Exercise Is Medicine

Reposting this for all you folks who haven't decided what to
make for your New Year's resolution focus for 2011.
And for all you trivia buffs the photo is of Marlon Brando training on the set of ""A Street Car Named Desire" from the 1950's.

Exercise is Medicine™ is an important new initiative being promoted to all physicians and healthcare providers, which is a shared vision of the American College of Sports Medicine (ACSM) and American Medical Association (AMA). Exercise is Medicine™ is designed to help improve the health and well-being of our nation through a regular physical activity prescription from doctors - including podiatric physicians - and other healthcare providers. As role models for health it is important for us to to become a vital part of this bold new initiative and incorporate its message into your daily practice.

What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you want your doctor to prescribe it to you? Certainly! Exercise is that prescription and it needs to be prescribed by physicians and healthcare providers to patients who are not exercising regularly.

The guiding principles of Exercise is Medicine™ have been well-documented in a new textbook titled, Exercise is Medicine™, which is supported by ACSM and written by Harvard-trained Steven Jonas, MD, MPH. Some of the highlights include the following principles:

1. Exercise and regular physical activity are important to health and the prevention and treatment for many chronic diseases.
2. More should be done to address physical activity and exercise in healthcare settings.
3. ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings.

Healthcare organizations (including AAPSM and APMA), physicians and other professionals, regardless of specialty, are being challenged to assess, to advocate for, and to review every patient's physical activity program during every comprehensive visit.

You can visit http://www.exerciseismedicine.org/ for additional information and a more detailed description of Exercise is Medicine™, including ways you can counsel patients on their exercise regimens, and information on how physical activity can be an integral part of any patient’s healthcare program. We are urged to make exercise consultation and referral a regular, important part of our interaction with every patient at every visit.

“Regular Exercise”

It has been suggested that the hardest part of “regular exercise” is the regular, not the actual exercise. Unfit patients should be encouraged to healthy lifestyle changes, including: regular exercise; consuming smaller, healthier food portions; and smoking cessation. Be a role model for patients and your children and lead by example! Karen Langone, DPM president of the AAPSM has continued the charge as part of the boards initiatives regarding exercise. She references a recent study that confirmed that doctors who exercise are more committed and comfortable in counseling patients on incorporating exercise into their lifestyles. She believes exercise is the most empowering tool we can give our patients.
Gary Hall an eye doctor and former Olympian, is part of a grass roots program called World Fit which targets middle school kids to get engaged in a regular walking program. Former and current Olympians including diabetes advocate Gary Hall Jr. are involved to get the kids excited about being part of the program at school rallies. A culture of exercise is developed and parents often start exercising as well.

Our US Surgeon General Regina M. Bejamin, MD and Robert E. Sallis, M.D., FACSM, Past-President, American College of Sports Medicine presented the foundation for the Exercise is Medicine™ initiative at the Inaugural Exercise is Medicine World Meeting in Baltimore. Listed below are important highlights, which you can use to discuss with your patients, friends, and families:

1. Our longevity depends on 3 factors; genetics, environment, and behavior. It is our behavior that is most problematic and that has lead to the leading causes of death (cardiac disease, cancer, and stroke) in the US.

2. The most preventable factors of premature death are tobacco use and physical inactivity. In 2004, a “tipping point” occurred with tobacco, when the number of ex-smokers outnumbered the number of current smokers.

3. The death rate for a fit 80 year old is lower than that of a sedentary 60 year old.

4. Exercise is a “wonder drug” and everyone should take it.

5. Our insurance industry needs to change. Why is it that insurance will pay to refer a patient for bariatric surgery, but will not pay to refer a patient to an exercise specialist?

6. We need to move from a treatment-oriented society, to a prevention-oriented society.

7. 7 out of ten Americans will die from a preventable disease.

8. Childhood obesity is our number one health problem in the US. For the first time in our history, our youth will have a shorter life span than adults, which is a terrible, embarrassing comment on our nation’s current health.

9. Each of us can play a key role to increase exercise in the US, starting by being a fit personal role model, and incorporating Exercise is Medicine™ into our practices.

10. Healthy food choices and lifestyle choices need to be part of the solution for healthy living.


Athletic Shoe Prescription

Athletic shoes can play an additional preventive role in exercise injuries by providing our newly-exercising patients with an appropriate athletic shoe prescription on each comprehensive visit. The athletic shoe prescription should include; proper athletic shoe type, athletic sock recommendation, lacing techniques, and supportive insoles or orthoses, if necessary.

Our Academy’s shoe review committee has made a tremendous effort to update our athletic shoe web pages (http://www.aapsm.org/), which include a wealth of contemporary knowledge needed to write an athletic shoe prescription - useful for the novice as well as the experienced podiatric practitioners. Also, a 2010 publication by Springer, Athletic Footwear and Orthoses in Sports Medicine, including 30 Academy-contributors, has provided an evidence-based resource on the benefits of appropriate footwear and orthoses recommendations.

Physical Activity Recommendations

The American College of Sports Medicine (ACSM) and American Heart Association (AHA) also recently released updated physical activity recommendations for adults. This message should be clear and consistent for all sports and medical organizations, and is listed below:

1- Moderate-intensity aerobic physical activity for a minimum of 30 minutes on 5 days each week, or

2- Vigorous-intensity physical activity for a minimum of 20 minutes on 3 days each week.

These recommendations are an update and clarification of the 1995 recommendations on the types and amounts of physical activity needed by healthy adults and older adults to improve and maintain health.

The core recommendation of the ACSM/AHA Physical Activity Guidelines is to promote and maintain health. The intent is to provide a more comprehensive and explicit public health recommendation based upon available evidence-based research of the health benefits of physical activity. The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce risk of chronic disease and premature mortality.

A single evidence-based message must continue to be drummed - from the surgeon general to the coach, including every contact from health-care provider, physical educator, school administrator, and yes, health insurance provider - into the daily routine of all Americans if we are to be successful in altering the exercise and activity behaviors in the United States.

Exercise is Medicine!

Matt Werd ,DPM is a graduate of Indiana University. He is past president and a current fellow of the American Academy of Podiatric Sports Medicine. He has completed over 70 triathlons including 3 Ironman triathlons.

Ben Pearl,DPM is a member of the American Academy for Podiatric Sports Medicine.
A graduate from PCPM, he was a competitive bike racer at Indiana University and currently teaches skiing part time. He has a private practice in Arlington, VA.

Barefoot Running , Minimalist Shoes and Beyond

The barefoot running movement has spawned a cascade of trends in the running shoe industry. The progression has been towards minimalist shoes the ever since Chris McDougall's seminal book "Born to Run". Prior to the sensation of “Born to Run” Vin Lanana has been using barefoot
running in training his runners at Stanford. He believed that incorporating barefoot running in training resulted in better times. When marketing executives from Nike visited him at the Stanford track they conceptualized a minimalist shoe; a shoe that simulate some of the elements of barefoot running yet provide some protection on the feet. needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.


Our profession should continue to play a leading role in setting parameters
for the new generation of minimalist shoes. It has become obvious to practitioners dealing with overly zealous runners transitioning to these shoes that they will end up in our offices with injuries. Although there are no injury data banks or studies to support these patterns the anecdotal cases should not be ignored.There seem to be more metatarsal fractures, achilles tendonitis and plantar fasciitis cases. In terms of trying to draw conclusions beyond clinical trends it has a non-polynomial solution. There are simply too many variables to factors to draw a conclusion. There are no current injury logs tracking injury patterns with barefoot and minimalist shoe conditions. This information could be something we as practitioners track.




There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe.


Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seem whether this is simply a marketing ploy or a functional piece of recovery equipment.

Walking in another man’s barefeet

The old adage walking in another man’s shoeapplies to running barefoot because until we try it out we are not experiencing the sensations of barefoot running. Malcolm Gladwell had a pilot put him in a death spiral for a few seconds when he was writing about panic and using the JFK Jr. crash as a case study. It should be know different for us then when we are treating this population. Paul Langer, DPM runs extensively in ..

Propriopceptive input is one of the things that purists insist is the thing that prevents them from experiencing the same amount of injuries as in minimalist shoes. Biomechanics guru Benno Nigg Phd has supported the notion that feedback can affect injury rates. Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics.

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Ankle Sprain Article from Men's Health

My colleague Dr. Karen Langone saw this in Men's health on ankles sprains. It gives a great rationale for why you want immobilization and not just a brace for a more severe sprains. The ice/heat contast drills are excellent.


http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100262883

Training Bode Miller Style

I was looking to do a rant about being amused at people that break out their new toner shoes and expect that they are going to have buns of steel.

My comment on a recent link on the subject was that people should be focusing much more on training intensity a la old school Bode's Miller than some new fangled shoe that you're going to wear while drinking a latte on your urban hike.

Looking for a pic of some of Bode's workouts I came across a National Geographic article of one of Bode's self inflicted strength/stability workouts. He wheel barrels his friends up a hill.

Training equipment will only get you so far. It is true that you can buy time on a racing bike

but when it comes to training equpment many people lose the primary focus for the frills and fads.

November is National Diabetes Month:Diabetics are Athletes Too

Gary Hall Jr. was something of a nonconformist in the pool during his gold medaled Olympic career. These days he makes waves on Capital Hill for diabetes advocacy and has made it his business to stay current with diabetes research.

Diabetics are Athletes Too: Knocking Out Old School StereotypesDiabetes and an athletic lifestyle are not mutually exclusive. Diabetics are tired of walking out of podiatrist’s office with a pair of prescribed shoes that look like Herman Munster's. They want a normal lifestyle. "Old school" doctors need to recognize that there are new and more appealing options for our patients. We must also take on the role of a coach for our patients that are athletes and those that need to become more like athletes. By helping out patients feel more comfortable and enthusiastic about exercising, we help reach their fitness goals and also help control their diabetes. High quality appealing footwear is an important component in helping our diabetic athletes and helping our diabetic patients to become athletes. Diabetic advocate and Olympic swimmer Gary Hall Jr. provides a first hand account of the problem:
"For all the efforts of removing the stigma attached to living with diabetes, the unfortunate mark of diabetes remains apparent in prescribed footwear. I dedicated my life to proving that diabetes didn't have to stop an individual from accomplishing their dreams, whatever the dream was. For me it was swimming in the Olympics. When I won gold I was able to help tear down that barrier (often viewed as liability) that separated people with diabetes from the rest of the pack. The important message was that while additional requirements were necessary in properly managing diabetes, a person living with diabetes was equal. Somehow that message hasn’t come through in shoe design. If you have diabetes you are asked to wear, let’s face it, ugly shoes.
It’s hard enough to get diabetes patients to comply with the call to exercise. Asking someone to slap on ugly shoes and exercise exacerbates that challenge. With a diabetes diagnosis we are bombarded with the mantra, “diet and exercise”. Regular exercise helps increase insulin sensitivity and lower blood glucose levels but competitions have a dramatically different effect.

The stress associated with competitions sends blood sugars soaring. Throw in endorphins and adrenaline and levels can reach dangerous and dizzying highs. My targeted blood sugar level before a major competition (last glucose test taken five to ten minutes prior) was around 140 to 150. I competed in the 50 meter freestyle; it typically took me 21 second to swim. I would test my blood sugar immediately after a competition and my levels were never less than the high 300’s. This dramatic hike associated with Game Day is common for athletes young and old, fast and not so fast and is in stark contrast to the blood glucose effects of Practice Days.

I enjoy sharing with people that as a swimmer about 60% of my training was done out of the pool. For any athlete living with diabetes, at any level, it is imperative to have a good pair of “trainers”. Is it too much to ask that a good pair of diabetes friendly sneakers be good looking too?"Fortunately, vendors that deal with diabetics are starting to get it. They are developing lines that incorporate style and function. Think about your experiences in everyday life and how that influences how you feel about the product or service. Flying Virgin Air on the way back from Seattle it struck me just how dramatic an effect style and attitude can have on an experience. The attention to lighting, elimination of listless airline stewardess safety instruction in favor of an upbeat graphic presentation on the multi-use personal movie screen convey a more relaxed, fun attitude. This will make me more likely to fly Virgin Air Again and the same holds true with our diabetic patients’ compliance with appliances, shoes and activities of daily living.

Fear has its place as a wake up call in certain cases but the unfamiliar will not help them comply when it comes to equipment. How much of what we dispense is actually worn at home? It turns out prescriptive shoes are only worn about 15% of the time in the home according to research by David Armstrong DPM. Appliances are only used about 25 % of the time.In an uncertain fast changing world people are more comfortable with things that they are familiar to them. In Martin Lindstrom's New York Times bestseller, Buy-Ology he attributes this phenomena to the ritualistic behavior that becomes attached to branding. It explains why people engage in tribal behaviors as well.

It's a lot more reassuring to trudging through the morning commute to be part of the "Apple Community" with an army of I-Phone users. The natural conclusion is that positive peer pressure and coming up with ritualistic hooks may be the key for less motivated diabetic would be athletes. The World Fit program is an example of positive peer pressure in action. At it's outset it was targeting middle school kids with a monitored walking program to combat obesity. Olympic athletes are involved as positive role models and Gary Hall Sr., also a former Olympic swimmer is one of the principal organizers. The unexpected benefit was that adults started participating in the program as well because of their kids. What happened here? In one sense a subculture was created. If we look at how strong that subculture can reinforce branding (think about a loyal legion of Harley Davidson riders) it may help us understand how we can create a subculture of diabetics as athletes instead of passive patients.

A Clockwork Orange and Compliance

The brutal movie, "A Clockwork Orange" explored how we are wired to do certain things like clockwork without consciously thinking about them and the limits to which behaviors can be conditioned. Conditioning and association can be so powerful it can even affect our memory. There was a study done where people were able to remember a series of playing cards that had normal colors and symbols better than a deck that had a reversed color scheme; red spades, black hearts etc. This helps explains why it can be so difficult to change behaviors to new ones when they are completely unfamiliar. Brain mapping research with MRI has shown that certain areas of the brain are consistently activated when it comes to making the choice to buy something impulsively or satisfying a craving such as lighting up cigarette for a smoker.
Medicine might do well to jump on the same research that Madison Avenue has been on to for some time.

Our routines are also somewhat wired. Consider the data on stopping and starting on ulcer formation and healing just presented in Seattle. New data suggest that takeoff and landing shearing is the most destructive factor. David Armstrong, DPM uses the analogy of the most dangerous periods for an airline flight being takeoff and landing. If we can change routines to reduce the number of start and stops we can improve ulcer healing outcomes. If the routine is to get up and change the channel on the TV because the remote has a dead battery a series of such routines can profoundly affect an outcome. When I related this research to a patient of mine that was having difficulty closing an ulcer he began wearing a pedometer to count his steps. The next visit the ulcer was closed. To that end, solutions that deal with that takeoff shearing would be something vendors could focus on in addition to our patients' lifestyle change.
Merging an Athletic Lifestyle for Diabetics with Technology in Training

Interest in exercise research is at an all time high. Just look at any list-serve with athletes or websites with forums on training. The following is just one example of useful training info for the diabetic athlete: A 10-second maximal sprint after moderate-intensity exercise reduces the risk of post-exercise hypoglycemia in young, otherwise healthy patients with type 1 diabetes.
Dr. Paul A. Fournier from University of Western Australia, Crawley, stated that, "It is our view that the effect of sprinting on reducing the risk of post-exercise hypoglycemia is probably not as marked in children and sedentary middle-age individuals with type 1diabetes, in part, due to their reduced capacity to engage in a maximal sprint effort.
In the area of biomechanics podiatry is starting to come out of its slumber in recognition of the research that needs to be done for diabetics and the translation of that research into product development.
Using more appealing athletic equipment may seem like a small thing however along with developing exercise networks with peer and family connections it will be the tipping point to establish an athletic lifestyle. Gary Hall Jr. recognized the importance of his own training style and being close to family networks in his competition and outside the pool in his daily life. He made it his own and that made the rigors of training more sustainable. When this attitude can be developed in our patients minds it will change everything.

Armstrong, David et al “Continuous Activity Monitoring in persons at High Risk for Diabetes Related Lower Extremity Amputation “ JAPMA volume 91 number 9 October 2001 451-455

Bijan Najafi, MD Crews RT, Wrobel JS.”The Importance of Time Spent Standing for those at Risk of Diabetic Foot Ulceration” Diabetes Care Aug. 2010
Lindstrom,Martin Buy-ology Broadway Books New York 2010
Dr. Ben Pearl is a member of the American Academy for Podiatric Sports Medicine. This article is part of a sport medicine series the Academy is collaborating with Podiatry Management.
A graduate from PCPM, he was a competitive bike racer at Indiana University riding in IU’s
Little 500. His senior thesis at IU was on sports as a vehicle for mainstreaming. He has a private practice in Arlington, VA.

Gary Hall Jr. is a three-time Olympian and a diabetes advocate who has testified on Capital Hill.
He currently is the director of business development at B2D Marketing. The Seattle based company exclusively represents a medical distribution network in China that services over 6,335 hospitals and health clinics. http://www.b2dmarketing.com/ .

Diabetics Are Athletes Too: Knocking Out Old School Stereotypes

Diabetics are Athletes Too: Knocking Out Old School Stereotypes

November is National Diabetes Awaresness Month.The New York Times Best Seller "Diabetes Rising" lets us know we're not out of the woods yet...

Diabetes and an athletic lifestyle are not mutually exclusive. Diabetics are tired of walking out of podiatrists office with a prescription for shoes that look like Herman Munster's. They want a normal lifestyle. "Old school" doctors need to recognize that there are new and more appealing options for our patients. We must also take on the role of a coach for our patients that are athletes and those that need to become more like athletes.



Diabetic advocate and Olympic swimmer Gary Hall Jr. provides a first hand account of the problem:

"For all the efforts of removing the stigma attached to living with diabetes, the unfortunate mark of diabetes remains apparent in prescribed footwear. I dedicated my life to proving that diabetes didn't have to stop an individual from accomplishing their dreams, whatever that dream was. For me it was swimming in the Olympics. When I won gold I was able to help tear down that barrier (often viewed as liability) that separated people with diabetes from the rest of the pack. The important message was that while additional requirements were necessary in properly managing diabetes a person living with diabetes was equal. Somehow that message hasn’t come through in shoe design. If you have diabetes you are asked to wear, let’s face it, ugly shoes.

It’s hard enough to get diabetes patients to comply with the call to exercise. Asking someone to slap on ugly shoes and exercise exacerbates that challenge. With a diabetes diagnosis we are bombarded with the mantra, “diet and exercise”. Regular exercise helps increase insulin sensitivity and lower blood glucose levels but competitions have a dramatically different effect.

The stress associated with competitions sends blood sugars soaring. Throw in endorphins and adrenaline and levels can reach dangerous and dizzying highs. My targeted blood sugar level before a major competition (last glucose test taken five to ten minutes prior) was around 140 to 150. I competed in the 50 meter freestyle, it typically took me 21 second to swim. I would test my blood sugar immediately after a competition and my levels were never less than the high 300’s. This dramatic hike associated with Game Day is common for athletes young and old, fast and not so fast and is in stark contrast to the blood glucose effects of Practice Days.

I enjoy sharing with people that as a swimmer about 60% of my training was done out of the pool. For any athlete living with diabetes, at any level, it is imperative to have a good pair of “trainers”. Is it too much to ask that a good pair of diabetes friendly sneakers be good looking too?"

Fortunately, vendors that deal with diabetic are starting to get it. They are developing lines that incorporate style and function. Flying Virgin Air on the way back from Seattle it struck me that even the in coach class on a red eye style and attitude can dramatically affect the experience. They payed attention to lighting, eliminate the stock airline stewardess 2 finger point to the nearest exit in favor of a more friendly graphic presentation on the multi-use movie screen in front of your seat and convey a relaxed fun attitude.

Fear has it's place as a wake up call in certain cases but the unfamiliar will not help them comply when it comes to equipment. How much of what we dispense is actually worn at home? It turns out prescriptive shoes are only worn about 15% of the time in the home according to research by David Armstrong DPM . Appliances are only used about 25 % of the time.

In an uncertain fast changing world People are more comfortable with things that they are familiar to them. In Martin Lindstrom's New York Times bestseller, Buy-Ology he attributes this phenomona to the ritualistic behavior that becomes attached to branding. It explains why people engage in tribal behaviors as well.

It's a lot more reassuring to trudging through the morning commute to be part of the "Apple Community" with an army of I-Phone users. The natural conclusion is that positive peer pressure and coming up with ritualistic hooks may be the key for less motivated diabetic would be athletes. The World Fit program is an example of positive peer pressure in action. At it's outset it was targeting middle school kids with a monitored walking program to combat obesity. Olympic athletes are involved as positive role models and Gary Hall Sr., also a former Olympic swimmer is one of the principal organizers. The unexpected benefit was that adults started participating in the program as well because of their kids. What happened here?
In one sense a subculture was created. If we look at how strong that subculture can reinforce branding (think about a loyal legion of Harley Davidson riders) it may help us understand how we can create a subculture of diabetics as athletes instead of passive patients.

A Clockwork Orange and Compliance

The brutal movie, "A Clockwork Orange" explored how we are wired to do certain things like clockwork

without consciously thinking about them and the limits to which behaviors can be conditioned. Conditioning and association can be so powerful it can even affect our memory. There was a study done where people were able to remember a series of playing cards that had normal colors and symbols better than a a deck that had a reversed color scheme; red spades, black hearts etc. This helps explains why it can be so difficult to change behaviors to new ones when they are completely unfamiliar.

Our routines are also somewhat wired. Consider the data on stopping and starting on ulcer formation t just presented in Seattle. Apparently. takeoff shearing is the most destructive factor. If the routine is to get up and change the channel on the TV because the remote has a dead battery a series of such routines can profoundly affect an outcome. To that end, solutions that deal with that takeoff shearing would be something vendors could focus on in addition to our patients' lifestyle change.

A Local Hero is Gone

A Local Hero is Gone

Rocky Belk died last week and the Arlington community was left with one less voice for the people that have none. Success did not come easy for Rocky. He was an athlete on the bubble; enough talent to make it all the way to the NFL but scrapping
every step of the way. Because Rocky had to carefully piece together his athletic career, he came to understand what it took to achieve his advanced education goals one piece at a time and he never forgot those that were not empowered with the same knowledge and voice along the way.

I met Rocky on the school yard one day while I was watching my daughter, Sirena, play in gym class. We had a conversation about youth, sportsmanship and life in general. We became friends that day and worked on a local project for the Arlington Career Center on better choices for student athletes. One night we went out to dinner at a restaurant off the GW parkway near closing and he got there first and they refused to serve us. I'll never know how much of it was racially motivated but that was Rocky's impression and it was upsetting to see that sort of thing play out for a man that was so giving of his time in the community. A few months later we saw "The Express, the Ernie Davis Story" together and I'm sure Rocky could relate to some of the scenes growing up particularly since he was also a Cleveland Brown for one season, a bit of life imitating art.

Rocky told me that when the Browns won a game the fans in his town home community would shovel snow in front of his door to greet him after the game. A celebratory snow in. He had skills but could not stomach the politics of pro football. The quarterbacks were partial to the players that they were used to and it affected who played. Sam Rutigliano was probably a bit ruthless for Rocky's taste. Nonetheless he got to experience a couple touchdowns in the pros and made good on his promise and ended up with a Sports Illustrated appearance while at the University of Miami. He got to catch more than few with hall of famer Jim Kelly when he played for the Hurricanes. His heroic exploits were more about what he did off the field.

Although he was always full of hale to greet his prized possessions,the children at Longbranch Elementary where he served as head gym teacher, Rocky had a very sensitive side. It was his big heart that in part played into his failing health at the end because he did not put the same level of focus on himself as he did on others. He had tremendous respect for the educational institutional process and for his
fellow faculty and head principal Felicia Russo. That process was so important to him because it was the ultimate equalizer. When Rocky finished up at school he gave more of his time to the Gum Springs Community Center near Fort Hunt where he went to high school.

Can we summarize a man's legacy, his life's work, in a memorial plaque? It would be kind of cool for students that knew him to tell those coming in that ask who was this Rocky Belk and what did he do? Those that knew him could tell them that Rocky Belk from Gum Springs followed his dreams and made it all the way to the NFL working every step of the way and after he got there he never stopped giving back. What motivated him was simply his love for the children he taught.
In the end, for those that knew him, it really doesn't really matter whether a plaque with Rocky Belk's name inscribed on it is put out at the horseshoe kiss and drop where the Longbranch students start their morning; because in the end every child and parent that Rocky touched will remember him at that horseshoe full of hale and with a big,easy,giving smile.

Wham-O! I'm not Supermam

So I was goofing off one summer in Buffalo,New York with my nephews on a slip and slide. I thought I might try cruising down the Slip 'n Slide set up on the lawn Silver Surfer style instead of ala Pete Rose head first into home plate... Big mistake.At the time I had no problem. Somewhere around eight that night my ankle started to feel like it was being crushed. Wham-O! I'm talking about tears streaming down your face type pain. The torque on my ankle from my jumping had caused an acute bone bruise and sprain. The body has a memory to insult and it can react the opposite of delayed gratification. In this case it was pay your dues for your mortal sin of thinking you could crash your body like a teenager. 6 Advils and several sessions of ice and elevation later I was able to get to sleep a little past midnight. Just last week I was reminded of my weekend warrior body when after taking up my secondsessions of Gaelic Football I started experiencing intense pain this time in my foot about 2 hours into my daughter's friend's birthday party that forced me to the couch and crutches for 8 hours.This time an acute sprain of my foot. The deal is that once your foot starts to swell even a little bit there are a lot of nerves down there that are not very happy. You also don't get to rest the area unless you are put in a cat or on crutches. I have patients that look at me dumbfounded regarding their hobbled condition with foot pain and I ask them what they did and they tell me I hiked or whatever and were fine at the but the reality is that your body remembers. Particularly if you have an old injury. You have to respect that

The OJ We Hardly Knew

Like a lot of kids growing up in the 70's my brother Mike and I grew up cheering for the Juice. I had an extra connection as my parents both grew up in Buffalo and my relatives were season ticket holders for the Bills so we would go up and watch them play around the holiday weekends.
OJ went to my families drugstore business in downtown Buffalo and was thought to be one of Buffalo's own; a regular sort of guy off the field. It is documented that OJ used to be very patient when filming various itterations of the Hertz Rent-A-Car commercials, the later of which, required him to be suspended from a wire harnass for hours on end.


I 'll tell you a story about OJ. I met an orthopedic surgeon at a conference in Montana who was MVP at a football camp & OJ gave the then kid an autographed football at the awards banquet
which was held in Niagara Falls. So later that night they cross paths in an elevator at the hotel & he says how he wanted to emulate his career. OJ looks him up & down and says "Fat chance kid!" OJ's pulling guard and best buddy Reggie McKenzie was with him at the time and protested "OJ why did you have to say that " And this is the best part of the story- he told me he took that football & threw it right in the trash. If I had been there I would have given the kid a standing o. Not exactly the iconic "Mean Joe Green" Coke commercial.

The truth was that OJ was cool with being OJ man of the people as long as OJ was the center of attention and adulation. Another running back, Gale Sayers wrote a book titled "I am Third". It was abook about his life and his short relationship with teammate Brian Piccolo. The title refers to the philosophy that the Lord is first, my friends and family are second and I am third. You look at our sports superstars today, Tiger Woods and the like and hope that a new generation of stars like rookie sensation Stephen Strasburg will give us sports heroes to cheer about on and off the field.

Floyd Landis & Santanna Moss Put Steroids Back in the News "Spin, Wash & Repeat"

Floyd Landis & Santanna Moss put Steroids Back in the news "Spin ,Wash & Repeat "

With Floyd Landis's new allegations impicating Lance Armstrong and other big guns a la Jose Canseco plus Santanna Moss's HGH link allegation here is a the low down on the differences between all the acronyms EPO, HGH, & steroids. If the charges stick aging vets like TO may get a second shot for playing time.

The Legacy of Steroids

Do you remember the night before the big fight in Rocky where he visits the Spectrum only to find that the banner of him has the colors on his boxing trunks reversed. The promoter who happens to be there that night responds to Rocky's soft protest with "It doesn't really matter, Rocky, does it. I'm sure you'll put on a good show." The show has taken over pro sports and our culture's obsession with being the best at any cost is overshadowing the athletes who are training hard a la old school. In 1935 Koch was able to isolate 20 mg of steroid material from 40 pounds of bovine testicles from the Chicago stockyards. In 1935 the first testosterone was synthesized from cholesterol by a scientist named Budenant of Schering. 1 week later Ruzicka working under Ciba announced a patent for the synthesis of testosterone and the two scientists working independently shared the Nobel prize in chemistry.Between 1948-1954 Ciba and Searl sythesized many analogues of testosterone. In 1954 at the weightlifting world championships, after being invited out to a bar the Soviet team doctor confided in the US team doctor John Ziegler that his team was using testosterone. Ziegler began using them for his team and later began working with Ciba to synthesize diabanol (methandosterone).The IOC banned the use of Steroids in 1967. Prior to the ban the Germans used and researched steroids extensively. In 1972 the IOC began a full testing program for detecting steroids.The anabolic steroid act of 1990 made steroids a schedule III drug along with morphine and amphetamines. It is illegal to use schedule III drugs without a doctor's prescription. The sale of steroids on internet is governed by the point of purchase. There are some jurisdictions where the sale of steroids is permitted without a prescription. It is not uncommon for websites to sell steroids and offer advice about how to mask detecting them.Who is using Steroids in the US?The Mayo Clinic estimates that 10% of the anabolic steroid users are teens which accounts for about 300,000 . A survey of 12th graders in 2000 showed 2.5% had used steroids while in 2004 the number climbed to 3.4% One survey found that 6.9 % of football players in Indiana had used steroids. Surprisingly, the main motivation for kids as reported by several studies was not scoring touchdowns but looking buff, one of our country's other national obsessions. Another misconception is that children emulate their sports heroes behavior. According to a Sports Illustrated poll 99% of the respondents that they would not use steroids because pro athletes use them. A study in Pediatrics showed that 65 % of teens would consider using steroids if they thought it would make them reach their athletic goals even if they might cause them harm. 57% said they would even if it meant shortening their life.On the BubbleSome athletes lose their chance to compete because others are cheating. The pressures to perform begin at an earlier level than ever, just ask any travel league athlete. As sports become more institutional the pressures to perform increase. Parents can add pressure and sometimes provide financial backing for steroids. Some athletes feel compelled to cheat to survive the last cut or to go from bench warmer to starter.Remember that anabolic steroids build up muscle tissue but pose unique medical risks for children. They can stop the production of testosterone, which will inhibit skeletal growth in teens. There is increased risk of knee and ankle injuries because the ligaments may not be able to withstand the forces generated by the larger steroid enhanced muscles. Also because the kids taking steroids are bigger, stronger and faster there is a greater chance of injuring other player in contact sports. A largely overlooked risk in the mainstream media is that because much of steroid traffic is underground, there is a greater likelihood that the steroids used will be at or below veterinary grade making them more dangerous. The internet appears to be the pharmacy of choice for teens and is widely used for illegal purchase despite the postal sevice’s efforts to crackdown on illegal shipments. Steroids use is linked with a higher early death rate. In a study reported by the National institute of Drug Abuse mice given steroids at levels proportionate to athletes for 1/5 of their lifespan experienced a higher early death rate.Other Medical RisksIt is important to note that there are important differences within the class of anabolic steroids. The oral 17 alpha forms are the most dangerous. The differences arise because this form of alkylation was developed expressly to allow oral steroids to have significant effects, meaning they will withstand a first pass through the liver thus increasing the liver’s exposure. There is evidence that long-term use of anabolic steroids in the oral form may damage the liver including necrosis of the liver. The injectable form has minimal exposure within the liver. Steroid use can also lead to lower HDL cholesterol and increased LDL levels and triglycerides. The data is scant for a direct causal relationship between cardiovascular disease and steroid use but cohort series suggest a link. Steroids impair glucose tolerance and increase insulin, a state that mimics type 2 diabetes.
What About Roid Rage?
Research on mood swings is still being reported but there are some important statistics. It is estimated by medical experts that 1-2% of steroid users will experience some extreme form of behavior. 3 of 4 studies documented some irritability with steroids giving scientists the hypothesis that some but not all steroids may cause mood changes. One study using testosterone vs. placebo found increased aggressive behavior in the placebo group leading the investigators to the conclusion that a placebo effect may be responsible for these behaviors. Within the individuals variability was noted suggesting a wide range of steroid affects on mood. Anabolic steroid can create withdrawal symptoms when suddenly stopped. This may lead to violent episodes. In addition, sudden cessation of steroids can lead to increased intracranial pressure that can be life threatening. 9.3 % of drug abusers in a drug recovery program reported previous use of anabolic steroids. Many feel this secondary drug use is due to insomnia and irritability associated with steroids.Signs of Steroid UseOne of the main points that most people do not realize is that because of the masculine changes steroids cause, the upper body muscle development distribution is greater than the lower body. Deepening of the voice, breast reduction, and body hair growth are changes noted in women. Testicular atrophy and development of breasts are changes that can happen to men.

Other Performance Enhancing Drugs (PEDS)

Human growth hormone is another agent that is used to increase lean muscle mass an increase bone density. Like steroids they are banned in sports. Popularity of HGH increased after a 1990 New England Journal of medicine article in which therewas some misinterpretation of the conclusions leading some to view HGH as an anti-aging elixir. The performance benefits if any and side effects are not nearly as dramatic. In theory it can increase the chance of developing diabetes. There is a legal homeopathic inhalent version of HGH which is available. EPO is a genetically engineered version of a natural hormone produced by the kidneys that increases bone marrow activity to make more red blood cells. Dangers of EPO use include heart attack and stroke. Over the counter supplements like creatine canbe harmful and are banned by the NCAA and the Olympics and NFL. Creatine can cause cramping and diarrhea and has been linked to muscle injury and kidney problems.The Problems with TestingAlthough testing has gotten better many feel that the testing can’t keep up with the cheaters. WADA has a budget of about 24 million but it is hard to keep pace with the designer steroids that some elite athletes use to evade detection. That’s the opinion of experts like Dr. Charles Yesalis and Don Catlin who runs a company called Anti-Doping research. Some drugs like epo are hard to test directly and use an indirect test of a hematocrit above 50% before confirmatory testing. One group of high schools randomly tested 500 athletes to yield 1 positive steroid result. At $175 per test a more cost effective way of prevention may be an emphasis on education.Education on steroid use is largely regulated to posters in wrestling rooms etc. with no formal curriculum. Given the rise in use by teenagers it would make sense to offer some steroid awareness curriculum before major competitive high school sports programs. Steroid awareness can also be raised in local community athletic programs. Positive adult role models can help.Above and beyond the health risks what kind of message are we sending our children when we have many parents putting pressure on their children for achievement and institutions that have been so slow to embrace a steroid free culture ? It’s ok to cheat as long as you don't get caught? Gary Hall Jr., Olympic gold medal winner in the 50-meter freestyle may have summarized it best when he said that we live in a society where we are innocent until proven guilty-the key word being ‘proven’. We don’t have any way of proving people are cheating.” He points out that many athletes have been implicated in steroid use by scandals such as Balco rather than through testing with the World Anti-Doping Agency (because of the difficulty in getting positive steroid tests.) Bill Moyers wrote that when we give up the fight to ensure an equal playing field we have given up on the bedrock of democracy itself. Athletes and others using steroids is really a reflection of our society rather than an isolated problem. As the tell-alls come out and the dominos fall maybe people will begin to realize that somewhere along the way the have forgotten where they were going in the first place.

Does Getting Up at an Ungodly Hour to Workout Like Rocky Balboa Work?

Who could forget the iconic image of Rocky Balboa getting up at some ungodly hour eating raw eggs in his quest to try and go the distance with Apollo Creed. There's only one problem.
If you are not getting your 8 hours of sleep particularly when you are
hammering in your training cycle your are not optimizing your body's recovery cycle.
Most of our healing and muscle building occurs while we are sleeping. It affect your body in so many ways. If someone comes into my office with warts I ask them if they are getting about 6 hours of sleep. About half of them will give me this look at me like I'm from another planet. Knowing that many people will answer yes thinking no problem because they are in denial that that they need more sleep versus simply asking them if they are getting 8 hours of sleep. Because a wart is a virus your sleep debt will make it more difficult for your body to get rid of it. Think about more severe illness like when you developed mono in college because you were burning both ends of the candle. If you have a disease that lowers your immunity like uncontrolled diabetes then sleep takes on an even bigger role. There are some Olympians that end up sleeping more than 8 hours on some days because of the stress they are putting their body through in training. Working out at reasonable hours in in the morning seems to fit our natural rhythm more. Working out too late can actually inhibit normal sleep patterns. If you can consistently get to bed early then getting up super early is not a bad thing. Remember, though , even Rocky broke training on his apartment couch with Adrien in the midnight hour so easier said than done.You may or may not get Salmonella if you eat the raw eggs but I guarantee you will not have your body performing optimally under a a demanding training cycle if you are not getting your 8 hours.

Wham-O! I'm Not Superman!

So I was goofing off one summer in Buffalo,New York with my nephews on a slip and slide. I thought I might try cruising down the Slip 'n Slide set up on the lawn Silver Surfer style instead of ala Pete Rose head first into home plate... Big mistake.





At the time I had no problem. Somewhere around eight that night my ankle started to feel like it was being crushed. Wham-O! I'm talking about tears streaming down your face type pain. The torque on my ankle from my jumping had caused an acute bone bruise and sprain. The body has a memory to insult and it can react the opposite of delayed gratification. In this case it was pay your dues for your mortal sin of thinking you could crash your body like a teenager. 6 Advils and several sessions of ice and elevation later I was able to get to sleep a little past midnight. Just last week I was reminded of my weekend warrior body when after taking up my second
sessions of Gaelic Football I started experiencing intense pain this time in my foot about 2 hours into my daughter's friend's birthday party that forced me to the couch and crutches for 8 hours.
This time an acute sprain of my foot. The deal is that once your foot starts to swell even a little bit there are a lot of nerves down there that are not very happy. You also don't get to rest the area unless you are put in a cat or on crutches. I have patients that look at me dumbfounded regarding their hobbled condition with foot pain and I ask them what they did and they tell me I hiked or whatever and were fine at the but the reality is that your body remembers. Particularly if you have an old injury. You have to respect that.

On the Road to Recovery-Never give Up! What can we learn from the Bill's "Groundhogs Day"how many different ways can you lose a Superbowl

Many people may have forgotten Leon Lett's stripped ball by Don Bebe at the goal line due to raw perseverance on the play in one of Bill's Groundhogs Day how many different ways can you lose a Superbowl but it demonstrates an important life lesson. Never give up! At that point the game was a blowout and Bebe could have just shut it down when Lett was about to score after picking up a fumble. Instead Bebe hustled and chased him down. Here is the play : http://www.youtube.com/watch?v=NTeqQY_T2mE

I have some patients in my practice that simply give up on themselves. After an injury, I can give patients a game plan to help them rehab their injury like a coach but I can't go out to their homes and workplaces and make them do it.

When I injured my ACL in knee a second time doing jumping drills in a sports conditioning class I saw the Redskins's orthopedic surgeon. His answer was a surgical approach that would involve bone graft taken from my knee to fill in divots in my knee. I chose the consevative rout. I dedicated myself to getting the muscles around my knee as stong and flexible as they could be through strength yoga, condition and simply being active in sports year round. I also strengthened my core to take pressure of the joints. I got lucky avoiding the knife a second time but would not have had the chance had I not payed my dues in the gym.

I am now playing soccer and skiing hard but smart. I know I still have some instability in that knee.
Over time our body can develop movement patterns in sports that compensate for the weakness. Some injuries are to severe for this approach but unless you are a pro athlete on a fat contract you usually have time to make a decision for surgery. Take personal responsibility for your recovery. Most of it is up to you. Oh- and don't ever showboat at the big show unless that's how you want to be defined. 20years later the two men Bebe and Lett have become friends. Leon Lett actually talks about the play as a life lesson when he does speaking engagements.

On Sacrafice

At the end of the race the athlete pants, “I’ve given everything to be here.”

The overwhelming majority of Olympians have given everything to be an Olympian. What does that mean? It means a lot of things in the way of sacrifice...from Gary Hall Jr.'s archives at the LA Times

http://latimesblogs.latimes.com/olympics_blog/gary-hall-jr/

Support Our Athletes at the Winter Games

Team USA's dreams are on the line! We're in the final countdown to the 2010

If you'd like to be more connected to the games
click on team USA

Watch Out Nike!

This study is part of a body of evidence that will reshape the running shoe industry. Because of the extreme cushioning in some running shoes there is a delay in the peak moment of force higher up in the leg.
Benno Nigg Phd confirmed this with his work with accelerometers. This will reverberate through the running shoe industry.

http://www.dailyfinance.com/story/do-running-shoes-make-us-run-the-risk-of-injury/19309476/?icid=main|netscape|dl3|link3|http%3A%2F%2Fwww.dailyfinance.com%2Fstory%2Fdo-running-shoes-make-us-run-the-risk-of-injury%2F19309476%2F

EET Fitness Intervals : The Ultimate Metabolic Message

The EET (Eating and Exercise TIMING) Fitness Plan utilizes Fat Burning Interval Workouts that only take 15-30 minutes.

At the end of this post, you will find one of the many research articles on Interval Training and why it is the best method of exercise for weight loss and fitness.

There is strong evidence that interval training is highly effective to dramatically improve your fitness level and muscle tone, as well as burning fat while maintaining muscle mass. Plus, the fat burning continues after interval training throughout the rest of the day.

There are many many such articles and research studies that support these claims.

So the scientific research can satisfy participants that EET workouts are the most effective possible.

But, there is more to the story. EET included the interval workouts before reading very much scientific research at all.

Why else would interval workouts be part of EET?

The answer lies in the fundamental concepts behind the EET Fitness Plan. Survival Instinct and sending the most powerful messages to your metabolism possible in order to create a new metabolic memory, which assists participants in losing weight and becoming more fit. Here's how it works:

Assume you lived in the time of the Ancient Romans and that you were a slave who was forced to become a gladiator.

During your fights, you would push yourself physically as hard as you could for a relatively short time (until you killed your opponent or they killed you). Even within each fight you would have times of maximum exertion wrestling your opponent, and a few brief pauses when you could try to catch your breath.

And, each time you would be asked to fight, you would know that your life depended on it. Your upcoming fight would be on your mind far more than when you were just fighting, and your body would be aware that it was going to be asked to defend itself to the highest level possible far more often than just during your fights.

The gladiators workout regime has several similarities to an EET Fitness Participant. First, by pushing yourself as hard as you can you are sending a clear message to your body/metabolism that you must be CAPABLE of doing your workout at the highest level of intensity you can manage, and your body/metabolism must adjust so that you can perform and continue to succeed at your workouts. Your body/metabolism will begin to do what it takes to become lighter and leaner to make it easier to survive the intensity of your interval workouts.

The message is just as clear that your body needs to retain as much muscle as possible in order to perform the challenging intervals. Also, by taking short breaks between sets of your intervals, you are sending a clear message to your body that you will allow your muscles to recover so you have full access to them during your sets.

Everything about the interval workout sends the ideal message to your body/metabolism and your mind about how you want your body to look and the level of fitness you desire.

Secondly, your body/metabolism as well as your mind will be aware at all times that the next interval workout is coming soon (within 24-48 hours) and therefore must continue to prepare itself to be able to handle that workout, in order to "survive".

This is why the workouts don't have to be long in order to have dramatic results. If your body knows it will be pushed to your limits even for a short time, it must be prepared to handle it and therefore it will work all day to ensure you are prepared for your battle.

As you continue to repeat and improve at EET's Fat Burning Workouts, your body and metabolism will understand the powerful message you are sending, that you are asking it to do something different than it has before, and as a result, your body and your metabolism must change in accordance with the message being sent.

And, like the gladiator, your body/metabolism will ensure throughout the day that you are prepared to handle your next brief "test of survival". Repetition of interval workouts will become a key part of your new metabolic memory that your body needs to be lean and fit because intervals will be an ongoing part of your life.

HIGH-INTENSITY INTERVAL TRAINING:
THE OPTIMAL PROTOCOL FOR FAT LOSS?

James Krieger

As exercise intensity increases, the proportion of fat utilized as an energy substrate decreases, while the proportion of carbohydrates utilized increases (5). The rate of fatty acid mobilization from adipose tissue also declines with increasing exercise intensity (5). This had led to the common recommendation that low- to moderate-intensity, long duration endurance exercise is the most beneficial for fat loss (15). However, this belief does not take into consideration what happens during the post-exercise recovery period; total daily energy expenditure is more important for fat loss than the predominant fuel utilized during exercise (5). This is supported by research showing no significant difference in body fat loss between high-intensity and low-intensity submaximal, continuous exercise when total energy expenditure per exercise session is equated (2,7,9). Research by Hickson et al (11) further supports the notion that the predominant fuel substrate used during exercise does not play a role in fat loss; rats engaged in a high-intensity sprint training protocol achieved significant reductions in body fat, despite the fact that sprint training relies almost completely on carbohydrates as a fuel source.

Some research suggests that high-intensity exercise is more beneficial for fat loss than low- and moderate-intensity exercise (3,18,23,24). Pacheco-Sanchez et al (18) found a more pronounced fat loss in rats that exercised at a high intensity as compared to rats that exercised at a low intensity, despite both groups performing an equivalent amount of work. Bryner et al (3) found a significant loss in body fat in a group that exercised at a high intensity of 80-90% of maximum heart rate, while no significant change in body fat was found in the lower intensity group which exercised at 60-70% of maximum heart rate; no significant difference in total work existed between groups. An epidemiological study (24) found that individuals who regularly engaged in high-intensity exercise had lower skinfold thicknesses and waist-to-hip ratios (WHRs) than individuals who participated in exercise of lower intensities. After a covariance analysis was performed to remove the effect of total energy expenditure on skinfolds and WHRs, a significant difference remained between people who performed high-intensity exercise and people who performed lower-intensity exercise.

Tremblay et al (23) performed the most notable study which demonstrates that high-intensity exercise, specifically intermittent, supramaximal exercise, is the most optimal for fat loss. Subjects engaged in either an endurance training (ET) program for 20 weeks or a high-intensity intermittent-training (HIIT) program for 15 weeks. The mean estimated energy cost of the ET protocol was 120.4 MJ, while the mean estimated energy cost of the HIIT protocol was 57.9 MJ. The decrease in six subcutaneous skinfolds tended to be greater in the HIIT group than the ET group, despite the dramatically lower energy cost of training. When expressed on a per MJ basis, the HIIT group's reduction in skinfolds was nine times greater than the ET group.

A number of explanations exist for the greater amounts of fat loss achieved by HIIT. First, a large body of evidence shows that high-intensity protocols, notably intermittent protocols, result in significantly greater post-exercise energy expenditure and fat utilization than low- or moderate-intensity protocols (1,4,8,14,19,21,25). Other research has found significantly elevated blood free-fatty-acid (FFA) concentrations or increased utilization of fat during recovery from resistance training (which is a form of HIIT) (16,17). Rasmussen et al (20) found higher exercise intensity resulted in greater acetyl-CoA carboxylase (ACC) inactivation, which would result in greater FFA oxidation after exercise since ACC is an inhibitor of FFA oxidation. Tremblay et al (23) found HIIT to significantly increase muscle 3-hydroxyacyl coenzyme A dehydrogenase activity (a marker of the activity of b oxidation) over ET. Finally, a number of studies have found high-intensity exercise to suppress appetite more than lower intensities (6,12,13,22) and reduce saturated fat intake (3).

Overall, the evidence suggests that HIIT is the most efficient method for achieving fat loss. However, HIIT carries a greater risk of injury and is physically and psychologically demanding (10), making low- and moderate-intensity, continuous exercise the best choice for individuals that are unmotivated or contraindicated for high-intensity exercise.

1. Bahr, R., and O.M. Sejersted. Effect of intensity of exercise on excess postexercise O2 consumption. Metabolism. 40:836-841, 1991.

2. Ballor, D.L., J.P. McCarthy, and E.J. Wilterdink. Exercise intensity does not affect the composition of diet- and exercise-induced body mass loss. Am. J. Clin. Nutr. 51:142-146, 1990.

3. Bryner, R.W., R.C. Toffle, I.H. Ullrish, and R.A. Yeater. The effects of exercise intensity on body composition, weight loss, and dietary composition in women. J. Am. Col. Nutr. 16:68-73, 1997.

4. Burleson, Jr, M.A., H.S. O'Bryant, M.H. Stone, M.A. Collins, and T. Triplett-McBride. Effect of weight training exercise and treadmill exercise on post-exercise oxygen consumption. Med. Sci. Sports Exerc. 30:518-522, 1998.

5. Coyle, E.H. Fat Metabolism During Exercise. [Online] Gatorade Sports Science Institute. http://www.gssiweb.com/references/s0...20000006d.html [1999, Mar 25]

6. Dickson-Parnell, B.E., and A. Zeichner. Effects of a short-term exercise program on caloric consumption. Health Psychol. 4:437-448, 1985.

7. Gaesser, G.A., and R.G. Rich. Effects of high- and low-intensity exercise training on aerobic capacity and blood lipids. Med. Sci. Sports Exerc. 16:269-274, 1984.

8. Gillette, C.A., R.C. Bullough, and C.L. Melby. Postexercise energy expenditure in response to acute aerobic or resistive exercise. Int. J. Sports Nutr. 4:347-360, 1994.

9. Grediagin, M.A., M. Cody, J. Rupp, D. Benardot, and R. Shern. Exercise intensity does not effect body composition change in untrained, moderately overfat women. J. Am. Diet Assoc. 95:661-665, 1995.

10. Grubbs, L. The critical role of exercise in weight control. Nurse Pract. 18(4):20,22,25-26,29, 1993.

11. Hickson, R.C., W.W. Heusner, W.D. Van Huss, D.E. Jackson, D.A. Anderson, D.A. Jones, and A.T. Psaledas. Effects of Dianabol and high-intensity sprint training on body composition of rats. Med. Sci. Sports. 8:191-195, 1976.

12. Imbeault, P., S. Saint-Pierre, N. Alméras, and A. Tremblay. Acute effects of exercise on energy intake and feeding behaviour. Br. J. Nutr. 77:511-521, 1997.

13. Katch, F.I., R. Martin, and J. Martin. Effects of exercise intensity on food consumption in the male rat. Am J. Clin. Nutr. 32:1401-1407, 1979.

14. Laforgia, J. R.T. Withers, N.J. Shipp, and C.J. Gore. Comparison of energy expenditure elevations after submaximal and supramaximal running. J. Appl. Physiol. 82:661-666, 1997.

15. Mahler, D.A., V.F. Froelicher, N.H. Miller, and T.D. York. ACSM's Guidelines for Exercise Testing and Prescription, edited by W.L. Kenney, R.H. Humphrey, and C.X. Bryant. Media, PA: Williams and Wilkins, 1995, chapt. 10, p. 218-219.

16. McMillan, J.L., M.H. Stone, J. Sartin, R. Keith, D. Marple, Lt. C. Brown, and R.D. Lewis. 20-hour physiological responses to a single weight-training session. J. Strength Cond. Res. 7(3):9-21, 1993.

17. Melby, C., C. Scholl, G. Edwards, and R. Bullough. Effect of acute resistance exercise on postexercise energy expenditure and resting metabolic rate. J. Appl. Physiol. 75:1847-1853, 1993.

18. Pacheco-Sanchez, M., and K.K Grunewald. Body fat deposition: effects of dietary fat and two exercise protocols. J. Am. Col. Nutr. 13:601-607, 1994.

19. Phelain, J.F., E. Reinke, M.A. Harris, and C.L. Melby. Postexercise energy expenditure and substrate oxidation in young women resulting from exercise bouts of different intensity. J. Am. Col. Nutr. 16:140-146, 1997.

20. Rasmussen, B.B., and W.W. Winder. Effect of exercise intensity on skeletal muscle malonyl-CoA and acetyl-CoA carboxylase. J. Appl. Physiol. 83:1104-1109, 1997.

21. Smith, J., and L. McNaughton. The effects of intensity of exercise on excess postexercise oxygen consumption and energy expenditure in moderately trained men and women. Eur. J. Appl. Physiol. 67:420-425, 1993.

22. Thompson, D.A., L.A. Wolfe, and R. Eikelboom. Acute effects of exercise intensity on appetite in young men. Med. Sci. Sports Exerc. 20:222-227, 1988.

23. Tremblay, A., J. Simoneau, and C. Bouchard. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 43:814-818, 1994.

24. Tremblay, A., J. Després, C. Leblanc, C.L. Craig, B. Ferris, T. Stephens, and C. Bouchard. Effect of intensity of physical activity on body fatness and fat distribution. Am J. Clin. Nutr. 51:153-157, 1990.

25. Treuth, M.S., G.R. Hunter, and M. Williams. Effects of ex

Choose the right tools for the job & avoid injury

So I was playing soccer the other night with my Mundo shoes. The little nubbie things grabbed the indoor carpet and I had one of those While E. Coyote moments (you know where he suddenly realizes he’s over the edge of the cliff and his head stays there a second agape while the rest of his body keeps moving.) as my knee popped in and out of joint. I originally hurt my knee with a bucket handle tear of my meniscus and acl tear on a red clay field that soccer field that is indigenous to the Washington DC area developed on swampland. Again the shoe selection,in this case cleats instead of my Mundos was the wrong one for the field. Sometimes a small thing can have a major effect on an outcome.

What I did was akin to using a flat head screw driver for a Phillips screw. Lesson learned:choose the right tools for the job, in the case of the turf flats such as Sambas. In the case of the dry red clay no cleats.

Making a Man Out of Mac & Getting Back the Six Pack Back For Spring

I was fascinated by the dude getting sand kicked in his face on the back of comic books growing up...
I now know that developing strength, tone and muscle building

is not a direct function of how much you max out on at the gym.
If you workout smarter and eat accordingly burning the fat and buffing
up does not have to eat up all your time.



For example if you work out one or two body parts per session i.e.
chest/ shoulders you will develop strength and muscle faster because
you are extensively working those targeted areas vs doing a bunch of
different body parts. Now throw on some Tabatta intervals on top of that
named after the Japanese speed skating coach which consist of 20
seconds at all out intensity of an activity such as jumping rope,
speed bag,or core work followed by 10 second rest for 4-5 minutes
and you will boost your adrenaline and testosterone levels promoting
fat burn and muscle building.

If you do additional cardio later that day you are burning down the calories
your body needs to muscle build. Also if you natural lean body mass like me
you have to up your calorie count particularly around the zones of your work out.
If you are on the other end of the spectrum then do not binge at night.
You can readmore on this on my friend Jon's posts on this blog.

In short order you will burn off the six packs watching ballgames and the
Olympics over the winter and build up your new six pack.
You still have to be consistent to make it back.