therapeutic benefits of yoga
As research continues to improve and advance, it is important to stay abreast of current trends. One of those trends is the development of yoga as a therapeutic intervention. While yoga has been practiced for thousands of years, its popularity for fitness has increased worldwide. In conjunction with this increase in practice comes an increase of research evaluating the therapeutic effectiveness of yoga on different diseases and populations.
There have been some recent literature reviews that evaluate the state of the current research and can help practitioners gain an understanding of alternative and complementary forms of treatments. Yoga has been routinely associated with breathing, movement and mindfulness that can improve stress levels. Indeed, one of the benefits of yoga is the ability to decrease stress. This reduction in stress has additional health benefits including the regulation of breathing, decreasing hypertension and potential to modulate PTSD, anxiety and depression. It has also been shown to be an adjunctive therapy for asthma.
The focus of the breath with yoga helps to regulate breathing and improve lunge capacity. Recently, a study looked to see if this improvement in breathing ability transferred to actual physical performance. A small sample of matched female participants were measured for cycling performance before, during and after being in a yoga group or a control. The practice group showed improvements in lung regulation and capacity at rest, but no improvement in cycling performance or VO2 max. So, while yoga may help with regulating breathing, it is still important to undergo training modalities to achieve physiological adaptation.
Another common reason to perform yoga is to improve balance and flexibility and both of these outcomes are achieved with routine practice of yoga. Athletes have even seen improvements in these areas compared to those that did not practice yoga. Unfortunately, no study has evaluated the on field transfer, prevention or rehabilitation potential of yoga on injury risk and performance measures. It still remains to be seen if yoga is a viable standalone prevention or rehab strategy.
An area of rehabilitation that does show promise is chronic low back pain. One of the main reasons for participants to choose yoga relates to low back pain (20%). Yoga practice has demonstrated effectiveness in decreasing the pain and dysfunction associated with chronic low back pain. Yoga also improves the symptoms and function of those suffering from knee arthritis. Yoga can help to decrease the pain, swelling and stiffness associated with OA.
While the use of yoga is showing promise as a therapy, there are definite opportunities to learn more and it is important to note a few things regarding its effectiveness as a therapeutic modality; the overall number of different yoga styles and instructors makes it very difficult to standardize yoga therapies, and thus, hard to compare outcomes to traditional therapies. The differences of the styles, instructor, location, class level and overall vigor of practice all have an effect on how a client will respond to the intervention. As studies regarding yoga become more robust we can make better recommendations to athletes and clients regarding its use, but currently our knowledge is limited to a few areas.
Beutler, E., et. al. (2016). Effect of regular yoga practice on respiratory regulation and exercise performance. Plos One, 11(4).
Chang, D., et. al. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedic Rheumatology, 3(1), 1-8.
Field, T. (2016). Yoga research review. Complementary Therapies in Clinical Practice, 24, 145-161.
Jeter, P., et. al. (2015). Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967-2013. The Journal of Alternative and Complementary Medicine, 21(10): 586-592.
Park, C., Braun, T., & Siegel, T. (2015). Who practices yoga? A systematic review of demographic, health related and psychosocial factors related to yoga practice. Journal of Behavioral Medicine, 38, 460-471.
Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49-54.
If your training goal includes building strength and size there is new research that can help. Researchers compared the effects of low repetition training with a typical moderate repetition training routine with interesting results.
Both groups were comprised of resistance trained men who followed the same exercise training program with different rep ranges to failure. On Monday/Thursday they did 3 sets of leg press/seated row, bench press/hamstring curl, plank. On Tuesday/Friday they did Shoulder press/biceps curl, Tricep extension/lLat pull down, leg extension. One group did 8-12 reps and the second did 20-25 reps per workout. After the workout both groups consumed 30 grams of protein and then once more before bed.
At the end of the 12 week session both groups had similar increases in size and strength. The low rep group had a greater increase in bench press strength, but otherwise there was no difference. As the exercise science field continues to evolve we learn more about effective programming. For strength and size, high rep low load is just as effective as lower volume higher weight. For some trainees, the constant heavy training causes joint pain and dysfunction. If lifting lighter weights leads to the same gains, it can be much easier to stay consistent. I also think it's important to point out that all the subjects consumed 2 high protein shakes a day and that every set was performed to failure. Training to failure recruits maximal muscle units and is probably what led to the strength gains in both groups.
For many people looking to improve their physique, the thought of lifting heavy weight can be a daunting process. If similar gains can be made by putting in maximum effort at light weight, it provides an appealing alternative. For strength and power athletes, it is still important to train with heavy loads, but for others, mixing up the repetition range and failure training is adequate to achieve results.
Morton, R.W., et. al. (2016). Neither load nor systemic hormones determine resistance training mediated hypertrophy or strength gains in resistance trained young men. Journal of Applied Physiology. http://jap.physiology.org/content/early/2016/05/09/japplphysiol.00154.2016
The National Strength and Conditioning Association has released a position statement on long term athletic development. With the rise in youth sport participation, injury trends, sport specialization and long term inactivity of today’s adults, it is important to encourage youth to participate in physical activity. This tenet forms the cornerstone of the position statement.
While long term athletic development is generally taken to mean the development of athletes, the NSCA broadened the term to include all youth and to consider all youth ‘athletic’. In this manner, they address the concern and health implications of physical inactivity and they believe that all youth should be encouraged to be active.
There are 10 pillars for successful long term athletic development:
It is also of vital importance to maintain physical and mental health of young individuals. Programs should incorporate neuromuscular control, movement training and injury prevention exercises to reduce the risk of injury. Programs should also strive to be inclusive and foster a community of acceptance for all the participants, regardless of age or physical ability.
Due to the long term health consequences of physical inactivity, we need to encourage all youth to participate in some form of physical activity. Programs that encourage movement, play, control and strength can be an enjoyable experience for all those that participate.
Lloyd, R.S, et. al. (2016). National strength and conditioning association position statement on long-term athletic development. Journal of Strength and Conditioning Research, 30 (6). https://www.nsca.com/long-term_athletic_development_position_statement/
If you are an endurance athlete, you are probably aware of the benefits of high intensity interval training (HIT). If you are not aware, interval training entails training at a higher intensity (percentage of maximum effort) to allow for greater physiological adaptations. The benefits of interval training, specifically for endurance athletes, include increased VO2 max, peak power output, ability to buffer lactic acid and the performance benefit of improved race times.
Many training programs focus on the long duration, low intensity training to gradually adapt to training and once the athlete is more accommodated, moderate and high intensity workloads are performed in order to improve some performance. Much like strength athletes, endurance athletes can benefit from systematically organizing their training to focus on improved performance. When using HIT workouts, there are many ways to integrate it: 1-3 times a week, shorter duration versus longer duration, number of sets performed, etc. A recent study on elite Norwegian cyclists wanted to evaluate the effectiveness of these different programming techniques on performance.
The cyclists performed the same overall workload throughout the study, in 3 different periodization schemes: decreasing intensity, increasing intensity and mixed intensity. The decreasing intensity started out performing HIT sessions at short duration and high intensity and gradually decreased the intensity of the workouts while increasing the duration. The increasing intensity group performed the opposite workouts and the mixed training performed a combination of shorter duration higher intensity and longer duration lower intensity HIT sessions.
At the end of the study all 3 groups had increased peak power output, increased VO2 max and faster times in their time trial with no single model being superior to the other two. The take home message is that once a foundation of long duration low intensity exercise is performed, athletes can benefit from incorporating HIT into their workouts.
There are significant performance benefits of performing 2-3 HIT sessions a week in conjunction to regular low intensity long duration training for endurance athletes.
Sylta, O. et. al. (2016). The effect of different high-intensity periodization models on endurance adaptation. Medicine and Science in Sports and Exercise. http://journals.lww.com/acsm-msse/Abstract/publishahead/The_Effect_of_Different_High_Intensity.97486.aspx
movement screens and injury risk
One of the newer trends in the fitness and sports medicine industry is to use movement screens when working with clients. The idea is that the screen will allow the clinician the ability to assess how a client moves and potentially predict who will have an injury. However, a new study published by the American Journal of Sports Medicine demonstrates that movement screens cannot accurately predict the risk of injury. Before we throw them out, though, let’s dive a little deeper.
We know that the greatest predictors of injury are previous injury and rate of increase. We also know that there are certain movements and postures that can lead to an injury depending on the joint. What we can’t do yet is look at a person moving and predict that they will get injured. We can see that they are at a higher risk for getting injured, but we can’t say when they will get hurt and what specific injury they will get. That does not mean that assessing movement does not have value. On the contrary, I believe that addressing movement dysfunction is essential to optimum health and performance.
As much as I enjoy science and research, we like to put all movement into a box in an attempt to eliminate individual variables, which does not happen in real life. We have what is considered the ‘ideal’ movement, but not everyone can achieve it. That doesn’t necessarily mean that individual is at greater risk for injury, it just means that we want to optimize movement in their body. Personally, I believe that injury screens are helpful the same way that testing is helpful; it provides baseline information that we can track for improvement over time. If individuals have movement compensations or asymmetries side to side that is something that we can correct, if need be, and optimize, along with improving strength, endurance and flexibility. When people move better, they tend to feel better and if they feel better they perform better.
So, while a movement screen may not predict specific injury risk, it can be a very helpful tool in crafting exercise and treatment programs geared toward achieving optimal individual movement quality. The value of the screen may not lie in the ability to predict injury, but in the ability to improve movement. The quantifiable score allows for objective information about how individuals are improving and can be integrated with standardized performance testing to assess ongoing progress.
Bushman, T. et. al. (2016). The functional movement screen and injury risk. American Journal of Sports Medicine; 44 (6). http://ajs.sagepub.com/content/44/2/297.abstract
Current fitness trends
These two articles from IHRSA offer some interesting insight into the current state of the fitness industry. On the one side, there are more and more people actively joining gyms and exercising worldwide, which is great, except for the fact that the US is still fighting an obesity problem. On the flip side is the proliferation of competitive style gyms, such as Crossfit, that focus on high intensity all the time. It appears that exercise is caught between these two extremes; either showing up is good enough versus an all-out effort all the time mindset.
I love training hard and pushing yourself to reach new heights, and a class or group workout can be great for that. But, it is also important to make sure that your training is smart and that you aren’t causing more damage than you can recover from each workout. Bear in mind that even competitive athletes take time to decompress and deload from their workouts so they don’t break down.
With the hustle and bustle of today, for many people just making it to the gym is success. Remember, though, that gains are made by progressive overload and recovery. If you have a high stress job, high stress at home and then do a high stress workout, you will eventually break down. Exercise should support your lifestyle and fuel your health, not detract from it. There is more to achieving your goals than just hopping on the treadmill for 30 minutes, too. Use the time you have to work at an appropriate level and then watch your diet. Take opportunities during the day to move more, too. Taking the stairs or walking to the store all adds up over the course of the week.
The best programs are the ones that fit your life and address your individual needs. Classes may support that, just like the occasional maximal effort workout will. Just be careful not to fall into the trap of not doing enough or doing too much.
If you’ve ever heard someone say that they are ‘double jointed’, they may have generalized joint hypermobility. Generalized joint hypermobility is a connective tissue phenomenon characterized as having loose connective tissue including joints and skin and is more common in adolescents and females. As we age, the collagen tends to stiffen up, but, for some people this extra joint motion can lead to various aches and pains.
The common screening tool for assessing general joint hypermobility is the Beighton score, which is a series of movements: 4 are performed bilaterally, with the last one being either yes or no. A scale of 4 or more out of 9 is indicative of having generalized hypermobility, but a score of 6 or higher is more indicative of having associated symptoms. The tests are pinky hyperextension done bilaterally, the ability to touch your thumb to your forearm bilaterally, hyperextension at the elbows and knees bilaterally and the ability to palm the floor from a standing position.
The reason we are concerned for joint hypermobility is the implication for injury and pain. Because the joints have some additional laxity (movement), symptomatic individuals have excessive joint motion. This additional motion can lead to a pain response as the joint moves beyond a ‘normal’ range. When I looked at the research to determine if the presence of general joint hypermobility can lead to injury risk, I was surprised that the answer was generally no. For most injuries, the risk of sustaining an injury increases if there has been a previous injury. For those with joint dislocations, the presence of generalized hypermobility was not as important as local hypermobility of that joint. There is a connection between generalized joint hypermobility and ACL risk in soccer players, however. This is probably related to the knee joint being loose and the fact that the individuals are not able to adequately stabilize during intense activity.
While the ability to predict injury based on generalized joint hypermobility does not seem evident, there are some interesting correlations when looking at different injury subsets. For people that suffer from musculoskeletal pain, back pain during adolescence, and fibromyalgia, there is a higher number of symptomatic individuals that have generalized joint hypermobility. Once again, the thought is that the joints have additional movement which causes a pain response. For many people that suffer from musculoskeletal pain, they have a hard time getting their pain receptors to calm down. The two main treatments for hypermobility related pain are exercise and massage or soft tissue work. The goal of exercise is to improve body awareness, positioning, control and strength. When the muscles are working properly, they have the ability to aid in joint stiffness and normal joint motion may decrease the pain response. Massage therapy and soft tissue work can help to ease pain through touch and by addressing specific problem areas. While the research is not definitive on the effectiveness of either exercise or massage, there are some observational studies that suggest it can help.
The key take home point is that generalized joint hypermobility is usually benign (there are other symptomatic forms), but can be involved with excessive motion that causes musculoskeletal pain. The main treatment and preventative technique is exercise to better stabilize joints, learn and reinforce proper movement and body control. In a flared up state, massage can help decrease the associated pain.
Folci, M and Capsoni, F. (2016). Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report. BMC Musculoskeletal Disorders; 17 (58).
Pacey, V. et. al. (2010). Generalized joint hypermobility and risk of lower limb joint injury during sport: A systematic review with meta-analysis. American Journal of Sports Medicine; 38.
Palmer, S. et. al. (2014). The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review. Physiotherapy; 9 (002).
Scheper, M. et. al. (2015). Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type); it is a challenge. Journal of Pain Research; 8.
Tobias, et. al. (2013). Joint hypermobility is a risk factor for musculoskeletal pain during adolescence. Arthritis and Rheumatism; 65 (4).
the science of weight loss
If your health and fitness goal includes weight loss, you have probably heard, read or watched a lot of different opinions on what is the best way to achieve it. You have probably also struggled with knowing what information is reliable versus what is not. In order to see what the scientific community had to say on the topic I read some research reviews to determine what was the most effective way of losing weight.
The simplest answer is to create a caloric deficit by eating less. The most effective way of achieving this end is to eat a diet higher in protein. For a long time you have probably heard that high protein diets (think Paleo and Atkins) are effective for weight loss, and they are. Changing your diet around to include higher protein seems to be the most effective way to lose weight, but maintain muscle. You can also opt for meal replacement shakes to get your protein and vitamins in, but in a calorie restricted way. The last trick is to go to bed hungry if your goal is weight loss. A quick word of caution on low carb diets: initially restricting them can lead to weight loss, but long term restriction can lead to sensitivity and weight rebounding. After an initial decrease add some more complex carbs in (rice, sweet potatoe, bread, etc), but focus it in the morning and after a hard workout.
For a while the recommendation has been to focus on diet and do cardiovascular exercise in order to lose weight. While steady state exercise has its place, it is not the most effective way to lose weight. Once you start moving and get used to a routine, weight training is the most important for weight loss. And, not just any weight training, but heavier lifting with lower reps seems to build muscle and decrease fat mass. Doing whole body exercises 3 times a week for 2-3 sets of 6-10 repetitions is the scientific recommendation if the goal is weight reduction. Ironically, this is the same recommendation if the goal is strength development, as well. For the non-endurance athletes, choosing endurance exercises that incorporate circuit training or interval training is also effective to achieve weight reduction. Just make sure that you are working at a high intensity, the best results in the studies were obtained when exercise was performed this way.
If diet is effective alone and exercise is effective alone, then what about the combination of diet and exercise on weight reduction. This in fact, is the most effective way to reduce weight. By adopting a calorie restricted diet and increasing your strength or interval training exercise you will have the optimal scientific plan for weight reduction. For people that have achieved 10% weight loss and have managed to sustain that reduction, it was discovered that they ate a diet fewer in calories than other groups who could not sustain weight loss and that the diet was higher in protein and lower in fat. They also moved more throughout the day than their counterparts. Using a fitness app to track your calories and steps is an easy to see how active you are. Simply increasing the number of steps and stairs throughout the day will have a positive effect on your goal.
In order to lose weight and maintain that loss it is important to adopt a lifestyle that supports that goal.
American Dietetic Association. (2009). Position of the American Dietetic Association: Weight Management. Journal of the American Dietetic Association; February 2009 (109): 2
Clark, J. (2015). Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight loss and changes in fitness for adults (18-65) who are overfat, or obese; systematic review and meta analysis. Journal of Diabetes and Metabolic Disorders (14): 31
Turocy, et. al. (2011). National Athletic Trainer’s Association Position Statement: Safe weight loss and maintenance practices in sport and exercise. Journal Athletic Training (46): 3
Wilson, P. (2016). Physical activity and dietary determinants of weight loss success in the general US population. American Journal of Public Health (106): 2
I recently completed the second talk in a 3 part series for Cornell Fitness Centers discussing program considerations based on goals. Each component could easily be its own article, so I am going to focus on the general considerations and leave the specifics for another time. This is one of my favorite topics, so I really enjoyed the talk! When putting a program together for an individual or team it is important to consider their goals for training, their personal history and comfort with exercise and explaining the commitment it takes to achieve success.
In order to be successful in a fitness program it is vital to not only do the exercises at the appropriate intensity, but to also make an effort for the recovery. True progress is not solely made in the gym, but by adopting a lifestyle that will lead to recovery, adaptation and long term success. Your body will adapt to the stress that you place upon it and the goal of exercise and training is to get it to adapt based on your goals. You will apply a load greater than where you are now then recover from that training and then apply a load greater than where you are now. This is the sequence that is used to achieve success. It may seem very simplistic, and it is. It really is a matter of applying a sequential load in an organized manner that creates adaptation. What load we choose to apply, and in what manner, is what will dictate the adaptation to our program.
For every goal, we will manipulate the program in an effort to create the adaptation that we want. In addition to the programming, it is essential to get enough rest to recover from the training. It is also important to have the proper nutrition that will provide both the fuel necessary for training and the nutrients necessary for recovery. Without having the basics covered, the program cannot deliver ideal results.
In order to build strength heavier weights must be lifted. Setting up a 4-6 week training block for each repetition range can help build a foundation that allows for strength development. Strength can be improved by lifting 2-3 times per week with multi joint compound exercises doing 3 sets of 8 repetitions or fewer. This heavier load recruits more muscle fibers leading to strength gains. Exercises include squats, deadlifts, lunges, chest presses, rows, shoulder presses and pull downs.
Power is the ability to produce force quickly and is achieved by combining strength and speed. In addition to getting stronger following the programming outline above, you also need to be faster. The two ways to gain power are to lift using maximal loads of 1-3 repetitions or to use light weight for maximum speed up to 6 repetitions. This combination of training will improve strength and speed leading to more power. This is very beneficial for athletic settings where the ability to produce force quickly is necessary.
Muscular endurance is not the same as cardio respiratory endurance. Muscular endurance is the ability to contract the muscle repeatedly to delay failure due to fatigue. Lighter weights with more repetitions help achieve this goal. Continue to use the same compound exercises to build more global muscular endurance or choose single joint isolation exercises to improve certain motions. This is also very beneficial for injury rehabilitation and recovery.
Muscular hypertrophy (size):
We used to think that gaining muscle meant performing 8-12 repetitions per exercise, but now know that size can be achieved by alternating heavier lifting days with lighter lifting days. The key is to work at maximal intensity. The intensity of the exercise performed for the repetitions is what leads to success. In addition to large movements, smaller isolation exercises can be used to increase size. Workouts can be total body in nature, or broken up to alternate the muscles worked.
What leads to sustained weight loss is a lifestyle change. A recent study that evaluated long term weight loss success versus failure identified that those who maintained the weight loss ate fewer calories per day, fewer calories from fat and moved more. In addition to exercise, their movement was generally more throughout the day. They would walk more, take the stairs and generally be more active. This greater activity during the day coupled with a healthy diet is what allowed them to maintain their weight loss goals.
Conditioning is very event driven. If your training is based on a team sport then performing intermittent sprints and recovery periods like interval training is very beneficial. This training can also be helpful for long distance events, as well. But for those, it is also necessary to do longer duration slower speed. For those of us who condition for health, doing more circuits and intervals are more beneficial since they are time effective and build muscle in addition to keeping your heart rate up. The occasional long, slow day is good for recovery if you’re sore or in need of some mental relaxation.
As you see, there is a lot that goes into programming, but by remembering that the outcome is dependent on the work performed, you can make your program work for you. This is one of my favorite topics, so you can expect future articles that dive into the specifics of each goal.
TeSting for sUccess
This morning I did a testing day with some clients and the results were really positive. They had increased their maximum number of push-ups and their plank hold. They also did very well on their one legged squats with close to equal strength per side.
I don't write this to point out how great they are, although they do work hard, but to point out that periodic testing can reveal a lot about your programming.
If you are struggling to make progress or feeling stalled out, it might be time to assess where you are. Sit down and really think about your goals. Then write them down in quantifiable terms with an end date. This now gives you something to shoot for. When you go for your workout try to get a baseline. How strong are you? How fast? How easily can you move your body? Find exercises that support your goal and use it as a way to track your progress.
Armed with this new information, make a plan that allows you to reach your goal by periodically reassessing how you stack up to your baseline. As you continually strive to achieve success you will have a marker to track your progress.
If you still feel stalled and frustrated it might be time to talk to a coach to assist you on your journey. Good luck reaching your goals. Having a plan will help you get there sooner.
I write on sport management, fitness, sports medicine and business topics to help you reach your goals
To learn more about what services we offer, to schedule an appointment or to get prices please contact me at
*This site is for educational purposes only, it is not meant to diagnose, treat or replace medical advice. Before starting an exercise program always make sure that you are healthy and able to do so safely.*