When I went to the doctor, I didn’t even have to see him before my problem was identified. His wife, who was assisting him, was recording my medical history. When she heard about my medicine ball escapade, she immediately told me that she often heard her husband advising patients my age (and even those quite a bit younger) not to lift weights overhead—and especially not repetitively. It was now clear to me, even before it was confirmed by the doctor and an MRI, that I had joined the crowd of my peers who had sustained a rotator cuff injury.
The orthopedist explained that, with age, there is simply less room within the shoulder joint because of normal calcification that occurs as the result of general wear and tear, and this room is compromised even more when we lift weights overhead. The result is trauma within the joint that tears the rather delicate rotator cuff muscles. This injury at least temporarily ended my nascent but promising boxing career. It also put a major crimp in my golf swing and the quality of my Pilates training. Fortunately, I didn’t require surgery, and after about 6 months of regular visits to an outstanding physical therapist, I returned to pain-free exercising.
As I described my experience to many of my patients, it seemed that half of the men and a third of the women I saw had also experienced rotator cuff problems. Many had required surgery, and almost all had learned the “nothing heavy overhead” lesson. I was really sorry that I hadn’t had that important piece of information earlier, when it could have saved me from my own injury.
During the time that my exercising was severely limited, I noticed another ailment. My wrist was hurting. Was this arthritis? No. It was carpal tunnel syndrome, a problem many of us boomers and preboomers develop by spending long hours typing on computers. In an informal survey of my patients and friends, carpel tunnel syndrome, like rotator cuff injuries, seemed to be occurring in epidemic numbers. And a quick review of the medical literature confirmed how common carpal tunnel syndrome has become in our postindustrial society.
I’m not telling you these stories to discourage you from exercising. The alternative is far worse. Being sedentary increases your risk of developing many of the illnesses known to man and woman, including arthritis, cancer, heart disease, and Alzheimer’s. I’m telling you this so you don’t make the same mistake I made. If I had known not to lift heavy objects repetitively over my head, I’d still be boxing today. The problem wasn’t the sport; it was the way I trained for it.
It doesn’t matter what activity you’re doing. You could be playing tennis, lifting weights, jogging, or ballroom dancing. If you do foolish things like ignore pain (as I did), do too much before your body is ready, ignore previous injuries, or don’t train properly for your sport or activity, you will get into trouble.
An Injury-Prone Generation
As more and more baby boomers heed the advice of their doctors and engage in various modes of exercise to stay fit, there’s no question they are becoming increasingly vulnerable to injury. Boomeritis is going to get a lot worse before it gets better. According to a 2006 article published in the New York Times, sports injuries were the number two reason for visits to a doctor’s office in the United States; only the common cold accounted for more visits! And orthopedists are reporting a surge of injuries among middle-aged athletes, weekend warriors, and wannabes.
Why are we injuring ourselves in record numbers?
One reason is that many people who have not exercised for years, or who have never exercised before and who are poorly conditioned, have suddenly decided to make up for lost time. They join a gym and start running full-out on a treadmill or lifting too-heavy weights with a vengeance, or they go for long jogs outside on hard pavement.
On one hand, it’s wonderful that so many people are inspired to start or increase a fitness program. On the other hand, this enthusiasm needs to be tempered with appropriate caution: Whatever form of fitness you pursue, it’s a good idea to begin slowly so you don’t get injured. There’s a reason our fitness program, which you’ll learn about in Part II of this book, is a three-phase program. During Phase 1, which you do for 2 weeks (or longer, if need be), you gently ease into an exercise routine, making sure your body is ready before you move on to the next phase. Once you’re in Phase 2, you will become stronger and more flexible, ready for an even more challenging workout. And once you’ve mastered Phase 3, you will know how to work your body in a safe, healthy way, and you’ll be able to integrate the concepts of the program into your own fitness regimen, if you like.
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living THE SOUTH BEACH DIET
Diane and Mark C., both age 58: A Diet We Can’t Stop Talking About!
My husband, Mark, and I have been following the South Beach Diet for more than a year, and we are so excited about our weight loss. We never stop talking about the diet. Over the past year, I have lost 38 pounds, dropping from 170 to 132. My husband lost 50 pounds, from 240 to 190. I started the diet first and within 2 weeks shed 8 pounds. Mark said he’d never go on a diet, but when he saw how well I was doing, he decided to join me. He lost an incredible 22 pounds over the first few weeks, and believe me, we didn’t starve ourselves.
I am a big eater, so the puny servings that most diets call for don’t satisfy me. But on the South Beach Diet, I ate until I was satisfied, and it sure worked for me.
Before going on South Beach, my husband was quite the junk-food junkie and a big beer drinker. Diets were never for him. He hated them. Today he’s a totally reformed eater and thrilled with his results. He’s good about following the principles of the South Beach Diet. Sometimes he’ll ask me, “Am I allowed to eat this?” He now realizes that he can have his cake and eat it, too, but not all the time and not so much.
I had tried many diets but always ended up gaining more weight than when I started. This time, it’s different. I actually went on an 11-day cruise and didn’t gain an ounce but ate very well. I had eggs for breakfast and ate nuts and veggies when I was snacking or hungry. For dinner, instead of having the ship’s decadent desserts, I’d ask for some fresh berries. The most amazing thing about the South Beach Diet is that it isn’t complicated, and you can always eat well no matter where you are.
Mark and I are both 58, and we had always heard that it’s harder to lose weight as you get older. The South Beach Diet made it easy.
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Too Much, Too Late
I’m a cardiologist who sees people every day who have heart disease or who are at risk for it. But sometimes I feel more like an orthopedist. I always take an exercise history from my patients because it is such an important part of their cardiac status. What I invariably hear is a litany of complaints characteristic of boomeritis: Low-back pain; rotator cuff pain; hip, knee, wrist, ankle, and neck pain; tennis elbow; Achilles tendinitis; and shin splints are the most common ailments cited. The good news is that almost all of these are preventable.
The problem is that many people—even the very fit—are not doing the right exercise for their bodies, especially their midlife bodies. For example, I see far too many knee and hip injuries in my practice, often among runners. In fact, I have rarely seen a baby boomer who runs regularly on hard surfaces who has not experienced knee, hip, and/or low-back problems. Many of these people continue to run even though their joints are tender and painful. I tell them that they can keep their running shoes, but it’s time to do more joint-friendly exercise, at least part of the time.
I also see a fair number of people who simply overdo it when it comes to exercise. Instead of giving their bodies a needed break, they keep pushing themselves harder and harder, farther and farther, to the point of injury. You can get away with running for miles every day on a hard surface when you’re in your teens or twenties, but by the time you hit 40, I don’t recommend it. The human body was never meant to sustain that kind of beating. (If you do want to continue running, I urge you to do an interval training program and run fast for only short periods of time, with adequate recovery periods. And, if possible, avoid hard surfaces.)
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sp; And it’s not just runners and middle-aged athletes who are exposing themselves to overuse injuries. Let me share another of my personal boomeritis experiences. About 10 years ago, I attended the annual American College of Cardiology meeting in New Orleans. I stayed at a hotel about a mile away from the convention center where the meeting was held. I walked to and from the center and then walked for miles within the convention center. Great exercise! Two days into the meeting, as I hiked back to my hotel, I began to notice pain and tenderness in my shins, which seemed to get worse with every step. Just as I thought I couldn’t walk any farther, I spotted a shoe-shine stand and decided that I needed a shine and a rest. As I sat down, I complained to the shoe-shine man that my shins were really aching. He observed the thin-soled loafers I was wearing and quickly made the diagnosis of shin splints. (I was clearly not the first conventioneer who had sought refuge at his stand because of shin pain.)
Dr. Shoe Shine quickly prescribed a well-known brand of rubber-soled shoes. Though I had long ago learned to wear thick-soled running shoes when I jogged, it had never occurred to me that I should be wearing them for walking or that shin splints wasn’t a malady suffered only by runners. I bought the recommended shoes and have walked long distances at many heart meetings since without a recurrence of shin pain. Still, too many others continue to pound the pavement one way or another without proper precautions, and they’re paying the consequences.
It’s not surprising, then, to learn that experts are predicting that the number of knee- and hip-replacement surgeries will soar as baby boomers reach their later decades. A study published in 2007 estimates that there will be 3.48 million total-knee replacements performed in 2030, a 673 percent increase from the number performed today. The study also predicts that there will be 572,000 hip replacements performed in 2030, a 174 percent increase from today’s number.
This does not mean that you should not exercise.
While it’s true that many of these spare parts will be going to aging athletes who have overworked their joints through the years, even more will be replacing the severely arthritic joints of people who may not have done enough exercise. A sedentary lifestyle can lead to being overweight or obese, and that too puts undue stress on the hips, spine, and knee joints. Even a small amount of weight loss can save your knees a lot of wear and tear. With every step you take, you impose a force of from three to six times your body weight across each knee. A 2005 study published in Arthritis & Rheumatism found that for every pound of body weight lost, there’s a 4-pound reduction in stress to the knee joint. Considering that you work your knee joints every time you stand or walk, the lighter the load, the better. The point is that overdoing it, as well as doing nothing, will lead you to the same operating room. This is why everyone needs to incorporate joint-friendly exercise and recovery periods into their fitness routines, and the earlier the better.
Smart Fitness
As it happens, many if not most of the boomeritis complaints I see in my office, including rotator cuff injuries and low-back pain, aren’t the result of sports injuries. Rather, they occur in people who are just going about daily chores, like bending over to strap a child into a car seat or picking up a bag of groceries. While some of these injuries are simply the result of weak core muscles and poor flexibility, I also see these problems occurring in the fittest of my patients—or at least the ones that look to be the fittest.
This gets me to another important point. Many people who think they’re doing smart workouts may be doing themselves more harm than good. Conventional weight lifting, sometimes called classic gym, can be counterproductive because it tends to isolate muscle groups and train them in a manner that is not naturally functional. In other words, the workout does not mimic everyday human activities, and it usually neglects the core muscles. The result is muscles that may look good in the mirror or on the beach but aren’t much help when it comes to injury prevention or performing active sports or day-to-day tasks.
The best exercises you can do to prevent boomeritis injuries are called functional exercises. These exercises, which are similar to movements you execute in your daily life, require you to use several muscle groups in one fluid movement. That’s why, in addition to cardio conditioning, our fitness program emphasizes functional fitness to strengthen your core and peripheral muscles. For example, when you lean over to pick up a child or lift heavy bags of groceries from your car, you’re not using just your arms and legs. If you did, you’d be overusing these muscles, leaving them vulnerable to injury. When you bend over to pick something up, you’re engaging all your muscles, including your legs, midline, back, and arms. The core muscles support all your other muscles and help you maintain strength, good posture, and balance.
You may be surprised to learn that as a cardiologist, I place as much importance on core-strengthening exercises as I do on cardio conditioning. The fact is, because this type of exercise promotes stability, strength, and flexibility, it’s essential for preventing injury and maintaining a healthy weight. And if you suffer an injury and you’re in pain, you’re not going to do an effective cardio workout—or any workout at all. In my practice, I see all too many patients who are no longer able to exercise due to injury.
The importance of functional fitness has only recently become appreciated. During my travels, I visit many gyms or fitness rooms associated with the hotels where I stay. I have noticed that more and more of the people who are exercising, with or without a trainer, have incorporated functional fitness into their workouts. I am pleased to find both women and men lifting hand weights while sitting on exercise balls, or using pulley-type machines, or standing on balance boards, which all require them to engage their core muscles as they work other parts of their bodies.
Watch the Core Busters
Of course, our ancestors didn’t have to worry about setting aside time to perform muscle-flexing and strengthening exercises to maintain fitness. They accomplished this while going about their everyday routines. Anthropologists tell us that cave dwellers had remarkably strong muscles and bones, thanks to their normal daily activities. Hunting and gathering was hard work. Stalking and killing prey and finding and picking fruits and vegetables provided a full-body workout. And if you injured your back, you might not survive. Even our very recent ancestors were more physically active than we are. Before society became industrialized, just getting through the day was physically challenging for both men and women. Chopping wood, tending the garden, scrubbing floors, washing clothes on a board or a rock and hanging them up to dry—all involved full and functional body movement.
Today we drive to work, take an elevator to our offices, and sit at our desks all day long. We now use the remote control not just for our TVs but for our sound systems, DVD players, lights, and even curtains. Our kids aren’t running around after school, climbing trees and playing sports like they used to, because they’re home playing video games. Our modern civilized world has created what I call core busters because they prevent our core muscles from getting the activity they were meant to experience. Muscles that aren’t used become weak and stiff, and weak, stiff muscles lead to further inactivity, a sluggish metabolism, and, eventually, injury.
Stop Sitting, Start Moving
We all need to be more aware of the core busters in our everyday lives. Exercising for a few hours a week is great, but we also need to think about what we’re doing the rest of the time. Are we just sitting around, or are we active and moving? Do we walk up the stairs or take the elevator? Do we hail a cab when we could walk? It turns out that the movements we do throughout the day—both consciously and subconsciously—burn calories. And these calories really do add up.
James A. Levine, MD, from the Mayo Clinic, has popularized a concept called NEAT, an acronym for “nonexercise activity thermogenesis.” NEAT reflects all the calories we burn when we are not sleeping, eating, or doing formal exercise. In a study published in 2005 in the journal Science, Dr. Levine and his colleagues compared NEAT in two groups
of people who did not formally exercise. Half were thin and half were obese. He found that the thin subjects who frequently got up from their desks to walk around or stretch, paced while talking on the phone, or just fidgeted were on their feet during their normal daily routines for 2 more hours than the obese subjects. This translated into burning 350 extra calories per day, enough to explain the difference in weight between the two groups.
In another interesting perspective on the importance of NEAT, William L. Haskell, PhD, of the Stanford Prevention Research Center, estimated that spending 2 minutes per hour sending e-mails rather than walking down the hall to speak with a colleague resulted in a 10-pound weight gain over 10 years. Wow! Maybe switching my office to paperless by using electronic medical software wasn’t such a good idea after all.
The unfortunate fact is that over the last 100 years, the proliferation of labor-saving devices, from the automobile to electronic software, has decreased NEAT by between 500 and 1,000 calories weekly. And this drop has clearly played an important role in our epidemic of obesity. But the impact of NEAT on our society, while disturbing, also presents an important opportunity. We need to plan our workplaces and our daily routines better to make up for all the energy expenditure we have lost because of the activities we no longer do.
NEAT is wonderful news for people who believe that the only way to stay trim and fit is to run marathons. Walking when you could be riding, standing when you could be sitting, and moving when you could be keeping still are easy ways to stay slim and strong for life.
The South Beach Diet Super Charged Page 7
