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Exercise Articles


Pole walking, also commonly referred to as Nordic Walking, Urban Walking or Exerstriding (or Cross-Country skiing without the snow and skis!!), is a relatively new fitness trend in the Toronto area although it has been very popular in Europe for over 20 years and also more recently on the West Coast as people are becoming increasingly aware of it’s health potential. It was originally created in Scandinavia to cross train their elite Cross Country skiers. It is a sport that can be enjoyed by people of all ages and all fitness levels with the convenient advantage of being done anywhere that you can walk, making it a very effective, inexpensive way to reap the benefits of the exercise.


While walking itself is a very natural activity and a great form of exercise (although often underrated), it is mainly a lower body workout. imageLearning how to walk correctly with poles turns your walking into a total body workout using up to 90% of the muscles in your body. It maximizes your time efficiency with 30 minutes of pole walking being the equivalent of 50 minutes of just walking. All with very little increased sense of effort while enhancing the aerobic and strengthening components of your workout.


Studies have shown that Pole Walking can be very beneficial for:


  • improving posture
  • increasing your core strength and control (up to 1800 abdominal contractions per mile!
  • decreased impact on lower body joints (useful for ankle/hip/knee arthritis)
  • increased balance and stability (decreased risk of falls)
  • increased upper body strength and endurance
  • increased endurance and cardiovascular health
  • increased confidence with walking
  • increased caloric output (up to 40% )
  • fibromyalgia
  • osteoporosis (even with history of spinal fractures)
  • low back pain
  • intermittent claudication
  • Parkinson's


Although the only equipment that you will need to start this fitness program is a pair of poles with the proper feet on them, using the correct technique will allow you to maximize the benefits while minimizing the chance of any injuries. For more information please feel free to contact Shelagh Baker, Physiotherapist (ext 207) at SMS.

Health Benefits Of Exercise

I am a physician of sports medicine. The people I deal with an a daily basis are generally people that are committed to exercise. For one reason or another they have decide that exercise is an important part of their life. This article is not for these people as that is like trying to convert the already converted. Although this will provide confirmation for them, the real purpose is to convert those that have not seen the light. Studies have shown that fewer than 7.5% of all adults perform regular physical activity and more than 25% do none at all.

It is often stated that doctors only treat the sick or injured. There has been a new emphasis now being place on prevention of illness. Certainly in these times of increasing debt and increasing health care costs the more we can prevent disease the better off we will be. People including doctors and scientists have long believed in that exercise is beneficial to your health, but it is only in the last several years that we have actually proven this to be true.

HEART: The most important and well documented benefit of exercise is the reduction in deaths from heart attacks. There are now several good studies proving this to be true. Regale exercise may in fact be the most important thing you can do for yourself to prevent heart attacks. The largest and most famous study come out of Harvard by a physician named Dr. Ralph Paffenbarger. He looked a t 16,000 Harvard alumni males aged 35- 74, all of whom were free of known heart disease. Those individuals who expended more than 2000 calories per week(about 20 miles of running) had death rates of 25-33% less than those whose calorie expenditure was less than 2000 per week. He also showed that the exercise had to be maintained as those individuals who were active in college but sedentary after lost their benefits of the earlier exercise. This works in two different ways.

The first is by cardiovascular fitness. This includes a slower heart rate, lower blood pressure, a more effective heart with more blood being pumped out by the heart. People who are active also have larger arteries which supply the blood to the heart. It is when these arteries get blocked that we have a heart attack. The second benefit is by increased metabolic fitness. Exercise lowers blood cholesterol levels and lowers sugar levels to prevent and control diabetes. The blood of people who exercise regularly is also less prone to clotting and blocking the arteries. Although we have mainly talked about men here the same will apply to females after menopause.

PSYCHOLOGICAL: A lot of people who exercise regularly experience a sense of well being. There is also the phenomena of the 'runner's high"" which I will discuss in later article. Exercise has been shown to reduce stress and tension. It has also been shown to have a positive effect on people who are prone to depression. Self esteem has been shown to be generally increased in regular exercisers.

ILLNESS: A previous article I wrote discussed a link to regular exercise and a reduction of colds and flus.

How Much Should I Exercise

Last week I wrote about the benefits of exercise. After reading that article most people hopefully will realize that regular exercise will not only allow them to live longer and healthier, but to enjoy life more on a daily basis being less sick and having more self esteem. Now the decision is what should you do and how often. The benefits of exercise that I talked about last week are from what we call cardiovascular fitness. The purpose is to increase your aerobic or functional capacity for work. This is based on developing a more efficient heart and the delivery system to the muscles which we are exercising. This will involve exercise that uses large muscles on a continual basis. This means using the legs such as walking or cycling, the arms as in swimming, or both as in cross country skiing. I am often asked by people as to what is the best exercise. Although some studies have shown that cross country skiers have the highest level of fitness in the world this does not necessarily mean this is the best exercise for you.

The best exercise for YOU is one you enjoy doing, which have good access to, and you can adhere to on a regular basis. FREQUENCY: Ideally you should exercise 3-5 times per week. It has been shown that you can increase your fitness with as little as twice a week if the duration and intensity is enough but three times a week should be the minimum. If losing weight is one of your main goals this should be increased to four times per week. INTENSITY: Ideally you should exercise at a heart rate which is 60-90% of your maximum heart rate. You can calculate approximately your maximum heart rate by subtracting your age from 220. Therefore if you are 45 years old your approximate maximal heart rate is 220-45=175. You should exercise at 60-90% of this at 105-157 beats per minute. You can easily learn to measure your pulse at your wrist or at your neck. Most people will measure for 10 seconds and multiply by six to obtain their heart rate.

DURATION: You should perform the exercise at the above calculated heart rate for 15-60 minutes. Most people will exercise for 30 -40 minutes. Remember to do a good warm up and cool down with your exercise program. MODE OF ACTIVITY: As mentioned above aerobic fitness is from using large muscle groups. When your heart is asked to increase its output because their is more demand from a particular part of the body for more oxygen it does not ask which part of the body it is going to. Often people will vary the type of exercise they are doing. They will swim one day and maybe go cross country skiing the next. This crosstraining is not only a good way to combat the boredom which might come if you are doing the same activity every time but also a good way to prevent injury by using different muscles. Dr. Ralph Paffenbarger quoted that there was increased longevity with expending more than 2000 calories a week.

This is equivalent to running about 20 miles peer week. A lot of people might find this hard strictly from a time or motivation point of view. But, if we can increase our activity in our daily lives such as climbing stairs as opposed to taking the elevator, or walking the extra block than we can decrease the amount of ""formal"" exercise needed to derive the benefits of exercise. So the person who gets off the bus one stop from work or goes for a walk at lunch may in fact only have to expend 1000 calories of formal exercise a week or 7-10 miles a week of jogging to derive the benefits of fitness. If you have not exercised in a while or if you are worried about any health problem see your doctor before you start exercising. Then pick an activity or ideally several activities and start to do them . Having a partner or group of people will make the activities more fun and be more motivating. It will usually take 6-10 weeks of regular exercise before you will actually start to feel the difference and I know you will like how you feel.

Hot Hot Exercising In The Heat
It sure seems not long ago that I was writing about exercising in the cold. Now that the Stanley Cup playoffs are over it sure seems to heat up fast. Exercising in various climates requires time for our bodies to adapt. The highest risk is early in the summer when our bodies have not had the time to adapt to the hot weather. We know just form how our bodies feel that it is harder to exercise in the very hot, humid weather. Decreased performance is just one factor of exercising in the heat, but their are other serious consequences. The important factor is that most if not all of these problems can be prevented with a little bit of knowledge and a lot of common sense. The following are the common problems with exercising in the heat in increasing order of severity. HEAT RASH This is often referred to as prickly heat. Probably all of us have experienced this before.. There is usually a skin rash consisting of dry red skin. This is not serious or life threatening and the only way to avoid this sensation if you are prone to this is by avoiding the heat.

HEAT CRAMPS These are a little more disabling. Heat cramps are very painful. They most often occur in the calf muscle, but can occur all over the body. In the worst case scenario, an individual will have continuos migrating cramps. This usually occurs after a long distance event. It will start with a cramp in one muscle and as soon as the one cramp is relieved another muscle will start to cramp. This rare situation is quite painful and sometimes hard to treat. The cause of the cramps is loss of fluid and electrolytes. This is from a combination of excessive sweating with not enough intake of fluids. The muscles in the body require a steady flow of electrolytes to contract and relax. If their is low fluid in the body their is less blood flow to the muscles which in turn supplies less electrolytes to the muscles. This changes the electrical sensitivity around the muscle causing it to contract involuntarily and stay contracted. Once you have a cramp the best way to relieve it is by stretching the muscle group involved. If the cramp is not relieved then massage or ice application will usually work.

The most important factor is to replenish the fluids and electrolytes that you have lost. That is with water and electrolyte drinks. After endurance events when the cramps are more severe and can not be resolved, we sometimes require intravenous fluids and even drug therapy to stop the cramps. After the cramp is resolved, their is really no reason that the person can not continue to exercise as long as the muscle is not to painful. The problem is that until you correct the fluid imbalance, the cramps are likely to come back. HEAT SYNCOPE It is not uncommon to feint or pass out in the heat let alone while exercising in the heat. This is due again to the loss of fluids in the body. In the upright position the blood pools in the lower extremity and their is decreased blood flow to the brain. This will cause you to pass out. The treatment is to lay down with your feet elevated. The next important thing is to cool down and replenish your fluids.

HEAT EXHAUSTION We are now getting into the more serious kinds of heat problems. At this point the body temperature is raised. You will become very fatigued and may not even be able to continue. The heart rate is raised and you may even cease to sweat as your fluids are so low. The early signs are decreased performance, increased breathing rate, mental confusion, blurry vision or hallucinations. decreased sweating, and collapse. This is very serious and must be treated. It can be fatal in the elderly, those with heart disease, or those that attempt to continue to exercise. HEAT STROKE As heat exhaustion becomes more serious it can lead to heat stroke which can be fatal even if treated. Their have been several deaths in marathoners during a hot race. This requires medical attention immediately. At the Toronto Marathon I treat several runners each year with this serious heat disorder. Luckily with our excellent medical team, no one has had serious trouble. The beast way to treat heat disorders is to prevent them. Here are a few tips.

1/FLUIDS This is the most important. You should drink on a regular basis to prevent chronic dehydration. Before exercise drink a glass of water or electrolyte drink and a further glass every15 minutes of exercise. Remember that their is a significant decrease in performance if you are even 4% dehydration. This occurs long before your thirst mechanism kicks in. If you have waited to drink until you are thirsty you have waited too long for both a safety and performance point of view.

2/TIME Avoid exercising during the heat of the day. Early morning is the best or in the evening.

3/DRESS Dress appropriately for the heat. Newer fabrics will help to keep you cool. Do not attempt to overdress to sweat more to lose weight in the heat.

4/DIET If you are prone to cramping, you should increase your intake of potassium and magnesium in your diet.

5/ACCLIMATE It takes your body at least two weeks to adapt to the heat. Do not attempt to push yourself in the heat without having time to adapt.

6/COMMON SENSE Listen to your body. Pay attention to the warning signs listed above. If it is very hot do not push yourself, even if it is a race you have been training for. Better to finish alive then not at all. Save your big performance for a day when the weather is cooperating. Remember as I stated early in the article all of these problems can be prevented.

Sudden Death During Exercise

The world is shocked when Reggie Lewis of the Boston Celtics suddenly dies on the court. Conflicting reports from two different groups of cardiologists made it not clear to the athlete of what he should do. Unfortunately, he wanted to play so badly that he listened to the most optimistic opinion. Several years ago Jim Fixx, the running guru and author on many books on running drops dead on the road, again shocking the community. The anti exercise groups were saying ""See, I told you exercise is bad."" The question is how real is the hazard of sudden death during exercise? You can basically break sudden death in athletes into two categories. The first is persons under age 30 and the other is over age 30. Reggie Lewis fell into the first category. When a young person dies while exercising it almost always due to a congenital abnormality in the heart or the blood vessels supplying the heart. There are three main problems which might exist.

The first is called hypertrophic cardiomyopathy. The heart muscle is thickened and as you exercise the heart beats harder and because the muscle is so thick, it actually blocks the blood leaving the heart. The second cause is an abnormality of the small blood vessel which supply the heart. Due to the abnormality the small blood vessel gets kinked and the blood supply to the heart is caught off and you have a heart attack. The third common cause and the cause of Reggie Lewis death is an abnormality of the hearts conduction system. A supply of nerves to the heart coordinate to allow the various parts of the heart to contract at the proper time and sequence. If their is an abnormality the heart will not beat as it is supposed to and it goes into an abnormal beating pattern.

This abnormal pattern is not efficient and the heart will not pump the blood out to the body leading to death. The Other cause of death in young athletes you might hear about is drug related where an athlete using a drug like cocaine will affect the heart and cause death. We have also all heard about death from anabolic steroid abuse. Is there a way to prevent sudden death in young athletes. Extensive testing of all athletes to determine if they have abnormalities would be too expensive and time consuming and only pick up the rare isolated athlete at risk. A lot of these we simply can not detect until something happens which may be fatal. There are certain things we can do to help detect certain individuals at risk. All participants in sport should have a pre-participation examination.

Some problems are in the family, so if their is a history of early sudden death in the family that athlete should have special investigations. If there is a thick heart muscle the athlete may complain of passing out with intense exercise. A history of chest pain with exertion or feeling irregular beats in the heart while exercising should lead to further investigations. If drug abuse is suspected then it can be dealt with at the physical exam as well. The next group is the group over age 30. In this group the major cause of sudden death is coronary artery disease. This is the cause if the common heart attack. What is the risk of jogging or playing a weekend game of tennis. The actual risk for an individual is very low unless you have signs of heart disease or have underlying heart disease that you do not know about.

One of the best studies was done by a physician named Thompson who looked at joggers in Rhode Island. They reported one death for every 396,000 man hours of jogging or one death for every 7620 joggers per year. This is less risk than dying in an airplane crash. On the flip side, those that exercised regularly have shown to have a reduced risk of up to 60% chance of a cardiac event than those that do not exercise. Not only that, but those that did exercise regularly had a much better chance of survival after a heart attack than those who were not fit. Jim Fixx had a strong family history of heart disease in his family. Before he took up jogging he was grossly overweight and smoked heavily. Before he died he had signs of heart disease which he ignored. He still outlived his father by many years.

The important thing here is to see your physician before you start to exercise. Look at your risk factors and look for any symptoms of heart disease. Listen to your body and if you have any concerns have it dealt with before it is too late. Once your physician has cleared you to exercise than start on a sensible program constantly monitoring your body for any warning signs. Exercise does not cause sudden death but only acts as trigger if you have underlying heart disease. Although you have a slight increased risk of a cardiac event while exercising if you are at risk, those that exercise regularly have a much overall reduced incidence of heart attacks. So even though you exercise for short period of time during the day , the effects of exercise will last for the remainder of the day. Definitively the slight risk exercise poses for presumed healthy individuals, should not overshadow the overall protective effect of regular exercise.