activities the same day.

17.5.1.5 When do you call 911?

Refusing water, vomiting, and changes in consciousness mean that the
victim’s condition is getting worse. Call 911 (or emergency services).
If the victim vomits, stop giving fluids and position the victim on
the side. Watch for signals of breathing problems. Keep the vitim
lying down and continue to cool the body any way you can. If you have
ice packs or cold packs, place them on each of the victim’s wrists,
ankles, groin, armpit, and neck (aka pulse points). Do NOT apply
rubbing (isopropyl alcohol).

17.5.1.6 At what temperatures and humidity are heat-related illesses likely?

These curves approximate the figure in the 1993 American Red Cross
Standard First Aid manual.

HOT: {93F (34 C), 20% humidity}, {87 F(31 C), 50%}, {82 F(28 C),100%}
Sunstroke, heat cramps, or heat exhaustion possible with prolonged
exposure/exercise

VERY HOT: {105F(41C), 20%}, {92F(34C), 60%}, {87F(31C), 100%}
Heat cramps or heat exhaustion likely

EXTERMELY HOT: {120F (49C), 20%}, {108F(43C), 40%}, {91F(33C), 100%}
Heat Stroke or sun stroke immminent

Reference, 1993 American Red Cross Standard First Aid Manual

17.5.2 Specific Cold-Related Injuries – Hypotermia and Frostbite

Frostbite involves the freezing of tissue, and can range from
mild to fairly severe. The skin will generally look yellowish, and
will be cold to the touch. First aid generally involves warming the
affected area using moderately warm water – remember that sensation
will be reduced in the area, and the temperature of the water
should be verified by running it on unaffected skin! Do *not*
rub the area, as this can cause further tissue damage.

Frostbite should be examined by a physician to assess the extent
of the damage. It is best prevented by proper clothing and limited
exposure to cold.

Hypothermia is a life-threatening condition wherein the core body
temperature has become dangerously low. Many of the same symptoms
as heat exhaustion, including dizziness, nausea, loss of appetite,
vision problems, etc., may be present. In the case of hypothermia
it is important to call 911 immediately, and use any means present
to warm the victim, such as removing excess clothing and putting
them in a sleeping bag with an unaffected person who
can provide body warmth until help arrives.

18. EXERCISE AND EATING

18.1 How long should I wait after eating to start
exercising?

If you ate something fairly light, you probably don’t
need to wait very long. However, since people are
different, it is difficult to say what the optimum waiting
period is for everyone.

18.2 What should I eat as my meal before an aerobic
workout?

Consider that you will probably burn between 300 and 450
kCal in an aerobics class. Keep the caloric content of the
meal below that if you’re intending to lose weight. That
pretty much lets out any sort of “heavy” meal. The average
American’s diet is very high in protein, and relatively low
in complex carbohydrates, so complex carbs before an aerobic
workout are probably better. Keep the total calories from fat to
25% or lower, in general.

18.3 How soon and how much should I eat after an aerobic
workout?

If you feel like eating immediately after a workout, be
sure that it’s high in carbohydrates, lower in protein, and
either very low or no fat content. The carbs should be
mostly complex. Durum or semolina pasta, fat-free granola
bars, and some of the lower-sugar fig or other fruit bars are fine.
Try to take in as few kCals as you can – just take the “edge” off.
Munching out on broccoli or cauliflower florets with just a touch
of fat-free Ranch is good.

If the workout was pretty intense, I’d recommend about an
hour’s wait afterward before eating a full meal. Most
people aren’t really ready to eat when they’re majorly
sweaty and still breathing heavily, anyhow. Cool down, then grab a
nice refreshing shower, and mellow out with a big glass of ice water.
Next, find some candles, and sit down to a nice plate of rigatoni with
tomato sauce with basil, green peppers, and little bits of chopped
mushroom. Brush your whole wheat toast with a film of olive oil,
sprinkle on some freshly-chopped garlic, …you get the picture.

19. BEST TIME TO EXERCISE

19.1 What is the best time of day to exercise?

As a general rule, if your habits are diurnal, exercise
in the early evening, when your metabolism is at its peak,
is more efficient. This varies widely, however, and you
really need to exercise at the time which “feels” best for
you. The best time to work out is when you *want* to, so
pick a time of day at which you find exercise enjoyable.

20. Major conributors to Part I are:
Bobbie Rivere < bobbie@panix.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it >
Larry DeLuca < henrik@husc.harvard.edu This e-mail address is being protected from spambots. You need JavaScript enabled to view it >
Bill Whedon < whedon@netcom.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it >

Help spread the word