Running adds value to your spine. Get moving!

Why running may be good for your back

This is a fabulous article I came across at the end of what has been a rather long week. Check it out at The New York Times: Why Running May be Good for Your Back

My case of disc bulge

I recently experienced an L5/S1disc bulge with symptoms of sciatica (including pins & needles, with associated calf and buttocks pain after running harder and longer efforts). This was about 6 weeks out from my Iron Man event in Cairns mid-June, so it really was bad timing for me.

At the time, doctors advised me to get a radiographic guided cortisone injection in the spine, which I declined. I’m not a fan of radical therapies, preferring the old-fashioned approach – try easing back and see what happens.

Recovery

I’m glad to say that I’m much better now although not yet completely recovered from the disc bulge. I still get the occasional tingling feeling running down my legs to my small toes. When it was at its worst, I really began to wonder if my running days were doomed, and pondered on a life without running. Unimaginable!!

Runners may have more resilient backs

So, this latest news story on research being conducted here in Melbourne at Deakin University has made me feel much more relaxed, and very happy about the future.

Runners may actually have better, stronger backs, and more resilient spinal discs.

Exercise adds value. Running is looking pretty good!

The health messages are getting ever stronger —

Exercise adds value to your life, just get on with it!

#hearthealth

Author: Kara Gilbert @ KMG Communications

The circulatory system

No wonder there is so much fuss about the heart.

The heart is at the centre of your body’s circulatory system, which is essential for distributing blood, nutrients, hormones, oxygen, and other gasses throughout your body.

The silent build up of fibrous and fatty material inside the arteries (a condition called atherosclerosis) can make the arteries become clogged, leading to coronary artery disease and other circulatory problems (e.g, stroke). Diet and lifestyle are among the major contributing factors. Therefore, looking after your heart health involves eating wisely and exercising regularly (and sensibly!).

How much do you know about your body’s circulation and your heart’s Lub-Dub? Your heart and the circulatory system have important interfaces with so many other parts of your body.

Check out this interesting overview of the Circulatory System at Pacific Medical Training:

http://ow.ly/6pjN30dfl7Q

 

Screening athletes for heart problems: More harm than good?

Check your blood pressure and pulse to prevent heart problems

Advocates of screening athletes for cardiac conditions claim that “screening saves lives”. Research is showing that this approach may actually be flawed, and that screening might be doing more harm than good. I tend to agree.

An article in the Guardian by Nicola Davis (April 2016) summarises very nicely the inadequacies with pre-participation screening programs for athletes and the research gaps that sit behind them. Davis draws on the work of a group of Belgian researchers, published in the British Medical Journal, Harms and benefits of screening young people to prevent sudden cardiac death.

Current practices

Pre-participation screening for competitive athletes is acceptable practice in some countries and is recommended by a number of sports organisations and governing bodies, including the International Olympic Committee. Screening can entail an assessment of personal and family history, physical examinations and/or electrocardiograms (ECGs).

Italy has been paving the way for mandatory pre-participation screening for young non-elite athletes since the late 1970s, with a seminal paper in 2006 purporting its benefits. Today, Italians are not eligible for competitive sports until their cardiovascular health has been confirmed. However, questions regarding the validity of the Italian study have been raised, and remain unanswered, as discussed by Dr Thompson in the highly regarded journal, Circulation. Interestingly, the Netherlands abandoned its mandatory screening program in 1984, due to “the poor diagnostic performance of screening tests”. Great Britain undertook screening of its elite Olympic athletes prior to the London Olympics, and while a couple of athletes were diagnosed ‘at risk’ apparently no one was excluded from competition. Free screening promotions targeting young people 14 to 18 years old are not uncommon in the United States and the United Kingdom, typically “looking for signs of hypertrophic cardiomyopathy, or HCM, an inherited condition that is the number-one cause of sudden death among young people under age 30”.

Problems with screening programs

Screening will increase the number of athletes falsely diagnosed with disease.

This can result in unnecessary medical treatment, disqualification from competition, and loss of contracts or sponsorship which will have lasting impacts on an athlete.

Screening will increase the number of athletes correctly diagnosed with real disease who may never be destined to experience a cardiac event.

Once doctors find abnormalities, they are obligated to perform additional tests and procedures, which may result in overly aggressive or inappropriate treatment. According to Nicola Davis, “An athlete would otherwise live a normal life if their cardiac disease is left undetected”, and can be put under considerable distress.

Disqualifying athletes simply on the basis of a diagnosis is inappropriate.

Assessing the risk of an adverse event occurring in an individual with cardiac illness and being able to tell whether they are likely to experience a cardiac arrest is not straightforward. Put simply, disqualification may not be the best remedy.

Most individuals with HCM do not die suddenly during physical activity.

No one really knows whether restricting exercise in an HCM patient improves their prognosis. In fact, exercise may have benefits for individuals with HCM, as for normal healthy athletes. British researchers have reported that athletes with HCM exhibit qualitatively similar physiological cardiac adaptation to normal healthy athletes.

A personal perspective

As an athlete with hypertrophic cardiomyopathy, I find the threat of disqualification from competition a real deterrent to screening and an unfair imposition on a person with a medical condition. I am a firm believer in the principle of Olympism (as outlined in the International Olympic Committee Charter) and I regard sport participation as the right of every individual. I don’t agree with recommendations that impose restrictions on sport participation for people like me with hypertrophic cardiomyopathy. I really think it should be up to the affected individuals to decide this, once fully informed and able to assess the risks for themselves.

My own diagnosis was not made through any screening process but prompted by presenting symptoms (a history of fainting). That said, although there are purportedly around 1% of young athletes with unrecognised or asymptomatic heart disease, I do not support the cardiac screening of athletes. While advocates for screening emphasise that “screening saves lives”, they don’t properly address the impact of a cardiac diagnosis on a young person.

Denver, Colorado, USA - April 27, 2008: Elite runners at the starting line of the Cherry Creek Sneak near Cherry Creek North Street in Denver, Colorado

Apart from the problems highlighted above, the following issues are also significant to a ‘diagnosis by screening’. Yet, they are rarely if ever discussed in the literature.

Personal health and life insurance

A positive test result for a “life-threatening medical condition” doesn’t give you much hope in the health insurance stakes (and don’t even think about qualifying for a life insurance policy).

I am grateful that at the time of my own diagnosis, I had existing health insurance and life insurance policies. Otherwise, after my diagnosis, I would have been ineligible. This matter of health insurance can be overlooked in fit young people.

I think it is terribly negligent of health care professionals and sports governing bodies to offer cardiac screening to individuals without flagging the implications of a positive result.

Psychological wellbeing

Athletes can experience significant emotional and mental wellbeing issues as a consequence of disqualification from sport, which invariably impacts their lifestyle and career choices. Sport participation can actually be better than no sport at all, even in the presence of a cardiac problem.

The athlete’s voice should count

” … making decisions affecting their future athletic careers through mandatory exclusion is paternalistic and such decisions are not rightfully within the domain of medicine.”

This is the real issue for me when it comes to screening — the athlete’s voice too often gets lost in discussions of diagnosis and intervention.

“There is a push for a system which involves screening and mandatory exclusion from sports participation of those at risk … while screening can provide useful information to at-risk athletes, making decisions affecting their future athletic careers through mandatory exclusion is paternalistic and such decisions are not rightfully within the domain of medicine.”  — Clearing House for Sport reporting on research published in the British Journal of Sports Medicine

I couldn’t agree more!

Pre-screening counselling

Pre-screening counselling on all of the above issues should be mandatory in the context of cardiac screening. Having a conversation with an athlete and getting him/her to consider the repercussions should screening flag a cardiac problem must be a critical part of the screening process. I believe it amounts to neglect if these issues are not touched upon when offering cardiac screening to athletes.

Recommendation

While there may be a time and a place for screening, I strongly urge any young person who is encouraged to undergo cardiac screening in the absence of symptoms to consider the impact of a cardiac diagnosis on your lifestyle and future sports participation.

Do give serious consideration to postponing screening until you have a valid health insurance policy in place.

Author: Kara Gilbert @ KMG Communications

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Running is not so bad on your knees, after all!

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I applaud studies that challenge the status quo, and make an effort to dispel ‘myths’ that have pervaded our culture to such an extent that they become regarded as the ‘norm’. I am also very sensitive to ‘scientific tradition’, which advocates a certain remedy, in spite of ‘personal experience’ that does not support the remedy. We are not all moulded out of the same stone.

How many times do you hear people bemoan running …

… as an activity not really so good for you? Such critics suggest that repetitive pounding destroys your joints and brings about all sorts of aches and pains. As someone who has spent most of my life running, I can’t say that I suffer this problem. After all these years, my joints still feel fabulous!

Benefits of exercise

There is so much evidence in the literature supporting the notion that exercise is one of the most effective ways to treat osteoarthritis because it:

  • Reduces pain;
  • Improves flexibility;
  • Strengthens the muscles supporting the joints; and
  • Promotes weight loss, which reduces the stress on your joints.

Yet, most of these proponents of exercise for osteoarthritis recommend non-weight bearing sports, such as swimming and stationary cycling, as beneficial for people with osteoarthritis.

‘New wave’ thinking

At last, there is evidence emerging to dispel these myths. It seems that people who don’t run suffer more joint pain than people who do run. Go figure!

Check out this interesting article by Alex Hutchinson, which gives us a new perspective on knee pain: Here’s More Evidence That Running Doesn’t Ruin Your Knees

I have always believed that running is a good thing!

Author: Kara Gilbert @ KMG Communications

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Exercising in the heat: How does hot weather affect you?

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It’s not simply the high temperature that affects your physical performance

Your body will show quite a complex physiological response to heart, and circumstances like chronic illness, medications, weather conditions, clothing and general physical form will affect your ability to adapt.

For more information about exercising in the heat and the implications this will have on your sport routine and performance, go to the Australian Fitness Academy to read my full article.

Author: Kara Gilbert @ KMG Communications

2017 My Year of ‘Enduro’

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Ironman 140.6 Date: June 11, 2017. Location: Cairns

In the closing phases of 2016, it felt like the time was right to sign up for my first full Ironman. In doing so, I committed myself to more than half a year of fairly solid training in preparation for the big day. I had competed in the IM 70.3 in Cairns, it was time to step up.

It’s a journey

In all honesty, I’m going to be testing the waters in more ways than one … as I discover the limits of my body and soul and, probably most significantly, I endeavour to take my heart to new levels. But hey, I’m not in a hurry. This is just one step of my longer-term journey.

Ironman is about covering the distance. Therefore, key goals for me this year are to:

  • Stay comfortable in training and racing;
  • Remain injury free; and
  • Ensure my cardiac recovery between races/training sessions.

The last point is especially pertinent for me. This time last year, I enjoyed successes in races, getting a couple of significant personal bests (PBs) and making apparently good progress. Over the space of four consecutive weekends, I accomplished:

  • 4th in my age group for the Gatorade Olympic distance triathlon;
  • Two Bays Trail Run, 28km in under 3 hours;
  • 11-kilometre kayak in a torturous day of weather while supporting my partner, Rob, in his Bloody Big Swim from Frankston to Mornington; and
  • 90km in 2:49 on the bike, as part of a relay team for the Melbourne Challenge long course triathlon.

My cardiac recovery is critical

I felt great! But, I was also spent, and paid for it in February (and, I’ll confess, well into March). I suspect a mix of atrial fibrillation in response to the physical load and in the absence of adequate recovery. It was not a pleasant experience.

A lesson was learned for me — my cardiac recovery is especially critical. I backed off for a while during some of last year. I’m feeling very glad to be getting back on track in 2017.

– January 2017 –

Two Bays Trail Run 28km

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I fronted up for my second Two Bays Trail Run (28km) on Sunday 17 January. Although slightly slower than last year (partly because we actually covered an extra 600m this year, due to some tampering with the course), I was very happy with my result. I didn’t want to stress my heart too early on the run. A couple of early surges on the hills to try and pass one or two people didn’t make me feel so good and I backed off. I probably took it more comfortably than was needed in the middle stages, however, this made for a strong finish over the last 5 or 6km, and I was elated my legs stood up to the distance without any cramps.

The Two Bays Trail Run stands out for me as one of the toughest there is. It is also incredibly beautiful, via goat trails, bracken forest, sandy paths, and through grasslands, up the infamous torturous steps to finally reach the top of Cape Schanck and the view over Bushrangers Bay on the Bass Strait side of the Mornington Peninsula … and, there, the finish line is within reach. The community supporting this run is like no other, truly fabulous people. The whole experience reminds me of why I bother to run.

Mt Martha Australia Day (MMAD) Swim 5km

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Then, on Australia Day, Thursday 26 January, I ticked a special box – my first 5km open water swim at Mount Martha. I am comfortable swimming but standing on the sand at the start line, I wasn’t sure about what to expect – would I get thirsty or hungry, would I hit a brick wall like a marathon runner might experience, would my arms lose their punch?

I don’t think I’ve ever finished so much in the rear guard but I had plenty left in me at the end and felt fabulous in the water. I thoroughly enjoyed every minute. I now know that I can manage the distance very comfortably (and, perhaps, a tad faster) and even be capable of getting on a bike for the next stage … mission accomplished!

I should mention that my arms felt like they were going to drop off for a couple of days after the race but I got them back eventually. Needless to say, I have started back at the gym! I think I need to bulk up.

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Where to from here?

January has now gone and February is here … I have the Geelong Ironman 70.3 scheduled in less than a couple of weeks. Let’s see where that takes me …

#hearthealth #myhearthealthjourney

Author: Kara Gilbert @ KMG Communications

Endurance athletes and arrhythmias: Is there an association?

Runner-shaped blip on a medical heart monitor (ECG - electrocardiogram) with blue background and heart symbol.

The largest prospective study of athletes ever

The largest prospective study in the world is happening right here on our doorstep (that is, if you live in Melbourne) – and it is focussed on athletes and their hearts. In a recent article that appeared in Cycling Tips, Dr Andre La Gerche from the Baker Heart and Diabetic Institute provides some interesting perspectives on the investigations, which will see researchers follow athletes over a long period of time. This story has special significance for me. A synopsis follows:

Athlete’s heart

Many of you would be familiar with the notion of ‘athlete’s heart’, which is essentially an enlarged heart attributed to excessive training, often associated with elite endurance athletes. But, did you know that one of the undesirable effects of a large heart is the increased tendency to experience irregular heart rhythms?

Atrial fibrillation (AF)

The most common heart rhythm disorder in people of middle-age and older is ‘atrial fibrillation’ – a random firing of electrical signals from the upper chambers of the heart that causes a rapid and irregular heartbeat.

Some people with AF do not experience symptoms, and are completely unaware that they have AF. Others may suffer symptoms, including the uncomfortable sense of an irregular heart rhythm, fatigue or breathlessness.

Is too much exercise actually bad for you?

Research has shown that there is a higher rate of AF amongst endurance athletes compared with non-athletic individuals (although, interestingly, this excess in AF has not been observed in female athletes). This begs the controversial question:

‘Can too much exercise start to cancel out the health benefits of moderate exercise?’

Despite the growing trend that warns of the dangers of over-exercising, there is a paucity of evidence to know whether the heart changes seen in athletes might cause other potentially dangerous arrhythmias. Furthermore, as La Gerche emphasises, we do not have reliable predictive measures for determining which athletes might develop problems down the track.

Food for thought … !

As someone with an existing heart muscle disorder, viz. hypertrophic cardiomyopathy, I’m obviously very interested in this research. I have a thickening in my ventricular wall which means that I am already predisposed to having irregular heart rhythms, notably non-sustained ventricular tachycardia (VT). After my diagnosis at the age of 35, I decided to take up endurance training where I could keep my heart rate down within relatively ‘safe limits’. I am very careful to keep myself in check on the odd occasion when I might run in shorter and sharper races, and I am also cautious when climbing hills. I must be careful not to get my heart rate too high, as this might trigger a potentially dangerous heart rhythm or cause my ICD/internal defribillator to discharge unnecessarily.

Hence, the article by La Gerche raises questions for me. If ‘endurance’ training has its own set of unique side effects, then someone like me with hypertrophic cardiomyopathy might not actually be taking the ‘safe course’ by concentrating on endurance, even if that accommodates a lower heart rate for training and competitions (Of course, there are many who would recommend the safest bet for me is to stay idle and not exert myself, at all – somehow that falls outside my scope of comprehension.)

If there should be any causative relationship between endurance and heart arrhythmias, does this mean that my already irregular heart rhythm is likely to become especially more unpredictable should I persist with endurance training over time? Am I more susceptible than the average Joe? Definitely, food for thought … !

The Pro@Heart Study

Researchers in Australia, Belgium and France are collaborating together to investigate the association between endurance sport and arrhythmias. They will comprehensively assess young elite athletes and follow their health and performance for many years.

Some of you might have heard of the large scale prospective studies of the general population that have contributed to our understanding of the health effects of cholesterol, blood pressure and other lifestyle factors – notably, the Framingham Heart Study (New England, USA) and the Busselton Health Study (Western Australia).

There have not been studies of this nature and scale in athletes. The Pro@Heart Study aims to be the largest propective study in the world.

Watch this space! This body of work will surely yield the most comprehensive picture of athletes’ hearts that we have to date. I know that I certainly will be following this one over time.

Author: Kara Gilbert @ KMG Communications

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