Only walking for exercise? Here’s how to get the most out of it
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We’re living longer than in previous generations, with one in eight elderly Australians now aged over 85. But the current gap between life expectancy (“lifespan”) and health-adjusted life expectancy (“healthspan”) is about ten years. This means many of us live with significant health problems in our later years.
To increase our healthspan, we need planned, structured and regular physical activity (or exercise). The World Health Organization recommends 150–300 minutes of moderate-intensity exercise – such as brisk walking, cycling and swimming – per week and muscle strengthening twice a week.
Yet few of us meet these recommendations. Only 10% meet the strength-training recommendations. Lack of time is one of the most common reasons.
Walking is cost-effective, doesn’t require any special equipment or training, and can be done with small pockets of time. Our preliminary research, published this week, shows there are ways to incorporate strength-training components into walking to improve your muscle strength and balance.
Why walking isn’t usually enough
Regular walking does not appear to work as muscle-strengthening exercise.
In contrast, exercises consisting of “eccentric” or muscle-lengthening contractions improve muscle strength, prevent muscle wasting and improve other functions such as balance and flexibility.
Typical eccentric contractions are seen, for example, when we sit on a chair slowly. The front thigh muscles lengthen with force generation.
buritora/Shutterstock
Our research
Our previous research found body-weight-based eccentric exercise training, such as sitting down on a chair slowly, improved lower limb muscle strength and balance in healthy older adults.
We also showed walking down stairs, with the front thigh muscles undergoing eccentric contractions, increased leg muscle strength and balance in older women more than walking up stairs. When climbing stairs, the front thigh muscles undergo “concentric” contractions, with the muscles shortening.
It can be difficult to find stairs or slopes suitable for eccentric exercises. But if they could be incorporated into daily walking, lower limb muscle strength and balance function could be improved.
This is where the idea of “eccentric walking” comes into play. This means inserting lunges in conventional walking, in addition to downstairs and downhill walking.
In our new research, published in the European Journal of Applied Physiology, we investigated the effects of eccentric walking on lower limb muscle strength and balance in 11 regular walkers aged 54 to 88 years.
The intervention period was 12 weeks. It consisted of four weeks of normal walking followed by eight weeks of eccentric walking.
The number of eccentric steps in the eccentric walking period gradually increased over eight weeks from 100 to 1,000 steps (including lunges, downhill and downstairs steps). Participants took a total of 3,900 eccentric steps over the eight-week eccentric walking period while the total number of steps was the same as the previous four weeks.
We measured the thickness of the participants’ front thigh muscles, muscle strength in their knee, their balance and endurance, including how many times they could go from a sitting position to standing in 30 seconds without using their arms. We took these measurements before the study started, at four weeks, after the conventional walking period, and at four and eight weeks into the eccentric walking period.
We also tested their cognitive function using a digit symbol-substitution test at the same time points of other tests. And we asked participants to complete a questionnaire relating to their activities of daily living, such as dressing and moving around at home.
Finally, we tested participants’ blood sugar, cholesterol levels and complement component 1q (C1q) concentrations, a potential marker of sarcopenia (muscle wasting with ageing).
alexei_tm/Shutterstock
What did we find?
We found no significant changes in any of the outcomes in the first four weeks when participants walked conventionally.
From week four to 12, we found significant improvements in muscle strength (19%), chair-stand ability (24%), balance (45%) and a cognitive function test (21%).
Serum C1q concentration decreased by 10% after the eccentric walking intervention, indicating participants’ muscles were effectively stimulated.
The sample size of the study was small, so we need larger and more comprehensive studies to verify our findings and investigate whether eccentric walking is effective for sedentary people, older people, how the different types of eccentric exercise compare and the potential cognitive and mental health benefits.
But, in the meantime, “eccentric walking” appears to be a beneficial exercise that will extend your healthspan. It may look a bit eccentric if we insert lunges while walking on the street, but the more people do it and benefit from it, the less eccentric it will become. 
Ken Nosaka, Professor of Exercise and Sports Science, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Calm For Surgery – by Dr Chris Bonney
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As a general rule of thumb, nobody likes having surgery. We may like the results of the surgery, we may like having the surgery done and behind us, but surgery itself is not most people’s idea of fun, and honestly, the recovery period afterwards can be a pain in every sense of the word.
Dr. Chris Bonney, an anesthesiologist, gives us the industry-secrets low-down, and is the voice of experience when it comes to the things to know about and/or prepare in advance—the little things that make a world of difference to your in-hospital experience and afterwards.
Think of it like “frequent flyer traveller tips” but for surgeries, whereupon knowing a given tip can mean the difference between deeply traumatic suffering and merely not being at your usual best. We think that’s worth it.
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Rewire Your OCD Brain – by Dr. Catherine Pittman & Dr. William Youngs
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OCD is just as misrepresented in popular media as many other disorders, and in this case, it’s typically not “being a neat freak” or needing to alphabetize things, so much as having uncontrollable obsessive intrusive thoughts, and often in response to those, unwanted compulsions. This can come from unchecked spiralling anxiety, and/or PTSD, for example.
What Drs. Pittman & Young offer is an applicable set of solutions, to literally rewire the brain (insofar as synapses can be considered neural wires). Leveraging neuroplasticity to work with us rather than against us, the authors talk us through picking apart the crossed wires, and putting them back in more helpful ways.
This is not, by the way, a book of CBT, though it does touch on that too.
Mostly, the book explains—clearly and simply and sometimes with illustrations—what is going wrong for us neurologically, and how to neurologically change that.
Bottom line: whether you have OCD or suffer from anxiety or just need help dealing with obsessive thoughts, this book can help a lot in, as the title suggests, rewiring that.
Click here to check out Rewire Your OCD Brain, and banish obsessive thoughts!
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The Worst Cookware Lurking In Your Kitchen (Toxicologist Explains)
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Dr. Yvonne Burkart gives us a rundown of the worst offenders, and what to use instead:
Hot mess
The very worst offender is non-stick cookware, the kind with materials such as Teflon. These are the most toxic, due to PFAS chemicals.
Non-stick pans release toxic gases, leach chemicals into food, and release microplastic particles, which can accumulate in the body.
One that a lot of people don’t think about, in that category, is the humble air-fryer, which often as not has a non-stick cooking “basket”. These she describes as highly toxic, as they combine plastic, non-stick coatings, and high heat, which can release fumes and other potentially dangerous chemicals into the air and food.
You may be wondering: how bad is it? And the answer is, quite bad. PFAS chemicals are linked to infertility, hypertension in pregnancy, developmental issues in children, cancer, weakened immune systems, hormonal disruption, obesity, and intestinal inflammation.
Dr. Burkart’s top picks for doing better:
- Pure ceramic cookware: top choice for safety, particularly brands like Xtrema, which are tested for heavy metal leaching.
- Carbon steel & cast iron: durable and safe; can leach iron in acidic foods (for most people, this is a plus, but some may need to be aware of it)
- Stainless steel: lightweight and affordable but can leach nickel and chromium in acidic foods at high temperatures. Use only if nothing better is available.
And specifically as alternatives to air-fryers: glass convection ovens or stainless steel ovens are safer than conventional air fryers. The old “combination oven” can often be a good choice here.
For more on all of these, enjoy:
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Want to learn more?
You might also like to read:
- PFAS Exposure & Cancer: The Numbers Are High
- It’s Not Fantastic To Be Plastic ← for the closely related topic of microplastics and nanoplastics
Take care!
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The Compass of Pleasure – by Dr. David Linden
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There are a lot of books about addiction, so what sets this one apart?
Mostly, it’s that this one maintains that addiction is neither good nor bad per se—just, some behaviors and circumstances are. Behaviors and circumstances caused, directly or indirectly, by addiction.
But, Dr. Linden argues, not every addiction has to be so. Especially behavioral addictions; the rush of dopamine one gets from a good session at the gym or learning a new language, that’s not a bad thing, even if they can fundamentally be addictions too.
Similarly, we wouldn’t be here as a species without some things that rely on some of the same biochemistry as addictions; orgasms and eating food, for example. Yet, those very same urges can also inconvenience us, and in the case of foods and other substances, can harm our health.
In this book, the case is made for shifting our addictive tendencies to healthier addictions, and enough information is given to help us do so.
Bottom line: if you’d like to understand what is going on when you get waylaid by some temptation, and how to be tempted to better things, this book can give the understanding to do just that.
Click here to check out The Compass of Pleasure, and make yours work in your favor!
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Age Later – by Dr. Nir Barzilai
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Dr. Barzilai discusses why we age, why supercentenarians age more slowly, and even, why it is so often the case that supercentenarians outside of Blue Zones have poor lifestyles (their longevity is because of protective genes that mitigate the harmful effects of those poor lifestyles—the ultimate in “survivorship bias”).
He also talks not just genetics, but also epigenetics, and thus gene expression. Bearing in mind, there’s a scale of modifiability there: with current tech, we can’t easily change a bad gene… But we often can just switch it off (or at least downregulate its expression). This is where studies in supercentenarians are helpful even for those who don’t have such fortunate genes—the supercentenarian studies show us which genes we want on or off, what gene expressions to aim for, etc. Further clinical studies can then show us what lifestyle interventions (exercise, diet, nutraceuticals, etc) can do that for us.
With regard to those lifestyle interventions, he does cover many, and that’s where a lot of the practical value of the book comes from. But it’s not just “do this, do that”; understanding the reasons behind why things work the way they do is important, so as to be more likely to do it right, and also to enjoy greater adherence (we tend to do things we understand more readily than things we have just been told to do).
There are areas definitely within the author’s blind spots—for example, when talking about menopausal HRT, he discusses at great length the results of the discredited WHI study, and considers it the only study of relevance. So, this is a reminder to not believe everything said by someone who sounds confident (Dr. Barzilai’s professional background is mostly in treating diabetes).
In terms of style, it is very much narrative; somewhat pop-science, but more “this doctor wants to tell stories”. So many stories. Now, the stories all have informational value, so this isn’t padding, but it is the style, so we mention it as such. As for citations, there aren’t any, so if you want to look up the science he mentions, you’re going to need a bit of digital sleuthery to find the papers from the clues in the stories.
Bottom line: if you’re interested in the science of aging and how that has been progressing for the past decades and where we’re at, this book will give you so many jumping-off points, and is an engaging read.
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Evidence doesn’t support spinal cord stimulators for chronic back pain – and they could cause harm
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In an episode of ABC’s Four Corners this week, the use of spinal cord stimulators for chronic back pain was brought into question.
Spinal cord stimulators are devices implanted surgically which deliver electric impulses directly to the spinal cord. They’ve been used to treat people with chronic pain since the 1960s.
Their design has changed significantly over time. Early models required an external generator and invasive surgery to implant them. Current devices are fully implantable, rechargeable and can deliver a variety of electrical signals.
However, despite their long history, rigorous experimental research to test the effectiveness of spinal cord stimulators has only been conducted this century. The findings don’t support their use for treating chronic pain. In fact, data points to a significant risk of harm.
What does the evidence say?
One of the first studies used to support the effectiveness of spinal cord stimulators was published in 2005. This study looked at patients who didn’t get relief from initial spinal surgery and compared implantation of a spinal cord stimulator to a repeat of the spinal surgery.
Although it found spinal cord stimulation was the more effective intervention for chronic back pain, the fact this study compared the device to something that had already failed once is an obvious limitation.
Later studies provided more useful evidence. They compared spinal cord stimulation to non-surgical treatments or placebo devices (for example, deactivated spinal cord stimulators).
A 2023 Cochrane review of the published comparative studies found nearly all studies were restricted to short-term outcomes (weeks). And while some studies appeared to show better pain relief with active spinal cord stimulation, the benefits were small, and the evidence was uncertain.
Only one high-quality study compared spinal cord stimulation to placebo up to six months, and it showed no benefit. The review concluded the data doesn’t support the use of spinal cord stimulation for people with back pain.
What about the harms?
The experimental studies often had small numbers of participants, making any estimate of the harms of spinal cord stimulation difficult. So we need to look to other sources.
A review of adverse events reported to Australia’s Therapeutic Goods Administration found the harms can be serious. Of the 520 events reported between 2012 and 2019, 79% were considered “severe” and 13% were “life threatening”.
We don’t know exactly how many spinal cord stimulators were implanted during this period, however this surgery is done reasonably widely in Australia, particularly in the private and workers compensation sectors. In 2023, health insurance data showed more than 1,300 spinal cord stimulator procedures were carried out around the country.
In the review, around half the reported harms were due to a malfunction of the device itself (for example, fracture of the electrical lead, or the lead moved to the wrong spot in the body). The other half involved declines in people’s health such as unexplained increased pain, infection, and tears in the lining around the spinal cord.
More than 80% of the harms required at least one surgery to correct the problem. The same study reported four out of every ten spinal cord stimulators implanted were being removed.
Chronic back pain can be debilitating. CGN089/Shutterstock High costs
The cost here is considerable, with the devices alone costing tens of thousands of dollars. Adding associated hospital and medical costs, the total cost for a single procedure averages more than $A50,000. With many patients undergoing multiple repeat procedures, it’s not unusual for costs to be measured in hundreds of thousands of dollars.
Rebates from Medicare, private health funds and other insurance schemes may go towards this total, along with out-of-pocket contributions.
Insurers are uncertain of the effectiveness of spinal cord stimulators, but because their implantation is listed on the Medicare Benefits Schedule and the devices are approved for reimbursement by the government, insurers are forced to fund their use.
Industry influence
If the evidence suggests no sustained benefit over placebo, the harms are significant and the cost is high, why are spinal cord stimulators being used so commonly in Australia? In New Zealand, for example, the devices are rarely used.
Doctors who implant spinal cord stimulators in Australia are well remunerated and funding arrangements are different in New Zealand. But the main reason behind the lack of use in New Zealand is because pain specialists there are not convinced of their effectiveness.
In Australia and elsewhere, the use of spinal cord stimulators is heavily promoted by the pain specialists who implant them, and the device manufacturers, often in unison. The tactics used by the spinal cord stimulator device industry to protect profits have been compared to tactics used by the tobacco industry.
A 2023 paper describes these tactics which include flooding the scientific literature with industry-funded research, undermining unfavourable independent research, and attacking the credibility of those who raise concerns about the devices.
It’s not all bad news
Many who suffer from chronic pain may feel disillusioned after watching the Four Corners report. But it’s not all bad news. Australia happens to be home to some of the world’s top back pain researchers who are working on safe, effective therapies.
New approaches such as sensorimotor retraining, which includes reassurance and encouragement to increase patients’ activity levels, cognitive functional therapy, which targets unhelpful pain-related thinking and behaviour, and old approaches such as exercise, have recently shown benefits in robust clinical research.
If we were to remove funding for expensive, harmful and ineffective treatments, more funding could be directed towards effective ones.
Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney; Adrian C Traeger, Research Fellow, Institute for Musculoskeletal Health, University of Sydney, and Caitlin Jones, Postdoctoral Research Associate in Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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