Dr. Kyle: High Intensity Interval Training!

I’m sure you’ve heard the hype about high intensity interval training (HIIT) – bursts of exertion separated by short periods of recovery – sound tough, right? That’s because it is. The attention around HIIT has provoked researchers to further investigate it’s physiological benefits, which have been promising.

The problem with most workout programs is lack of intensity. People putt around the gym for about an hour, jump from one machine to the next without breaking a sweat. What’s the problem? Nothing, if your goal is to build strength. But from a physical fitness and weight loss perspective, you are overlooking HIIT’s cardiovascular and fat-incinerating benefits.

HIIT is a time-efficient strategy to increase muscle and accelerate fat loss. Intervals of activity and rest can vary between 30 seconds to a few minutes. The duration and intervals can be modified depending on the individual and goal in mind. The objective is to create a fast-paced and physically demanding workout that challenges our threshold of exercise intensity.

So why HIIT vs. cardio?

HIIT is most commonly compared to moderate intensity continuous training (MICT). MICT, also known as steady state cardio, consists of long periods of activity at constant intensity. For example, 45 minutes of jogging at 5km/h is considered MICT. Although it provides significant cardiovascular improvements and may be a favourite for endurance training, HIIT can offer more!! Remember, you can’t go wrong with increasing the intensity of exercise. Let’s compare!

With regards to that pesky body fat, HIIT significantly reduces abdominal and visceral fat in both men and women (1). High intensity training, above 90% peak heart rate, was more effective at reducing whole-body adipose tissue. Many studies show HIIT is superior to MICT in improving aerobic fitness (2). Cardiovascular measures (VO2 max, contractile function, ejection fraction, respiratory fitness and endothelial function) significantly improved with 7-12-week HIIT programs. This holds true for people who have previously suffered from a cardiac incident. Implementing HIIT under supervision during cardiac rehabilitation can improve quality of life by enhancing their cardiorespiratory fitness. No deaths or cardiac events occurred during HIIT programs across all recent studies. What doesn’t kill you makes you stronger, right?

Additionally, studies have demonstrated greater improvements in insulin sensitivity, glucose regulation, HDL cholesterol, and blood pressure with HIIT compared to MICT (2,3). Improved insulin sensitivity allows the body to utilize glucose more efficiently as energy, instead of being stored as fat! By implementing HIIT with intermittent fasting, the body utilizes fat stores for energy, increasing fat oxidation and mobilization (4). HIIT is also more effective than MICT at reducing oxidative stress and inflammation (5). These benefits are observed in subjects across all age categories. HIIT doesn’t discriminate; all can experience the health advantages of HIIT.

HIIT is extremely efficient because we experience what’s known as “excess post-exercise oxygen consumption,” or EPOC – meaning we reap the calorie-burning effects hours after our workout.

During intensive exercise, energy stores are quickly depleted. Our carbohydrate stores, oxygen and other essential compounds are exhausted, resulting in an energy deficit. After HIIT, we eventually reach our normal resting level of metabolic function. Carb stores are replaced (with an appropriate diet), oxygen levels will increase, and body temperature will return to normal (6). These processes require energy, explaining why we continue to burn calories after exercise. Even though HIIT and MICT both induce EPOC, HITT increases lipid metabolism to a greater extent AND is extremely time efficient (6).

So whether you want to call it HIIT, interval training, circuit training, etc., say hello to the most time efficient and beneficial exercise available. Combining HIIT with intermittent fasting and a wholesome diet, expect accelerated fat loss and physical fitness improvements. So what are you waiting for? Let’s turn up the intensity to 11!

References:

1. Maillard F, Pereira B, Boisseau N. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Medicine. 2018 Feb 1;48(2):269-88.

2. Hannan AL, Hing W, Simas V, Climstein M, Coombes JS, Jayasinghe R, Byrnes J, Furness J. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Open access journal of sports medicine. 2018;9:1.

3. Costa EC, Hay JL, Kehler DS, Boreskie KF, Arora RC, Umpierre D, Szwajcer A, Duhamel TA. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in adults with pre-to established hypertension: A systematic review and meta-analysis of randomized trials. Sports Medicine. 2018 Sep 1;48(9):2127-42.

4. Wilson RA, Deasy W, Stathis C, Hayes A, Cooke M. Combining intermittent fasting with high intensity interval training reduces fat mass by increasing fat oxidation and mobilization. InAustralia and New Zealand Obesity Society and Breakthrough Discoveries 2018 Joint Conference, Melbourne, Australia, 16-18 October 2018. 2018

5. Ramos, Joyce S., et al. “The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis.” Sports medicine 45.5 (2015): 679-692.

6. Ahlert M, Matzenbacher F, Albarello JC, Halmenschlager GH. Comparison of epoc and recovery energy expenditure between hiit and continuous aerobic exercise training. Revista Brasileira de Medicina do Esporte. 2019 Feb;25(1):20-3.

Dr. Phil Shares: Does Your Water Need A Boost?

Does Your Water Need a Boost?

Since the body is 60% water, drinking H20 is “crucial for so many of the most basic biologic functions. Cells need to be hydrated with water or they literally shrivel up and can’t do their job as efficiently,” says Robin Foroutan, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics. That includes an impaired ability to expel environmental waste and detox; if you’re dehydrated you may feel cloudy-headed, have headaches or feel constipated, among other ills.

Plain water should always reign as your drink of choice. “It has a better capacity to usher out metabolic toxins from the body compared to liquid that already has something dissolved in it, like coffee or tea,” says Foroutan. However, there are certain additions that can make the once-plain sip seem more interesting and deliver health benefits, too.

Here, alternative hydration boosters to try (and which ones to skip):

Not only does a slice of lemon provide a refreshing taste, but “it’s alkaline-forming, meaning it helps balance out things that are naturally acidic in the body,” says Foroutan. This can have an added post-workout benefit “it can reduce lactic acid, an end product of exercising muscles,” she says.

This amino acid supplement is in a powder form, so it dissolves nicely in water and has a lemon-like taste, says Foroutan. “Acetyl L-Carnitine is a mitochondrial booster. Your mitochondria, the powerhouses of the cells that make cellular energy, help the body use fat for fuel more efficiently,” she says.

Vitamin B12 is crucial for overall health and plays a key role in keeping the brain and nervous system working. “It’s mainly found in animal products, meaning many vegetarians and vegans need to supplement with it, but even some meat eaters have trouble absorbing it,” says Foroutan. “You can have the best kind of diet and even feel OK but have a B12 level that’s less than optimal. When we bring those levels up, people tend to feel more energetic and their mood is better,” she says. Try adding a dropper-full of B12 to your glass of water once a day, suggests Foroutan.

Many grocery stores now stock bottled hydrogen water, but a less expensive solution is purchasing molecular hydrogen tablets to add to your drink. “These can be used to help balance inflammation in the body,” says Foroutan. While inflammation is a normal body process — it happens during exercise, too — low-grade chronic inflammation is damaging. One review in the International Journal of Sports Medicine concluded hydrogen may also boost exercise performance, though researchers are still examining potential mechanisms.

If you have trouble getting enough water because you don’t like the taste, then a bubbly drink (one that contains zero artificial or real sweeteners) can be a healthy way to motivate yourself to drink more. Research in the American Journal of Clinical Nutrition found sparkling water was just as hydrating as regular water. Still, there’s some concern these drinks may wear away at tooth enamel, (although the American Dental Association says they’re far better than soda), so consume carbonated water in moderation.

If you’re active, you lose electrolytes in sweat and it’s important to replace them, but in a smart way, says Foroutan. Many bottled electrolyte waters contain just a trace amount and are often loaded with added sugars, notes Foroutan, so it’s important to read the labels carefully. You can also skip the sugary drinks altogether by buying electrolyte tablets and dissolving them in water. What’s more, “you can get electrolytes from leafy greens (Think: a handful of spinach in your smoothie or a chicken-topped salad),” says Foroutan.

Alkaline water has a higher pH than regular water, but alkalized bottled water is expensive, and there just isn’t enough research to support making the investment, according to the Mayo Clinic and Cleveland Clinic. Foroutan agrees there’s no reason to buy it bottled, but if you really want to try it “you can add a pinch of baking soda to water to create alkaline water.”

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Should You Get an Extra Hour of Sleep or a Workout?

Should You Get an Extra Hour of Sleep or a Workout?

You’re lying in bed, trying to decide what time to set your alarm for tomorrow. You could get a full seven hours of sleep if you wake up at your normal time, or you could wake up an hour and a half earlier to make that morning spin class. Which should you choose?

This seemingly simple riddle is one we’ve all faced at some point. The decision seems impossible. Sleep is essential for a healthy immune system and injury-prevention, but exercise can contribute to better, sounder sleep.

PRIORITIZE SLEEP

“Sleep and exercise are both incredibly important for your body, but if you have to choose one it has to be sleep,” says Amy Leigh Mercree, a wellness coach. “Adequate amounts of sleep gets your body the time it needs to replenish and refresh your cellular functioning. If you do not get to do that, your health will suffer greatly.”

Most experts agree that when forced to choose, they’d almost always choose sleep. Adults need 7–9 hours of sleep, according to the National Sleep Foundation, for optimal performance, memory retention and good health. But achieving a sound night’s sleep is largely dependent on your commitment to your body’s circadian rhythm, which is when we normally go to bed and wake up. A Northwestern study showed our muscles also follow that circadian cycle, meaning if you’re working out during the time when you’re normally asleep, your muscle repair will be less efficient.

EXERCISE IS IMPORTANT, TOO

But just because sleep is usually the answer doesn’t mean you should discount the need for exercise for your overall health if you’re always crunched for time. “Exercise changes the brain and is critical for brain health. What’s good for your body is good for your brain, too,” said John Assaraf, brain researcher and CEO of NeuroGym. “Through exercise, you are feeding your brain by increasing blood and oxygen flow.”

When you have to choose, remember a short workout is better than no workout at all. If you have only 10 minutes, do a quick workout at home with simple exercises like squats, jumping jacks and planks. There are also lots of apps that can give you a quick workout for a specific time frame using only your bodyweight.

BE HONEST WITH YOURSELF

If you find yourself constantly short on time, it might also be good to see where that time is actually going. Try tracking your days meticulously for a week to see where you might be wasting time. Almost everyone is guilty of too much time on social media or watching TV, so see if you could substitute that time for working out. This will help you get a proper night’s sleep and a workout.

by Tessa McLean

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: Posture Perfect

You can prevent slips and falls. You can reduce your risk of a motor vehicle accident. You can limit contact sports. One thing that you cannot avoid however, is gravity. If your body and spine are not aligned, the force of gravity will start to wreak havoc on your musculoskeletal system. Making sure we maintain proper posture throughout our work day is critical for longevity in our career. So how do we protect ourselves?

The secret to good posture is maintaining the spines natural curves. When standing, your head, shoulders, hips and ankles should all line up. When sitting, your ears, shoulders and hips should be in line and your buttocks should be at the back of the chair. Sit tall with your chest and head up.

Some tips for creating an ideal posture include:

• Stand tall with shoulders back
• Tuck your chin
• Brace the abdomen
• Squeeze your glutes
• Keep your knees slightly bent

Due to modern day technology, one of the most common signs of poor posture is anterior head carriage. This mean that the head is resting too far forward away from the body. We are not always cognisant of our head posture as we check our smart phones and work on our laptops. The farther our head protrudes forward, the greater the force on our neck. This can lead to chronic neck and upper back pain and lasting postural alterations.

One exercise I recommend to patients to reduce anterior head carriage are chin tucks. These can be done up against a wall or lying flat on your back. You simply bring your chin directly in towards the spine and hold. You can press gently into the wall or pillow to enhance the muscle contraction of your deep neck extensors. Now your spine will naturally carry the weight of your head and allow your neck and upper back muscles to relax. So keep your chin up and your pain levels down!

For more tips and tricks to enhance your posture, visit my Instagram page @drkylearam of email me at drkyle@forwardhealth.ca.

Dr. Kyle: Tips For Sleeping Better

1. Make your bedroom your oasis. If you are going to invest in something, why not invest in a good mattress and pillow that you will spend almost a 1/3 of your life on. Complete your bed with comfy blankets and sheets.

2. Keep it dark. Shut off all alarm clocks, TV’s, phones etc. Make sure no LED light is being emitted. This may require you to unplug some electronics around your room. Black-out curtains are a must.

3. Control room temperature. Make sure you are not too hot or too cold. There is nothing worse than sweating all night under the covers while your body struggles to maintain optimal body temperature.

4. Stop consuming caffeine after 2pm. This ensures that the effects of caffeine will be long gone before your head hits the pillow. Try a decaf coffee in the afternoon to fight off cravings.

5. Don’t work out within 2 hours before bed. This will disrupt hormone rhythms and deprive your body of energy stores needed to repair your body as you sleep.

6. Meditate. A simple 5-10 minutes mediation or deep breathing routine will calm the nervous system and transition you from our fight-or-flight response to your rest-and-digest state.

7. Reduce exposure to blue light after the sun goes down. Change display settings on your phone or use computer programs to block out blue light at night.

8. Have a chamomile tea or small snack with raw-honey to maintain your blood sugar levels throughout the night.

Sweet Dreams!

Dr. Kyle: Torn ligament? Maybe not.

Knee pain can come in a variety of presentations. Whether from a sports injury, slip and fall, or out of the blue, no two knee injuries are completely alike. The extent to which tissues are damaged is specific to the patient’s genetics, lifestyle, trauma, and fitness level. A well-trained athlete may be quite high functioning even with a serious tear, while a mild injury may keep a very sedentary person out of commission for several months.

Often times I will hear “hey doc, I think I might have heard a pop and the inside of my knee really hurts!”. My first reaction is to suspect a ligament tear. Once examining the patient further however, orthopedic testing shows stable knee ligament testing, no swelling or redness, and no severe joint line tenderness. So what’s the deal?

Like most soft tissue injuries, ligaments can be damaged to varying degrees. In the clinical world, there are 3 grades of ligament tears. Grade 1 is mild ligament damage, grade 2 is moderate, and grade 3 is severe/ruptured ligament tear. Common symptoms of a complete tear include sudden onset of pain and severe swelling, joint instability, and impaired function. The truth is, disruption of tendon fibers can happen to varying degrees. Think of muscle strains and ligament sprains on a spectrum of structural damage from 0 to 100%. The higher percentage of damage, the longer time it will take to establish preinjury performance levels.

Fortunately, if ligament stability is determined to be adequate by a healthcare professional, a conservative trial of care will often resolve symptoms. Ligaments in the body have the natural ability to heal on their own. Healing consists of 3 distinct phases including the inflammatory phase, the reparative phase, and the remodelling phase. Simply put, fibrotic scaffolding will be laid down so newly formed collagen can connect the severed ends of the tear. It is important to seek proper medical attention so that rehabilitation can begin as soon as possible.

For injuries of this nature, treatment will often begin with controlled range of motion exercises. Other modalities such a laser and acupuncture are helpful for enhancing healing at this stage. As tensile strength of the ligament improves, the joint will be able to tolerate more load. Eventually strengthening exercises will be included into the plan of management and progressed with increasing difficulty.

So if you or someone you know is worried that their knee pain may need surgical intervention, make sure you get it assessed by a medical professional who specializes in musculoskeletal injuries. It may be quite reassuring to know that with the right tools and knowledge the body will be able to heal and adapt on its own.

For more information, please contact drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:
Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. Journal of biomechanics. 2006 Jan 1;39(1):1-20.

Dr. Phil Shares: 3 Common Walking Myths, Busted

3 Common Walking Myths, Busted

When it comes to exercise, walking doesn’t always get the respect it deserves — and it’s time that changed. Before buying into the idea that walking isn’t a worthwhile workout, learn the truth behind these three common walking myths.

There is a great feeling of accomplishment when your fitness tracker buzzes to signal you hit 10,000 steps. But Carol Ewing Garber, PhD, professor of movement sciences at Columbia University, believes it might be an arbitrary target.

Yes, there are studies that show walking 10,000 steps per day is associated with lower blood pressure and improved glucose tolerance but the idea of walking the equivalent of five miles per day could feel overwhelming to new exercisers.

“[Walking 10,000 steps] will result in health benefits,” Garber says. “But it should be noted that … there is benefit even with small amounts of walking and the benefits increase with the more steps you walk each day.”

Garber suggests aiming for 150 minutes of moderate-intensity exercise each week instead of setting a step count goal.

If you want to count steps, consider this: Walking an additional 2,000 steps per day — even if your current step count is minimal — helps lower body mass index and boost insulin sensitivity, according to research published in the journal BMJ.

Leslie Sansone, fitness expert and creator of Walk at Home Workouts is adamant: “Walking works for weight loss!”

A slow stroll around the block isn’t going to move the needle on the scale (although it does burn more calories than binge watching legal dramas). To lose weight with a walking workout, Sansone suggests high-intensity interval training or HIIT.

Picking up the pace — without breaking into a run — at regular intervals during your walk has a major impact on weight loss.

In one small study, researchers at the University of Virginia found that overweight women who logged three 30-minute, high-intensity walks and two moderately-paced walks per week for 12 weeks lost six times more belly fat than women who went for a slow stroll five days per week. A second study found that varying speed burned up to 20 percent more calories than maintaining the same pace.



Incorporating HIIT into your walking workout is simple, according to Sansone. After a 5-minute warmup walk at a slow pace, walk at a brisk pace for 30 seconds and then a regular pace for 4 minutes. Repeat the interval four times. End with a 5-minute cooldown walk.  

“Walkers have so many choices to get fit and stay fit for life,” Sansone says.

Walking can be a “gateway exercise” that helps new exercisers improve their cardiovascular fitness and stamina to transition to running but not all walkers want to run — and that’s OK.

“Walking is a good exercise for everyone,” Garber says.

study published in the journal Arteriosclerosis, Thrombosis and Vascular Biology found rates of hypertension, high cholesterol, heart disease and diabetes were lower for regular walkers than runners.

While a walk around the block is a good start, maximizing the benefits of a walking workout requires logging sufficient time in your sneakers. Garber suggests focusing on distance, duration or calorie expenditure (all viewable on your fitness tracker) noting that it’s the amount of exercise that counts — for both walkers and runners.

“If you start fitness walking today, you will instantly feel better and know you’re doing something good for your body, mind and soul,” Sansone says.

by Jodi Helmer

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Screen Time Negatively Affects Children’s Health

Screen time is quickly becoming one of the hottest topics for parents, healthcare practitioners, and educators. How much screen time should children and adolescents be allowed per day? Does screen time include the time spent on laptops to complete homework and reading assignments for classes? At what age should children begin to use screens? When is an appropriate developmental timeframe to buy your child a phone? Does the use of screens increase the risks of behavioral disorders and sleep problems in children and adolescents? The list of questions goes on and on.

Unfortunately, many of the answers to these questions are simply unknown at this time and some, honestly, are personal choices that each family has to make for themselves. Truly, there is no denying that the digital age is here to stay; screens are all around us, from televisions to smart watches, from iPods to smart phones, from tablets to laptops, there is literally a screen for everything. In 2017, 98% of homes in the US with young children had a mobile touch-screen device compared to 2011 when only 52% of households had such technology.1

Globally, the availability and usage of mobile touch-screen devices by children are at astonishingly high rates:1

  • In Australia, children under 2 years are reported to have an average weekly screen time of 14.2 hours, while those between 2-5 years old average 25.9 hours
  • In France, 78% of children were using a mobile touch-screen device by 14 months of age and 90% of children by 2 years of age
  • Across five countries in Southeast Asia, 66% of children between 3-8 years of age are reportedly using their parents’ mobile touch-screen device, while 14% of children already owned their own devices
  • In Britain, 21% of children aged 3-4 years of age are reported to own their own device

Interestingly enough, part of the dilemma of creating set guidelines on screen time in children is that there are various groups with sometimes competing and conflicting interests in this subject. Educational and tech focused organizations encourage the use of screen time for educational advantages and for enhanced benefits to long-term career and financial goals as children grow into adults. On the other hand, public health officials warn of the potential detriment to young minds and their still developing behaviors.

What is screen time displacing?

There are a variety of reasons cited by experts for keeping screen time to a minimum, particularly in young children.

Take for example the CDC, which states that children between the ages of 8-10 spend, on average, 6 hours per day in front of screens, including 4 hours of TV viewing.2 In children ages 11-14 this number skyrockets to 9 hours per day with approximately 5 of those being TV watching.2 Finally, in teenagers aged 15-18 the number of hours per day in front of a screen averages 7.5 with 4.5 being in front of a TV.2 These numbers are startling high when one realizes the activities which are NOT taking place when this much screen time is involved.

For instance –

  • Mentally and physically supportive health benefits which come from engaging in physical activity such as organized sports, neighborhood pick-up games, the unorganized activities of exploring and using imaginative play alone and in groups, and the quiet, downtime children and adolescents need to regroup and restore their bodies and minds
  • Social aspects of cultivating relationships with physically present individuals, learning how to read and empathize with emotional cues and needs, developing problem solving skills alone and in groups
  • Interconnectedness and responsibilities that come from supporting the family and local community networks through chores, volunteering, and taking part in events
  • Restful sleep and downtime to restore brain and body
  • Reading and engaging in learning opportunities not involving screens or directed education/learning
  • Mindful, present, and nutritious eating time with family, so as to avoid passive overconsumption of nutrient void foods

All of the above suffer when screen time overtakes the activities of unplugged healthful daily life.

Screen time duration impacts wellbeing

A study looked at the effects of screen time in 40,337 children and adolescents in the US between 12-17 years of age.3 For the purpose of this study, screen time included cell phones, computers, electronic devices, electronic games, and TV. The amounts of time spent on screens was compared to an array of psychological wellbeing measures.3

Results from this study found that the wellbeing of children and adolescents did not differ significantly (except in curiosity) between those spending no time on screens and those spending 1 hour or less per day on screens.3 However, after exceeding 1 hour of screen time, the risks to wellbeing increased– the researchers explained that increased screen time (> 1 hour/day), “was generally linked to progressively lower psychological well-being. In terms of relative risk (RR), high users of screens (≥ 7 hours/day) carried twice the risk of low well-being as low users (1 hour/day).”3 The low wellbeing measures included not staying calm (especially among 14- to 17-year-olds, RR 2.08), not finishing tasks (RR 2.53), not being curious (RR 2.72), and having less self-control and emotional stability.3 High users of screens compared to low users were described as more difficult to care for, while twice as many high (vs. low) users of screens had an anxiety or depression diagnosis.3 It was found that the effects of high screen time use on wellbeing was generally greater in adolescents than in children.3

Beyond psychological wellbeing, increased time spent on screens is also associated with increased risk of cardio-metabolic diseases and being overweight.4 It comes as no surprise that longer duration of reading and doing homework is associated with higher academic achievement.5 High use of screen time has also been linked to worsening sleep patterns in children and adolescents.6 In a review of 67 studies published from 1999 to early 2014, it was found that screen time was adversely associated with sleep outcomes (shortened duration and delayed timing) in children and adolescents in 90% of the studies.6  Knowing that restful and adequate sleep, particularly in children and adolescents, is associated with lower obesity risk, better psychological wellbeing, improved cognitive functioning, and lower risk-taking behaviors, it is important that the detrimental effects that screens have on sleep be minimized in this developing population.7

Managing & modeling healthy screen behaviors

A quick peak at the leading organizations’ recommendations on supporting healthy screen time in children and adolescents reveals similar guidelines across the groups which can be broken into 3 key areas:.

1. Model appropriate screen behavior. Modeling appropriate screen behavior begins with parents, guardians, caretakers, and educators. The authors in a BMC Obesity publication concluded that, “Mothers’ and fathers’ media parenting practices were associated with children’s screen time. Interventions aimed at reducing children’s screen time should address both mothers’ and fathers’ media parenting practices.”8 Screen time habits discussed in this article included, among other factors, screen use by parents during meal times.8

2. Limit screen time and limit to age-appropriate content. The American Academy of Pediatrics recommends the following guidelines:9

  • For children younger than 18 months, avoid use of screen media other than video chatting. Parents of children 18-24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they are seeing.
  • For children ages 2-5 years, limit screen use to 1 hour/day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children 6 years and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health.

Some researchers and practitioners recommend limiting screen time to 2 hours/day after age 5, not including educational screen time such as what is used for school, studying, and work-related screen interactions.10

3. Encourage face-to-face interactions and physical activity on a regular basis. Be intentional about daily “screen-free” time, particularly during mealtime, conversations, play time, family time, and bedtime. Support daily exercise for all children and adolescents being especially cognizant that sedentary screen time does not become a part of a child’s habits before the age of 5.11

Citations

  1. Straker L et al. Conflicting guidelines on young children’s screen time and use of digital technology create policy and practice dilemmas. J Pediatr. 2018;202:300–303.
  2. CDC. Screen time vs lean time. https://www.cdc.gov/nccdphp/dch/multimedia/infographics/getmoving.htm. Accessed December 18, 2018.
  3. Twenge JM et al. Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep. 2018;12:271-283.
  4. Braig S et al. Screen time, physical activity and self-esteem in children: the Ulm birth cohort study. Int J Environ Res Public Health. 2018;15(6):E1275.
  5. Carson V et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6)3:S240-265.
  6. Hale L et al. Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Med Rev. 2015;21:50–58.
  7. LeBourgeois MK et al. Digital media and sleep in childhood and adolescence. Pediatrics. 2017;140(2):S92–S96.
  8. Tang L et al. Mothers’ and fathers’ media parenting practices associated with young children’s screen-time: a cross-sectional study. BMC Obes. 2018;5:37.
  9. American Academy of Pediatrics. AAP announces new recommendations for children’s media use. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Announces-New-Recommendations-for-Childrens-Media-Use.aspx. Accessed December 18, 2018.
  10. Mayo Clinic. The Mayo Clinic Minute. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-much-screen-time-is-too-much-for-kids/. Accessed December 18, 2018.
  11. Canadian Paediatric Society, Digital Health Task Force. Screen time and young children: promoting health and development in a digital world. Paediatr Child Health. 2017;22(8):461–468.

Bianca Garilli, ND, USMC Veteran

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: Building Stronger Bones

When discussing bone health, we often talk about proper nutrition. Adequate vitamin D and calcium intake are usually recommended to enhance bone mineral density (BMD). What is not discussed as often is the role of exercise and weight training for increasing bone strength. A holistic approach looking at what we put IN our body as well as what we DO with our body is the key for building stronger bones.

As we age our body experiences several physiological changes. Our hormone levels change, muscle mass declines, and bones become less dense. Low bone density, otherwise known as osteopenia, increases our risk of fracture. Although we can bounce back from a slip or fall in our early years, a hip fracture in older individuals can have detrimental effects on quality of life. The good news is, there are important steps you can take to prevent or slow down the decline of BMD.

Research has demonstrated that healthy individuals and patients with osteoporosis can improve BMD with high-moderate impact activities and resistance training. A few examples of high impact exercises include step classes, jogging, and jumping jacks. Resistance or weight training on the other hand can include elastic band, pully, and free-weight based exercises. To put it simply, the more force you transmit through the bone, the more the bone will remodel and grow! Clinical judgment is needed to determine the intensity of force that each patient can tolerate.

Recent studies have found that high-intensity resistance training and impact training improves BMD and physical function in postmenopausal women. Low-intensity and light-resistance exercise programs are not enough to stimulate bone remodelling and improve BMD. Heavy multi-joint compound exercises such as squats and deadlifts induce extensive muscle recruitment and transmit greater force through the bones. In particular, these exercises will apply force through the lumbar spine and femoral neck, making them stronger and more resilient to fracture. Proper form and supervision are crucial when performing any high intensity or heavy loading activities.

Talk to a primary health care provider about your BMD and if an exercise program for developing BMD is right for you. Not only will exercise strengthen your bones, but it will have profound impacts on many other systems of the body as well. As always, if you have any question do not hesitate to contact me at drkyle@forwardhealth.ca or visit my Instagram page @drkylearam!

Reference:

Sinaki M. Exercise for patients with established osteoporosis. InNon-Pharmacological Management of Osteoporosis 2017 (pp. 75-96). Springer, Cham.

Mounsey A, Jones A, Tybout C. Does a formal exercise program in postmenopausal women decrease osteoporosis and fracture risk?. Evidence-Based Practice. 2019 Apr 1;22(4):29-31.

Dr. Phil Shares: What You Need to Know About Going to a Chiropractor

What You Need to Know About Going to a Chiropractor

The chiropractor. A lot of people swear by chiropractic treatments as the only way they get relief from back pain, neck pain, headaches, and a host of joint problems. Others aren’t so sure about this holistic wellness discipline. Regardless of what camp you’re in, allow us to demystify this type of care for you.

Chiropractors Train as Long as MDs Do

That’s right, a Doctor of Chiropractic (DC) studies for four years of undergraduate and four years of chiropractic school, using similar books that MDs use for study, says Scott Bautch, DC, president of the council on occupational health for the American Chiropractic Association. Chiropractors must also pass a licensure test and take continuing education courses to stay abreast of the latest trends in their field and maintain their credentials.

Chiropractors Can Help with Overall Wellness

People mostly see chiropractors for pain relief, but it’s becoming more popular to see a chiropractor for general wellness. “Chiropractors are increasingly becoming overall wellness advisors — advising patients about their eating , exercise, and sleeping habits,” Bautch says. Since chiropractors focus on the health of the nervous system, particularly the spinal cord, they are treating the entire body. Therefore, they are addressing both acute injuries (such as low back pain), as well as general, chronic issues (such as fatigue).

The First Appointment Will be Really Thorough

Chiropractors use comprehensive intake screenings to learn not just about what ails you, but also to get a complete picture of your overall health (hence the “holistic” descriptor). This will include health history questionnaires as well as functional and neurological assessments to see how your body moves, how well you can balance, etc. The doctor may also take x-rays. Finally, there will be a discussion about cost and course of treatment.

This thorough first appointment was experienced by New York City resident Karl Burns. In a tennis game, Burns swung his racket too forcefully and injured his low back. He was referred to chiropractor Cory Gold, DC. “At first, I thought, ‘I’ve never been injured before, I don’t need a voodoo doctor,’” says Burns. “But Dr. Gold and I immediately gelled. After many tests and questions, he told me, ‘Your treatment plan will be three times a week for a couple weeks, then two times a week for a couple weeks, then once a week — this is not a lifetime injury.’”

You’ll Likely Be a Regular, Initially

In most cases, people see chiropractors for acute injuries (like throwing your back out) or chronic conditions (like headaches), so it may take a few of weeks of multiple visits to stabilize the problem. After a few weeks of multiple treatments per week, treatment tapers gradually to once per week, then once per month for maintenance, until the spine is able to stay in alignment without the chiropractor’s adjustments. The course of treatment and length of time until stabilization vary from person to person.

That said, visits are often quite short — an average of 15 to 20 minutes — of hands-on manipulation. “Chiropractors aren’t trying to fight an internal battle against infection the way medical doctors are,” says Burns. “The treatment consists of much smaller movements and adjustments to your body and alignment of the spine.” Burns points out that he experienced pretty significant pain relief from the get-go. “Every time I walked out of there, I felt amazing,” he says. “The benefits are instant and can be perceived better [than with conventional doctors].”

You Won’t Be a Patient Forever

There’s a general belief that chiropractors want to make you reliant on them, but Bautch and Burns believe otherwise. “There are three phase of care,” Bautch says. “Acute — let’s get you functional; corrective — let’s adjust you so that it doesn’t happen again or as frequently; and then maintenance — maybe down to once a month.” Indeed, this is what Burns experienced — but he also learned the hard way the importance of self-maintenance. “Chiropractors take the approach of ‘let me teach you how to fish,’ not ‘let me just give you the fish,’” says Burns. He, like most patients, was given exercises to compliment and maintain his recovery — and he only ran into trouble again once he stopped doing them. “If I skip my exercises, sure enough, my lower back gets tight,” Burns says.

BY: Amy Roberts

Shared by Dr. Phil McAllister @ Forward Health Guelph