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Science of Healing and Exercise

Written by BY SARAH SHARPLES

http://mosman-daily.whereilive.com.au/lifestyle/story/science-of-healing-and-excercise/

HELPING people to make lifestyle changes, create healthy habits and exercise more are rewarding for Joanna Jaques.

But Ms Jaques, 34, is not a personal trainer.

She is an accredited exercise physiologist (AEP), a growing profession that specialises in exercise and behavioural modification programs, for the prevention and management of chronic diseases and injuries.

Four years ago, she set up her business Active Partnerships in Mosman, where she consults with patients and conducts small exercise classes.

She generally works with people who have chronic health conditions such as diabetes, heart disease, arthritis and osteoporosis and those at risk from high blood pressure or obesity.

“I enjoy helping people take ownership of their health to improve their quality of life, and put in place a habit like exercise, that can help manage a health condition,” she said.

“I’m working with younger people who are managing risk factors and older people who want to stay active and at home.”

“It’s really fulfilling when you see someone make a change and it’s something they can do longer term on their own and they’re not coming back to see us again and again.”

With a decade of professional experience, Ms Jaques said she usually worked an 8-10 hour day.

She sees patients who have been newly diagnosed and assesses their current health and exercise habits, prescribes programs to do at home, takes small groups of four to five for an exercise class and education and conducts home visits with the elderly to assist in mobility.

“In the last five years there has been a lot more opportunities, (EPs) have been recognised through Medicare and private health funds, so there is more opportunity for patients to receive rebates, and there is growing recognition in the medical community of the benefits of exercise,” Ms Jaques said.

An article by Active Partnerships’ Joanna Jaques was featured in the Summer 2012 edition of the Northern Sydney GP Network (NSGPN) update newsletter. Joanna writes about how GPs can effectively partner with allied health professionals such as Exercise Physiologists in order to provide the best outcomes for patients wanting to improve their health.

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However, exercise is often over-looked in most approaches to weight loss or abandoned too early when immediate changes on the scales are not seen.  It is well worth recognising that exercise brings about many health changes including reductions in blood pressure, lipid profiles and sugar levels independent of weight loss.  You can really think of exercise as a medicine when prescribed appropriately and not just a means of weight loss.

Here are some of the extra benefits of adding prescribed exercise to a dietary approach for lifestyle change:

Exercise improves your “metabolic fitness”

Exercise has a unique effect on improving blood pressure, cholesterol levels (particularly HDL – “good” cholesterol) and improving insulin sensitivity beyond those seen with weight loss alone.  Medication usage for blood pressure, cholesterol and diabetes has also shown to be significantly lower for people achieving higher levels of fitness through regular exercise.

Exercise reduces risk of cardiovascular disease and increases longevity

Exercise capacity or aerobic fitness is a strong predictor of cardiovascular disease and mortality risk.  Men with high levels of aerobic fitness have a 50% lower risk of mortality from cardiovascular disease.  This relationship is independent of body weight and other traditional risk factors, meaning that being fit is as important as losing weight!

Exercise helps to keep weight off

Regular exercise has shown to be one of the key predictors of people who sustain weight loss longer term.  Exercise has an important role in maintaining lean body mass which is crucial for avoiding a drop in resting metabolic rate seen with rapid weight loss.

Exercise makes you feel good

Regular exercise brings about many psychological benefits including improvements in mood, reductions in anxiety levels and increased self-esteem.  All of these benefits not only make you feel better but make it easier to maintain long term lifestyle changes.

Exercise improves endurance, strength and mobility

Last but not least exercise improves physical capacity, meaning that day to day activities are completed more efficiently and with less exertion.  For many people this transfers into increased energy levels and improved recovery.

Joanna Jaques - Active Partnerships

Joanna Jaques is the principal Exercise Physiologist and owner of Active Partnerships.  With over 10 years in the industry, Joanna is one of the most widely experienced and well-known clinical Exercise Physiologists in Australia.  For more information, visit www.activepartnerships.com.au.

Reference: N Engl J Med 2002; 346: 393-403., Med Sci Sports Exerc. 2010; 42(1): 152-159., Circulation. 2008;117:614-62

Every now and again I come across what seems like the perfect exerciser – disciplined, consistent and exercising at the right dose, but the interesting thing is that they are still not achieving their weight loss goals.  After closely checking their program, I have to look outside the box to see what other factors may be impacting on their results.

Most people think that weight loss is directly linked to the traditional model of energy balance – which tells us that if energy output (activity) exceeds energy input (food) then weight loss would occur.

But, did you know that there are also many behavioural, physiological and genetic factors that influence each person’s ability to lose weight with exercise?

The great thing is, many of these factors are easily within your control.  Here are some key tips:

Maintain incidental physical activity levels

People are often successful in increasing energy output through their structured exercise, but unintentionally reduce their day-to-day activities.  Have a think about it, have your ever felt that you don’t need to walk somewhere because you have just finished your exercise session, or, what about resting more than usual on days you have exercised?  That’s right, we all do it without even thinking about it!

It is just as important to maintain your incidental activity as well as structured exercise to make an impact on weight loss.

Watch exercise related snacks

Did you know that consuming extra calories in the form of high sugar drinks or snacks before, during or after exercise supresses the body’s ability to burn fat during exercise?

Avoiding exercise for at least one hour after eating and consuming only lower GI snacks post exercise can help reduce these effects.

Get a good night’s sleep

People who sleep less than five hours per day often have imbalances in hormones that regulate hunger and higher levels of stress hormones that can impact on fat breakdown.

Sleep quantity and quality are both important for the regulation of metabolism.

Reduce stress levels

High levels of stress impact on the release of many hormones in the body promoting fat storage and making weight loss a challenge.

Including stress management strategies into any weight loss program is crucial for longer-term success.

Avoid weight cycling

People with a history of losing and re-gaining significant weight have shown to be less responsive to exercise.  This is usually due to a reduction in muscle mass and overall metabolic rate through repeated low calorie dieting.  Slow, steady weight loss in combination with regular exercise is the key to avoiding weight cycling.

There are also factors that are out of your control when it comes to weight loss.  Things like gender, ethnicity, muscle fibre characteristics and thyroid function that will impact on response to exercise.  It’s definitely not as simple as energy in – energy out!

Exercise should be a key component of a weight management program alongside nutrition, sleep and stress management and medical intervention to address specific metabolic alterations.  When all of these lifestyle areas are addressed, weight loss and health outcomes are maximised in a sustainable and safe manner.

Joanna Jaques – Active Partnerships

Joanna Jaques is the principal Exercise Physiologist and owner of Active Partnerships.  With over 10 years in the industry, Joanna is one of the most widely experienced and well-known clinical Exercise Physiologists in Australia.  For more information, visit www.activepartnerships.com.au.

Reference: Obesity Reviews (2009) 10, 671-680.

How many steps do people normally take?

Recent data from the US revealed that adults take on average between 5,900 – 6,900 steps per day.   We have seen dramatic reductions in incidental physical activity levels over the past century which has been closely linked to the rise in many chronic health conditions. An interesting pedometer study conducted to compare the activity levels of modern office workers with those of Australia settlers 150 years ago demonstrated that office workers today walked an equivalent of 17 Km per day less!

How many steps are equivalent to current health guidelines?

Current physical activity guidelines recommend that adults accumulate 30 min of moderate intensity activity on at least 5 days per week or a total of 150 min per week to maintain cardiovascular health and body weight.  Achieving this recommendation has been equated to achieving between 7,500-10,000 steps per day of which at least 3,000 steps should be of a moderate intensity (ie. a noticeable increase in breathing rate but still able to carry out a conversation).

How do I rate?

To find out how you are doing, see where your daily step count falls in the following classification table that has been compiled using the results from large pedometer studies:

Physical Activity Hierarchy CurrCardioRiskRep (2010) 4: 271-276

These studies have shown that individuals achieving less than 5,000 steps per day had a higher incidence of cardiovascular health issues and those achieving greater than 12,500 had the best health profiles.  A useful approach to goal setting is to record your activity baseline and aim to increase your activity level to the categories above representing an increase of 2,500 steps.

Keep stepping,

Joanna Jaques (BSc (Ex Sc) MApplSc  ESSAM)

Exercise Physiologist

Pedometers are easy to use, cheap and now readily available.  We also have enough evidence to show that they do work – that is, their use can increase daily activity levels and bring about reductions in weight and blood pressure.

But, did you know that the secret of the pedometers success may lie in the accompanying motivational strategies used rather than the tool itself?  Programs in which people have just worn the device without any goals or monitoring have not been as effective from a health point of view.

Goal setting is one of the key strategies to successful habit change.  When people set a specific step target and record their daily totals, their activity levels increased by 2000-3000 steps per day as compared to only 820 steps per day for those who didn’t.  It was also the people who set goals and recorded their progress who achieved weight loss and reduced their blood pressure by 3-4 mm Hg.

Here are some simple steps to turn your pedometer into a motivational tool:

• Wear it all day - The pedometer is most useful for monitoring whole-day activity patterns, so get in the habit of putting it on first thing in the morning and taking it off before you go to bed.
• Record a baseline over at least 3 days before you start changing your activity levels. This gives you a starting point and something to reflect on as you progress.
• Set a personal goal using your baseline recording and review it regularly.  This could be a percentage-based increment (10-20%), adding 500 steps per day or eliminating sedentary days (< 5,000 steps/day).
• Don’t just read it, Write it down! Use a calendar, diary or on-line program to record your daily totals. Writing it down provides visual feedback, helps to identify activity patterns and produces a personal record of success.
• Submit your results – submitting your results to friends, family or health professionals increases accountability and builds a support network.  This could be as simple as putting your recordings on the fridge or joining an on-line challenge.
• Reward yourself – from the outset have an end target in mind and a healthy reward in store when you achieve it.

Join the Active Partnerships team in January for our on-line New Year Walking Challenge in which we will accumulate steps to achieve the equivalent of a walk from Perth to Broome (2417 Km, 2.9 million steps). For more information contact Active Partnerships.

Joanna Jaques (BSc (Ex Sc) MApplSc  ESSAM)

Exercise Physiologist

References: Sports Medicine 2009; 39 (12), 981, Current Cardiovascular Risk Reports 2010; 4, 271.