Walking can prevent low back pain, a new study shows
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Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly 70% of people who recover from an episode of low back pain will experience a new episode in the following year.
The recurrent nature of low back pain is a major contributor to the enormous burden low back pain places on individuals and the health-care system.
In our new study, published today in The Lancet, we found that a program combining walking and education can effectively reduce the recurrence of low back pain.
The WalkBack trial
We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control).
Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences.
The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls.
The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program.
Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred.
People in the control group received no preventative treatment or education. This reflects what typically occurs after people recover from an episode of low back pain and are discharged from care.
What the results showed
We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services.
The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%.
Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group.
Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group.
This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings.
Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians.
Walking has multiple benefits
We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all previous studies have focused on treating episodes of pain, not preventing future back pain.
A limited number of small studies have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals.
On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care.
Walking also delivers many other health benefits, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases.
While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants reported that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently.
Why is walking helpful for low back pain?
We don’t know exactly why walking is effective for preventing back pain, but possible reasons could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which block pain signals between your body and brain – essentially turning down the dial on pain.
It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, no studies have investigated this.
Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.
Tash Pocovi, Postdoctoral research fellow, Department of Health Sciences, Macquarie University; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Mark Hancock, Professor of Physiotherapy, Macquarie University; Petra Graham, Associate Professor, School of Mathematical and Physical Sciences, Macquarie University, and Simon French, Professor of Musculoskeletal Disorders, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What are heart rate zones, and how can you incorporate them into your exercise routine?
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If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.
Heart rate zones reflect different levels of intensity during aerobic exercise. They’re most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.
But what are the different heart rate zones, and how can you use these zones to optimise your workout?
The three-zone model
While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:
- zone 1: 55%–82% of maximum heart rate
- zone 2: 82%–87% of maximum heart rate
- zone 3: 87%–97% of maximum heart rate.
If you’re not sure what your maximum heart rate is, it can be calculated using this equation: 208 – (0.7 × age in years). For example, I’m 32 years old. 208 – (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.
There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.
What do the different zones involve?
The three zones are based around a person’s lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.
Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.
On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.
Wearable technology has taken off in recent years. Ketut Subiyanto/Pexels In the three-zone model, each zone loosely describes one of three types of training.
Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.
Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where it’s difficult to speak full sentences.
Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.
Striking a balance
To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.
While zone 3 is thought to produce the largest improvements in maximal oxygen uptake – one of the best predictors of endurance performance and overall health – it’s also the most tiring. This means you can only perform so much of it before it becomes too much.
Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.
So how much time should you spend in each zone?
Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.
Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.
Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150–300 minutes of moderate intensity exercise per week, or 75–150 minutes of vigorous exercise per week.
If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure you’re exercising to meet these guidelines.
What if I don’t have a heart rate monitor?
If you don’t have access to a heart rate tracker, that doesn’t mean you can’t use heart rate zones to guide your training.
The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.
With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.
Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you don’t want to worry about heart rate zones at all, that’s also fine. The most important thing is to simply get moving.
Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Procrastination Cure – by Jeffery Combs
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Why do we procrastinate? It’s not usually because we are lazy, and in fact we can often make ourselves very busy while procrastinating. And at some point, the bad feelings about procrastinating become worse than the experience of actually doing the thing. And still we often procrastinate. So, why?
Jeffery Combs notes that the reasons can vary, but generally fall into six mostly-distinct categories. He calls them:
- The neurotic perfectionist
- The big deal chaser
- The chronic worrier
- The rebellious rebel
- The drama addict
- The angry giver
These may overlap somewhat, but the differences are important when it comes to differences of tackling them.
Giving many illustrative examples, Combs gives the reader all we’ll need to know which category (or categories!) we fall into.
Then, he draws heavily on the work of Dr. Albert Ellis to find ways to change the feelings that we have that are holding us back.
Those feelings might be fear, shame, resentment, overwhelm, or something else entirely, but the tools are in this book.
A particular strength of this book is that it takes an approach that’s essentially Rational Emotive Behavior Therapy (REBT) repackaged for a less clinically-inclined audience (Combs’ own background is in marketing, not pyschology). Thus, for many readers, this will tend to make the ideas more relatable, and the implementations more accessible.
Bottom line: if you’ve been meaning to figure out how to beat your procrastination, but have been putting it off, now’s the time to do it.
Click here to check out The Procrastination Cure sooner rather than later!
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Fruit & Veg In The Fridge: Pros & Cons
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝What effect does refrigeration have on the nutritional value of fruit and vegetables??❞
It’s difficult to give a single definitive answer, because naturally there are a lot of different fruits and vegetables, and a lot of different climates. The answer may be different for tomatoes in Alaska vs bananas in Arizona!
However, we can still generalize at least somewhat
Refrigeration will generally slow down any degradation process, and in the case of fruit and vegetables, that can mean slowing down their “ripening” too, as applicable.
However…
Refrigeration will also impede helpful bioactivity too, and that includes quite a list of things.
Here’s a good study that’s quite illustrative; we’d summarize the conclusions but the rather long title already does that nicely:
So, this really is a case of “there are pros and cons, but probably more cons on balance”.
In practical terms, a good take-away from this can be twofold:
- don’t keep fruit and veg in the fridge unless the ambient temperature really requires it
- if the ambient temperature does require it, it’s best to get the produce in fresh each day if that’s feasible, to minimize time spent in the fridge
An extra thing not included there: often when it comes to the spoilage of fruit and veg, the problem is that it respires and oxidizes; reducing the temperature does lower the rate of those, but often a far better way is to remove the oxygen. So for example, if you get carried away and chop too many carrot batons for your hummus night, then putting them in a sealed container can go a long way to keeping them fresh.
See also: How Does the Nutritional Value of Fruits and Vegetables Change Over Time?
Enjoy!
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Why You Can’t Skimp On Amino Acids
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Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize (thus called: “essential”) and absolutely must get from food. Normally, we get these amino acids from protein in our diet, and we can also supplement them by taking amino acid supplements if we wish.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
Why this matters
A lot of attention is given to protein, and making sure we get enough of it, especially as we get older, because the risk of sarcopenia (muscle mass loss) increases with age:
However, not every protein comes with a complete set of essential amino acids, and/or have only trace amounts of of some amino acids, meaning that a dietary deficiency can arrive if one’s diet is too restrictive.
And, if we become deficient in even just one amino acid, then bad things start to happen quite soon. We only have so much space, so we’re going to oversimplify here, but:
- Histidine: is needed to produce histamine (vital for immune responses, amongst other things), and is also important for maintaining the myelin sheaths on nerve cells.
- Isoleucine: is very involved in muscle metabolism and makes up the bulk of muscle tissue.
- Leucine: is critical for muscle synthesis and repair, as well as wound healing in general, and blood sugar regulation.
- Lysine: is also critical in muscle synthesis, as well as calcium absorption and hormone production, as well as making collagen.
- Methionine: is very important for energy metabolism, zinc absorption, and detoxification.
- Phenylalanine: is a necessary building block of a lot of neurotransmitters, as well as being a building block of some amino acids not listed here (i.e., the ones your body synthesizes, but can’t without phenylalanine).
- Threonine: is mostly about collagen and elastin production, and is also very important for your joints, as well as fat metabolism.
- Tryptophan: is the body’s primary precursor to serotonin, so good luck making the latter without the former.
- Valine: is mostly about muscle growth and regeneration.
So there you see, the ill effects of deficiency can range from “muscle atrophy” to “brain stops working” and “bones fall apart” and more. In short, any essential amino acid deficiency not remedied will ultimately result in death; we literally become non-viable as organisms without these 9 things.
What to do about it (the “life hack” part)
Firstly, if you eat a lot of animal products, those are “complete” proteins, meaning that they contain all 9 essential amino acids in sensible quantities. The reason that all animal products have these, is because they are just as essential for the other animals as they are for us, so they, just like us, must consume (and thus contain) them.
However, a lot of animal products come with other health risks:
Do We Need Animal Products To Be Healthy? ← this covers which animal products are definitely very health-risky, and which are probably fine according to current best science
…so many people may prefer to get more (or possibly all) dietary protein from plants.
However, plants, unlike us, do not need to consume all 9 essential amino acids, and thus may or may not contain them all.
Soy is famously a “complete” protein insofar as it has all the amino acids we need.
But what if you’re allergic to soy?
Good news! Peas are also a “complete” protein and will do the job just fine. They’re also usually cheaper.
Final note
An oft-forgotten thing is that some other amino acids are “conditionally essential”, meaning that while we can technically synthesize them, sometimes we can’t synthesize enough and must get them from our diet.
The conditions that trigger this “conditionally essential” status are usually such things as fighting a serious illness, recovering from a serious injury, or pregnancy—basically, things where your body has to work at 110% efficiency if it wants to get through it in one piece, and that extra 10% has to come from somewhere outside the body.
Examples of commonly conditionally essential amino acids are arginine and glycine.
Arginine is critical for a lot of cell-signalling processes as well as mitochondrial function, as well as being a precursor to other amino acids, including creatine.
As for glycine?
Check out: The Sweet Truth About Glycine
Enjoy!
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Longevity… Simplified – by Dr. Howard Luks
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In the spirit of the book itself, we’ll keep this one simple:
The information in this book will not be new to regular readers of 10almonds, or at least, not if you’ve been with us for a while (because we can only cover so much per day, so long-time readers will have accumulated more knowledge).
On the other hand, the information is clear, correct, and very much stripped down to the most important basics. Not the very simplest basics, which would be an oversimplification to the point of inutility, but the most important basics.
To take an example, when it comes to exercise, he doesn’t say “exercise more” but rather that “a complete exercise program has four pillars: aerobic training, resistance training, balance training, and high-intensity interval training (HIIT)”, and then he goes about explaining, in clear and simple terms, how to do those.
The style is similar when it comes to diet, sleep, and body-part-specific chapters such as about heart health, brain health, and so forth.
Bottom line: if you’re a long-time 10almonds reader, you probably don’t need this one, but it’d be a great book for someone else who has expressed an interest in getting healthier, as it really is a top-tier “primer” in increasing health and healthspan.
Click here to check out Longevity… Simplified, and enjoy simplified longevity!
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Why STIs Are On The Rise In Older Adults
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Three Little Words
Sexually Transmitted Infections (STIs) are often thought of as something that predominantly plagues younger people… The truth, however, is different:
❝Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over-50s.
These data likely underestimate the true extent of the problem as limited access to sexual health services for the over 50s, and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.❞
Read more: Managing The Rise In STIs Among Older Adults
That said, there is a gender gap when it comes to the increased risk, for example:
❝A retrospective study from the USA involving 420,790 couples aged 67 to 99 years, found that widowhood was associated with an increased risk of STIs in older men, but not women❞
~ US Dept of Health & Human Services
Source: CDC: | Sexually Transmitted Disease Surveillance
Is abstinence the best preventative, then?
It is inarguably the most effective, but not necessarily the best for everyone.
This is because for most adults, a healthy sex life is an important part of overall wellbeing.
See also: Mythbusting The Big O
Even in this case there is a gender gap in:
- the level of importance placed on frequency of sexual interactions
- what act(s) of sexuality are held to be most important:
❝Among sexually active men, frequent (≥2 times a month) sexual intercourse (P < .001) and frequent kissing, petting, or fondling (P < .001) were associated with greater enjoyment of life.
Among sexually active women, frequent kissing, petting, or fondling was also associated with greater enjoyment of life (P < .001), but there was no significant association with frequent intercourse (P = .101).
Concerns about one’s sex life and problems with sexual function were strongly associated with lower levels of enjoyment of life in men and to a lesser extent in women.❞
Source: Sexual Activity is Associated with Greater Enjoyment of Life in Older Adults
If you have the time to go into it much more deeply, this paper from the Journal of Gerontology is much more comprehensive, looking also at related lifestyle factors, religious/political backgrounds, views on monogamy or non-monogamy (of various kinds), hormonal considerations, the impact of dementia or other long-term disabilities that may affect things, widowhood, and many other elements:
The National Social Life, Health, and Aging Project: An Introduction
What’s the best preventative, then?
Regular health screening for yourself and your partner(s) is an important key to preventative health when it comes to STIs.
You can Google search for a local STI clinic, and worry not, they are invariably discreet and are well-used to everybody coming in. They’re just glad you’re being responsible about things. It’s also not their job to judge your sexual activities, even if it’s something you might have reason to wish to be secretive about, try to be honest there.
Secondly, most of the usual advice about safe sex still goes, even when there’s no risk of pregnancy. For example, if there’s at least one penis involved, then condoms remain the #1 barrier to all manner of potential infections (we know, almost nobody likes condoms, but sometimes the truth isn’t what we want to hear).
Lastly, if there’s at least one vagina involved, then please for the love of all that is holey, do not put anything there that could cause a yeast infection.
What can cause a yeast infection? Pretty much anything with sugar, which includes but is not limited to:
- Most kinds of food that Cosmo-style “liven things up in the bedroom” advice columns might suggest using (including fruit, honey, chocolate sauce, whipped cream, etc)
- Hands that are not clean (watch out for bacteria too)
- A mouth that has recently been eating or drinking anything with sugar in it, and that includes many kinds of alcohol, as well as milk or hot drinks that had milk in
Yeast infections are not nearly so serious as the STIs the other measures are there to avoid, but they’re not fun either, so some sensible policies in that regard are always good!
On a related note, see also: How To Avoid UTIs
Recap on the single most important part of this article:
At all ages, it remains a good health practice—unless one is absolutely celibate—to regularly get oneself and one’s partner(s) checked for STIs.
Take care!
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