01 August 2008

Exercise is Medicine

How we deliver a message to others greatly affects the level of cooperation we can expect from them and whether our suggestions are met with a smile or hostility. This is true for the politician who may be seen as an elitist; it’s true for health care professionals relating to their patients, parents to children and mentors to students.

Excerpts from an article by Judith Graham of the Chicago Tribune:

Researchers are offering a rare glimpse into the interior world of Alzheimer’s patients. The study indicates even those deeply disoriented or cognitively impaired dislike being patronized or treated as if they were children. It suggests that a sense of adult identity remains intact in people, even when an individual isn’t able to remember how old she is, where she is, what day it is or which family members are alive or present.

Videotapes of elderly men and women showed aides helping patients bathe, brush their teeth, dress, eat and take medicines, among other things. A frame by frame analysis of the tapes found that when nurses or aides communicated by using language that assumed a state of dependence patients were twice as likely to resist their efforts to help. The older men and women would turn or look away, grimace, clench their teeth, groan, grab onto something, or say no. These behaviors might be viewed as indications of distress at being patronized.

What does this have to do with our sport? Do you remember when you first started training for triathlon or Ironman? I remember my own level of excitement. In fact, I occasionally shared my enthusiasm with others. However, that didn’t last long because nearly everybody outside the sport who heard about my plans had something less than encouraging to say. I soon decided not to discuss my training with folks outside the sport.

Let’s shift focus a bit to a specific segment within our sport’s population. What is it like for the Vets and Super Vets in our sport? I was discussing this with Scott Molina a couple days ago. His comment was "What I’m hearing from older athletes is that when they tell some one about their training or that they are training for an Ironman the listener’s response is usually negative – that they’re ruining their health."

While on my run I was thinking about dementia and heart disease and many other physical and mental maladies. I think it important that we encourage masters athletes to explore limits by remaining active. We know for a fact that mental stimulation maintains plasticity in the brain. Learning new skills, a new language, laying down new neuropathways and having concrete physical goals are proven methods for keeping the brain young and even reversing signs of aging. It is a fact that most of us can actually increase the plasticity of the brain. We know the heart builds corollary arteries when confronted with high cholesterol and arterial blockage and we know that a positive mental outlook is one of the driving forces behind maintaining over all health; especially as we mature. In some cases, it appears that the loss of choice and a sense of 'power' risks setting in motion physical decline. We should be asking "how can encourage mature men and women to stay very active".

In over 25 years in a practice where patients come to me in pain it has been my experience that activity or inactivity alone is not a predictor of degenerative joint disease (DJD or osteoarthritis). Sedentary folks can and do have advanced DJD _and_ the severity of the osteoarthritis doesn't always match the patient’s symptoms. Like wise, only mild degeneration can be accompanied by debilitating pain. DJD, can stem from a familial or a genetic predisposition. I see young men and women with arthritis absent trauma and I see older men and women who are very active who have little or no degenerative changes.

What does give a peek into the future beyond family history is a patients past history of acute injury. Trauma can lead to adhesions, inflexible scar tissue, decreased blood flow, ligament damage and aberrant motion. Loss of normal motion and optimal circulation do seem to be predictors of osteoarthritis. In other words, maintaining motion and restoring normal motion and function is the key to recovery following injury/trauma and as prevention.

Some people see an athlete with DJD and assume it is from a lifetime of running or biking or lifting weights but fail to consider that the arthritis might be there whether the athlete ran or not. In fact, it is my opinion that a lifetime of exercise often lowers complications of the disease. Some medical experts are of the opinion that activities such as running and biking actually stimulate growth of new cartilage in those areas that are wearing out.

There is a need to have increased open discussion among endurance athletes that explores long term health and elite performance; as well as the benefits of endurance sport that stave off aging (mental and physical) versus possible degenerative changes. Given that many if not most veteran athletes have some form of degenerative change, and that increased activity benefits the human condition in many ways, I see a greater need to promote awareness.

More from Scott: When Dr. John Hellemans opened his first Sport Medicine practice named SportsMed he did so with this slogan on the building: “Exercise is Medicine.


Dr. Kevin Purcell DC
Certified Active Release Technique (ART)
USAT Level ll Certified Coach