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Exercise Away Blues

It would be great if we could have an easy solution to cure depression of just feeling down. While pure significant depression is not uncommon many people suffer from a mild form a depression which can make life difficult. While in this Prozac world there is evidence that regular exercise can have a benefit in raising your mood. In the more severe cases medical treatment is crucial but, exercise can still play a role. Studies have shown that regular exercise can brighten mood, increase energy and improve sleep. This is in conjunction with all the other benefits of regular exercise. The next question is usually what type of exercise is best for raising your mood. There has not been one type of exercise that has been shown to be that much better than the other. Whether you are doing an aerobic activity such as walking or cycling or a more stationary activity such as yoga or weight training.

The key is to choose an activity or a variety of activities that you can maintain doing. The most important criteria is that you should enjoy the activity. Especially if you are somewhat depressed when your motivation is more of a factor it is imperative that you choose an activity that you look forward to doing. Choosing a variety of activities can also be helpful in motivating yourself to keeping active. This can help prevent the potential for boredom in just a single activity. If you have not exercised in a long time then it is important to start off slowly and increase your level of activity slowly. This will allow your body to adapt to the feeling of exercise and prevent injury to your body. Try and exercise a minimum of three times a week for at least 35-40 minutes.

Do not worry about intense exercise as research has shown that it may be even more beneficial to your mood if your exercise level is moderate that intense. Starting an exercise program is hard for anyone let alone if you are somewhat depressed. It is easy to get discouraged early in your program as it is hard work and initially it may make you feel worse.The key is to persevere and the benefits will become evident. That hard exercise early on will become an easy accomplishment that you will feel proud of six weeks later. There are a few factors that may help you enjoy your exercise more and help you be more consistent. The first is to make it social. If you are exercising with a friend or a group the social aspect will make it more enjoyable and thus easier. It will also help you be more consistent with the motivating factor that someone else is depending on you to help them be consistent.

This may mean joining a club, hiring a personal trainer or a regular scheduled walk with a friend or colleague. Try using other adjuncts to raise your mood while exercising. A walkman with your favorite music will help to raise your mood and motivate you to exercise longer. Exercising outdoors has several benefits. Some people get depressed by SAD(seasonal affective disorder) This is a disorder especially in the winter months where people who are not exposed to enough light will feel depressed. The cure is to get outside during the day when it is light.

This is a more common disorder than you think. Peoples mood are generally lower in the winter. Nature in itself is soothing. Nature is the most spiritual place on earth. Think of how calm and how free your mind is when you are climbing a mountain, strolling along a river bed or pondering life on a quiet northern lake. While those environments are not accessible every day there are places you can go in the city where you can get closer to nature. If you are feeling down or blue then you now know that there is a simple solution to exercise regularly and not only feel better but have the positive knowledge that you are doing something good for yourself.


Commotio Cordis

Last year in the hockey playoffs we were all holding our breath when Chris Pronger went down after a seemingly innocent cross check to the anterior chest area. He stood up and then collapsed. Luckily he recovered fairly quickly but that has not been the case with some other athlete in a similar situation. There have been about 80 reported such deaths in the last 15 years including the famous death in Canada of an Italian hockey player who died after being innocently struck in the chest by a Toronto player playing in the Italian league. There is nothing wrong with Pronger's heart or nothing wrong with any of the other players who have died in this manner. The cause of death is an sudden change in the rhythm of the heart when it is struck at a precise moment of the heart cycle. The heart then start quivering and is unable to pump the blood through the body. The player will die quickly unless we can get the heart back to its normal rhythm within a couple of minutes.

Chris Pronger was very lucky in that his heart converted back on its own, but others have not been so lucky. This is different than people who may have a congenital problem with their heart that may lead to sudden death in sport. This problem called commotio cordis occurs mainly in people between the ages of 8-15 ranging in age from 2-28. It is thought the compliance of a young chest makes them more susceptible to blows that can affect the heart. Unfortunately even if medical help is there immediately it is very hard to cure the problem which is why it is crucial to try and prevent it from happening. It has occurred most commonly in sports where there is a chance that there can be a blow to the chest such as hockey and baseball where the blow is from the ball itself. Sudden death was also reported from blows to the neck area where there was damage to the arteries causing death. It is the chest and the neck that is not properly protected that we have to be concerned about.

The obvious treatment is to protect the areas that are vulnerable. Hespler, a hockey equipment manufacturer has designed a special shoulder pad called the Hespler Cardiaguard with added protection for the heart. They have also designed a separate protector that can be used in conjunction with the shoulder pads you might already be wearing. This is a concept that there is not a reason not to wear. Although the occurrence of this problem is rare the effects are tragic. The global use of this equipment may help to prevent the few deaths we are seeing. Chest protection should be worn in other sports where the chest is exposed to trauma. This would include a chest protector for the pitcher and catcher in baseball.

The other important factor in baseball is the hardness of the ball. They are now manufacturing softer balls to be used in the younger age groups. The softer balls have been shown to greatly reduce the force delivered to the chest and thus reduce the chance of developing the fatal commotio cordis. There are now age appropriate balls available for five year olds up to 13 year olds. Unfortunately their use is not mandated by any governing body so it is up to the parents and the league conveners to mandate that the kids play with the safest balls possible. As we get more experienced in sport medicine we find that even sport can cause death. It is catastrophic when a young healthy athlete has to die participating in sport. When we have developed knowledge that can help prevent these deaths it is a crime when we do not do everything possible to prevent these deaths.


Skin Problems In Summer Sports

Playing sports in the outdoors in summer is one of the great joys of life. The warm sunshine and the freedom it brings inspires us to be more active. With the increase in activity and the exposure to the sun and the heat we have to be careful of a few things. The most important element to be aware of is the sun. That is not aboriginal war paint being worn by Patrick Rafter as he plays in the summer Grand Slams of tennis. It is sun block. Patrick comes from Australia where there is the highest incidence of skin cancer in the world and the medical community has been very proactive to protect its citizens from the harmful effects of the sun. It is therefore wise to protect yourself from the sun as much as possible. Avoid long exposure to the midday 10-4 sun. Wear a hat to protect your head and face. Sunscreen with a minimum of SPF 15 with combined UVA and UVB protection should be applied 20 minutes before exposure.

Choose a product that is water resistance so that your sweat does not wash it all away. Apply the sunscreen even on cloudy days when the power of the sun's rays is deceptively strong. Blisters are more common in the summer with the increased sweat rate and the longer exposure to exercise. It is best to prevent blisters than treat them. Blisters occur as a result of friction between the skin and another surface. They are more common in longer events such as running or in start and stop events like tennis. Make sure shoes are well fitted, in good repair and appropriate for the activity that you are doing. Wear good socks and even some of the extra padded socks or two layer socks if you are more prone to blisters. Avoid cotton socks as they tend to absorb the moisture as opposed to wicking it away. Be extra careful if your are doing a sport for a much longer duration than previous or one of the first times of the summer.

Keep the exposed areas as dry as possible. Lubrication with petroleum jelly in the toe areas can be effective to avoid the friction. Most marathoners coat their toes in petroleum jelly to prevent blisters developing in the race Once a blister occurs, drain the blister with a small sterilized needle. Keep the skin intact over the blister as long as possible as this protects the painful area. Cover the blister with a membrane type dressing specific for blisters like Spenco second skin. Chaffing is a problem when certain parts of the skin are repeatedly rubbed back and forth. The most common areas are the axilla, the nipples and the groin. The nipples can be protected with bandaids or a proper athletic bra. The area between the thighs can be protected by wearing a spandex type short long enough to cover the affected areas. Lubricants can be used in all these area to avoid chafing. Calluses can develop on areas of increased contact such as on the hands or racquet players of more commonly on the feet. Proper shoes are again crucial.

Small calluses are not a problem and can be even quite protective in themselves. If calluses become too large or painful then they have to be pared down and perhaps an alteration in the forces causing the callus. Summer acne is caused from pressure, friction, occlusion and heat. A preexisting acne condition may or may not have been present. It is most common when all the above factors work together when equipment is worn such as in a hockey player. It can also be caused by clothes as in a synthetic aerobic outfit. The best thing is to wear a clean shirt that is designed to wick the sweat away from the body. There are many products now available that do this quite well. After a work out the area should be well washed with a mildly abrasive cleanser and scrub. Over the counter acne preparations can be useful or your physician may prescribe acne preparations for you. Enjoy the summer, it is one of the best times of the year to get outside and be active, but prepare yourself to avoid any of these summer exposure pitfalls.


Prevention Of Sports Injuries

The last two articles explained acute and chronic sports injuries. Although we do see a lot of sports injuries we would ideally like to prevent most of them. The following is a list to help you prevent injuries.

1. Start easy in any exercise and progress slowly. We tell our Olympic athletes to increase their training 10% a week. Avoid doing ""Too much-Too soon"".

2. Use the proper equipment for the sport and the level you are playing at. Make sure the equipment is not worn out or is checked by the appropriate person before you use it (ie. ski bindings checked every season)

3. Do a complete and appropriate warm up for the sport you are doing.

4. Cool down after doing your sport. Stretching is probably more important after than before you exercise.

5. Apply ice(not heat) if you injure yourself or have pain after exercise.

6. Exercise consistently and not in spurts.

7. If you have been injured make sure that you are fully rehablitated before you return to full activity. Protect the injured area if possible with a brace or better equipment.

8. Pre train for your activity. If you know you are going on a week sports or fitness holiday, train SPECIFICALLY for the activity you will be doing.

9. A pre-exercise physical examination may be appropriate for certain people. This will include a/ participating in a contact sport b/ having not exercised in a long time c/ previous or ongoing medical illness d/ previous injury e/ family history of sudden early death f/ over age 40

10. Use pain as your guide if you do sustain an injury. If the pain is severe or if it persists see a physician.


Exercising In The Cold

As we approach the winter season the issue of cold weather exercises arises. A lot of people will venture indoors to avoid the cold, but outside exercise in the winter can be quite invigorating and safe if you follow a few rules. Besides being uncomfortable in the cold their are some serious problems which can arise from exposure.

The most common is frostbite. Frostbite is freezing of the skin and superficial tissues. It most commonly affect the exposed skin such as the face or the extremities (toes and fingers). Superficial frostbite when caught early is easily reversible with rapid thawing. Prolonged exposure and deeper frostbite can cause lasting disability.

Certain factors will make a person more prone to problems from the cold. Some of these include alcohol, old age, injury, bleeding, and certain medical problems such as thyroid or diabetes. People with heart disease should be more careful in the cold as the cold may trigger chest pain. . I am often asked about freezing lungs.

This is a common misconception. Even temperatures well under 50 degrees below zero will have no effect on the lungs. Asthmatics may have more problems in the cold weather. Breathing through a face mask or scarf will allow warm breath to be recirculated. The following are tips to help you exercise safely in the cold.

1/ Exercise within your means. Avoid sudden bursts of exercise which will rapidly increase your sweat.

2/ Watch the wind. Windchill will greatly lower the temperature. Exercise initially against the wind and come back with the wind at your back.

3/ Watch the weather forecast and make sure a storm is not approaching if you will be out for a long time.

4/ Maintain hydration. You will sweat even in the cold.

5/ Avoid alcohol

6/ Avoid 100% cotton clothing because once it is wet it loses its insulating capabilities. Newer fabrics such as polypropylene wick away moisture and keep your body dry.

7/ Use mittens as opposed to gloves.

8/ Up to 40% of heat is lost through the head; therefore wear a hat.

9/ Layered clothing is more effective in retaining heat. It can also be removed and added depending on the weather and your level of activity.

10/ Protect the face with a gator.

11/ Boots should be comfortable and not too tight. Be careful of wrinkled socks.

12/ Males should protect their genitals with double fronted underpants.

13/ Outer apparel made from waterproof breathable cloth is the ideal choice to keep you warm without adding bulk.


Ski Injuries

As the snow begins to fly some of us get excited about the start of the ski season. Skiing is a great family sport which allows one to exercise outside for a prolonged period of time in a season where we spend so much of our time indoors. The last thing we want to think about are ski injuries but they are a reality. It certainly is not as much fun waiting for your friends in the chalet while they are out shushing the slopes. The two most common ski injuries I see in skiers are knee and shoulder injuries. In the old days the boot top fracture was the most common injury but with the increase in height of the boot the forces are now transferred up to the knee and most commonly the skier will tear their knee ligaments. The most common shoulder injuries are shoulder dislocation and damage to the rotator cuff muscles. The most important thing is to prepare your self for the ski season with a solid conditioning program.

 The program has three components. They are aerobic training(endurance), anaerobic training(quick muscle movements), and specific muscle strengthening . The program should start at least six weeks before you begin to ski. The aerobic portion can be doing any exercise using large muscle groups in a continuos manner. This may include running, cycling, stair machine, or fitness classes. You should work up to 30-40 minutes 3-5 times per week. You can use the same equipment to develop your anaerobic system. This is especially important for the racer or for the more aggressive skier who may be skiing a lot of moguls. The simplest pattern is to do 30-60 second sprints to exhaustion. Rest in between each sprint 2-4 times the length of the sprint. Work up to doing 10-30 sprints depending on your level.

Specific muscle strength and flexibility is crucial for the downhill skier. The skier will concentrate on the quadriceps, hamstrings, calves, and the abdominals. (see diagram) Strength drills are most easily done in three sets of 10-15 repetitions. If you belong to a fitness facility the gym instructor can design a program for you. I will give you a short list of exercises you can do at home. ABDOMINALS: Bent knee sit-ups isolate the abdominal muscles. QUADRICEPS: 1/ Half squats where the individual drops rapidly to a half squat position 2/ Wall sits where the individual sits in an imaginary chair for an increasing amount of time as tolerance develops 3/ Box jumps where the individual jumps back and forth over a box mimicking the skiing motion HAMSTRINGS : A hamstring curl can be done standing or lying face down CALVES : The individual raises up and down on the edge of a stair


Tips On Avoiding Ski Injuries

The last column discussed a pre-ski conditiong program. This is the most important thing you can do to not only avoid injury but to ski better and enjoy the sport. The following is a list to follow to further avoid injury.

1/ Check all equipment at the start of the season. Your weight and ability may have changed from last season and this will require adjustment. Bindings have improved in the last few years to release at more angles and prevent injury. Do not scrimp on the most important piece of equipment. Have the bindings checked and do not be afraid to upgrade if you have to. Well tuned skis will perform much better than untuned skis.

2/ Test release bindings yourself every day(ask at the ski shop). Make sure you take time to clear snow and ice off skis, boots, and bindings after every fall. Jammed release bindings are the major cause of knee injuries.

3/ Use break away pole straps or non at all. This will help prevent thumb and arm injuries.

4/ Ski within your ability. Ski areas all have detailed maps which you should study to know where to ski. Be careful following better skiers or locals.

5/ If you are at a new area learn where the ski patrol hut is in case you need help.

6/ Do not ski alone in under skied ares.

7/ Avoid alcohol or drugs

8/ Do not ski after minor injuries. The next injury may compound the first.

9/ Warm-up not only when after arriving at the hill but anytime you have taken a break or even a long chair-lift ride.

10/ Quit early: Most injuries occur late in the day when the skier is fatigued and the light is flat. These are basic tips to help you enjoy your time on the slopes.


Sports Injuries: What Are They?

Sports Medicine is perhaps the fastest growing and most exciting field of medicine. This column will discuss topics in health , fitness, and sports injuries. This first column will discuss what a sports injury is. Being that one persons pain is another persons agony, the definition of an injury will differ.

Basically a sports injury is a problem that will stop a person from participating in their sport or activity. Sports injuries are divided into two categories. ACUTE INJURIES are traumatic in nature and happen quickly. A sudden force damages muscles, tendons, ligaments, joints or bones.

A good example was Drake Berehowsky""s knee injury last year. Although these injuries can be broken bones most of these injuries fall into the sprain or strain category. CHRONIC INJURIES are the most common of sports injuries.

They are due to an overuse syndrome where too much repetitive stress to a particular body part will cause tissues to break down(too much- too soon) A n example of one of these injuries is Jack Morris's shoulder tendinitis . The next column will deal in more detail with acute injuries and how to treat them.


Osteoarthritis

Why does Bobby Orr walk as poorly as he does? We all seen the football or hockey player who later in life has to hobble around. What is it that makes these thoroughbred athletes become such a cripple later in life. The major cause is Osteoarthritis of the hip or knee. There are many types of arthritis but the main type is osteoarthritis. This is a degenerative process. The main reason that this occurs is a previous injury to a joint. Although arthritis can occur in any joint it is scene mostly in the knee. There are other factors such as genetics that may cause osteoarthritis, it is usually do to a previous injury and previous surgery to the knee. The classic case is an athlete that has had a meniscus cartilage removed 10-15 years ago. The knee then loses the protection of the meniscus and the knee degenerates on the side without the protection. Recent estimates indicate that there are 1.75 million people(one in 14) in Canada that suffer from osteoarthritis.

The person may complain of pain, swelling, instability, decreased range of motion, locking, and a progressive change in the angle of the knee. A x-ray clearly reveals the problem and the severity. Unfortunately at the present time there is no cure for this problem. Therefore treatment is base on decreasing the symptoms and taking some of the stress off the injured part of the knee. The following are the things you can do if you suffer from osteoarthritis of the knee.

1/MEDICATION Medication is used to control the pain. This can be as simple as Tylenol or ASA. There are many excellent anti-inflammatory medications on the market which have proven to very effective. There are different families of these drugs, so you may have to try different ones to determine which one will work best for you. The main side effect of these drugs is stomach irritation and ulcer in the most severe cases. Often a knee is injected with cortisone to help reduce the pain and inflammation.

There are several new substances which we now inject in the knee to coat the injured joint surface. These thick viscous substances have been effective to reduce the pain from 6-18 months.

2/ THERAPY This is the best thing that a person with osteoarthritis can do for themselves. It has been proven that strengthening the legs muscles will diminish the symptoms of the arthritis. The other important components are flexibility and aerobic conditioning which are also important in maintaining the function of the joint and therefor the whole person.

3/ MODALITIES Sometimes a joint can be calmed down with modalities such as heat, ice, ultrasound, laser, TENS. Many other things have been claimed to help such as acupuncture, magnets, topical creams, vibration therapy but none have actually been proven to help.

4/ WEIGHT LOSS Obviously the less weight transmitted through the joint the better off the joint will be.

5/ BRACING Over the last several years there have been braces designed to unload the pressure on the part of the knee that is degenerative. These custom fit braces work best when there is only one part of the knee that is a problem and the brace angles the leg so the weight is transferred to the good part of the knee.

6/ SURGERY When there is again only one part of the knee that is degenerative we will consider an operation called a high tibial osteotomy. A wedge of bone is removed from the tibia(lower leg bone) and the leg is angled to allow the weight to go through the good part of the knee. If the knee is full of debris we will consider an arthroscopic procedure. The knee is washed out through the scope and often will give relief for 6-18 months.

Ultimately the only solution is a total knee replacement. This can be a big operation with a slow recovery. This is usually put off as long as possible. Fortunately with better knowledge and better surgical techniques through the arthroscope we will eliminate a lot of the problems later in life that we are seeing in our mature athletes today. For those that are suffering now although we can not cure the problem there is a lot we can do to help.


Fat Burning

One of the great quests of the North American people is to be thin. People spend a lot of time and money trying to lose weight. People regularly go one and off diets which have not been shown to be effective in the long term. I believe that the only way to lose weight and to maintain the new weight loss is to make real long term changes. Not only it is important to change your eating habits, it is equally important to have a regular exercise program. Weight change is simply a matter of the difference between the energy(calories) you take in and the energy you expend(daily living and exercise). While losing weight is important from a health point of view for those of you that are over weight it is important to realize that the other extreme does exist where people can be obsessed with being too thin and this has its own health ramifications.

The important thing is to have a good balance. The question then is what exercise is best. We know that fat is used as a primary energy source for exercise when you are exercising at low intensity(40-60% of VO2max). There are thus people that believe that if you are trying to lose fat then you should exercise in your ""fat training"" zone. This is a lower intensity then people who exercise have been accustomed to. The fitness clubs have now started ""fat burning"" classes to promote this longer duration low intensity exercise. At higher intensity exercise the major fuel is carbohydrate. It has not been proven that selectively using different fuels in your body will make a difference in weight loss. In fact the opposite is probably true. If you burn more calories from exercise no matter how you will still lose the weight.

Although a greater percentage of fat may be burned at low intensity exercise, the total grams of fat burned at high intensity exercise is actually greater. A jogger who runs a slow five miles would not burn more fat than someone racing five miles. To lose a pound of fat you must burn 3,500 calories. The threshold for fat loss is to burn at a minimum of 1,000 calories per week. People who are initiating an exercise program and/or are overweight will be only able to handle low intensity exercise. As you progress in your fitness the intensity may increase, but be aware that you may be more prone to injuries. If you are exercising at a low intensity then you must exercise for a longer period of time to burn an equivalent amount of calories that would be burned at a higher intensity.

The important thing is to maintain a regular exercise program for weight control and health. A person should perform moderately intense(once they can tolerate this level) for 30-40 minutes on most days of the week(minimum 4 days). The best exercise is one that the individual enjoys and is easy to access. The exercise should use large muscle groups in a repetitive motion such as walking, jogging, cycling, swimming. Start your quest now. See your physician before you start if you are over 40 or have not exercised in a long period of time. You will soon feel and look a lot better when you exercise and burn fat.



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