Category: Exercise Right.

Exercise and Bardet-Biedl Syndrome

Exercise and Bardet-Biedl Syndrome

Bardet-Biedl syndrome (BBS) is a rare genetic condition that affects several body systems, including the kidneys, eyes, and genitalia. People with BBS often have an intellectual disability and may be born with extra fingers or toes. They are also prone to developing abdominal obesity – a condition where fat is deposited mostly around the abdomen (rather than on the arms or legs). People born with BBS are usually a normal weight at birth, but rapidly gain weight in infancy.

Children and adults with BBS often need support from a team of healthcare professionals – including Accredited Exercise Physiologists (AEPs) – to maintain good health and optimal quality of life.

WHY IS EXERCISE IMPORTANT FOR PEOPLE WITH BBS?

Overweight and obesity, common features of BBS, are linked with a higher risk of developing several health conditions, including heart disease, type 2 diabetes, some cancers, stroke, high blood pressure and joint problems, among others. Abdominal obesity, in particular, is associated with metabolic changes that can increase the risk of cardiovascular disease. It is estimated that up to 45% of people with BBS have type 2 diabetes.

Furthermore, excess weight can further complicate problems with the heart and blood vessels seen in some people with BBS. These include early stiffening of the heart valves and heart defects that can lead to irregular heart rhythms.

Exercise plays a crucial role in maintaining healthy heart and circulatory function. Exercise also supports a healthy metabolism, helping to reduce the risk of developing metabolic disorders such as type 2 diabetes. Because people with BBS are already prone to these problems, exercise is especially important for maintaining health and reducing disease risk.

Exercise can also help with the neurodevelopmental difficulties that affect some people with BBS, such as problems with coordination and motor skill development.

Additionally, children and adults with BBS often don’t get enough sleep. Lack of sleep is linked with overweight and obesity, chronic kidney disease and increased cardiovascular risk. Exercise has been shown to improve sleep quality and quantity.

Research into exercise for people with BBS is very limited. However, AEPs understand the condition, how it affects the body, and how to design exercise interventions tailored to each person’s needs, lifestyle and preferences.

WHAT TYPE OF EXERCISE IS BEST?

BBS affects each person differently and symptoms vary from one individual to another. An AEP can create an exercise program that is safe and beneficial for you or your child. This will usually include different types of exercises and training of support people where needed.

Aerobic exercise

Aerobic exercise is any activity that gets the heart pumping and raises your breathing rate. Regular aerobic exercise helps to condition the heart and lungs and maintain healthy metabolic function. It also assists with weight loss and/or maintenance. Moreover, it triggers the release of mood boosting chemicals that can alleviate symptoms of anxiety and depression, which affect some people with BBS. Examples of aerobic activities include walking, cycling, swimming, boxing, dancing and many team sports. People with BBS frequently have vision loss and foot problems, so they may need adaptive equipment (such as an adapted stationary bike or specialised shoes) or support to do aerobic exercises.

Resistance exercise

Resistance exercises help build or maintain muscular strength and endurance, which is important for optimal physical function. Muscles use energy, so building or maintaining muscle mass also helps with metabolism and weight management. Examples of resistance exercises include activities using weights, resistance bands, or body weight to strengthen muscles.

Motor skill and balance training

BBS can cause problems with balance, co-ordination and the development of fine and gross motor skills. Specific exercises might be prescribed to help with these.

Training support people

People with BBS may need assistance to exercise. For example, children will need help from their parents or caregivers to do exercises that help with motor skill development. Children or adults with low vision may need support to access community exercise facilities or participate in team sports.

Building the capacity of support people helps ensure people with BBS can achieve adequate physical activity levels to reach their health goals, while reducing the need for assistance from healthcare professionals.

GUIDANCE FROM AN ACCREDITED EXERCISE PHYSIOLOGIST

People living with BBS have complex and varied needs, including health issues which can impact their ability to exercise safely and effectively. It’s therefore important to seek guidance from an AEP before embarking on an exercise program.

For example, heart defects can cause irregular heart rhythms which may be dangerous. Intellectual disability, visual problems and hand and foot abnormalities may impact the ability to perform some activities or necessitate adaptive equipment.

Your AEP will consider these factors and create a program tailored to your (or your child’s) function, goals and activity preferences. It will be modified in accordance with any changing needs and circumstances. Where needed, it will include training of supports to ensure exercise forms part of a healthy lifestyle.

Click here to find an exercise physiologist near you.

Written by Amanda Semaan and Kara Foscholo. Amanda and Kara are Accredited Exercise Physiologists and Co-Directors of Active Ability, whose mission is to support people with disability to achieve optimal independence, health and quality of life.

Tackling the physical activity gender gap

Tackling the physical activity gender gap

Have you ever considered how gender shapes your health and well-being? Despite there being many factors contributing to this, physical activity is one very large piece of this puzzle.

With that in mind, who do you think is generally more active? Males or females?

You probably answered males, and you’d be right! But have you ever thought about why?

How active are men compared to women?

In a nutshell, only 2 in 5 Australian women are sufficiently active compared to 1 in 2 men. This trend also occurs across most countries and is what is referred to as the ‘physical activity gender gap.

We all know that insufficient levels of physical activity put people at a higher risk of disease; cardiovascular disease, type 2 diabetes and osteoporosis. By being physically active, we can improve our mental and musculoskeletal health, as well as reduce risk factors such as obesity, high blood pressure and high blood cholesterol. So, it’s no surprise that with lower levels of physical activity, women are more likely to experience multiple chronic conditions in their lifetime in comparison to men.

How can we close the gap?

Unfortunately, closing the physical activity gender gap is not easy. This is an issue that extends right back to the beginning of time, entangling the complex concept of gender norms with it.

When a child is exposed to narrow gender norms, values, and expectations, it can result in a lack of enjoyment and confidence in movement and the body. This is reflected in the generally more physically taxing lunch time activities of schoolboys compared to girls.

Sadly, these gender norms extend outside the school grounds and into adulthood. The danger of these gender norms in the context of physical activity is that such restrictive and harmful attitudes create lifelong barriers to movement and exercise.

Perceived barriers for women

Common barriers to physical activity for adolescent females include low confidence, concern with appearance, lack of energy and lack of time. Perceived barriers to physical activity are higher among young females than males. In addition, we know that the number of these barriers can determine compliance to physical activity recommendations.

This plays into why young females are more sedentary than young males and fall below the recommended physical activity guidelines at 13 years old – two years earlier than their male counterparts. It is this vicious cycle of gender norms to barriers that feed the inequalities in health and well-being for women across their lifespan.

Mental health plays a role too

To make matters worse, while battling barriers to physical activity during adolescence, depressive symptoms in girls begin to rise. Since 2012, twice as many females between 15- and 19-years-old have experienced psychological distress such as anxiety, depression, and poor self- esteem, compared to males of the same age. Unfortunately, these numbers continue to rise. If we apply what we know about the mental health benefits of physical activity, adolescence is certainly not a time where girls should be increasing sedentary time. In fact, it’s a vital period for intervention.

So how can we get girls moving more?

The literature identifies those interventions promoting physical activity among young females are effective. This is particularly true of multi-component interventions that also offer a physical education that addresses the unique needs of girls.

So, it is the role of exercise professionals to do just that.

It’s important to implement programs aimed at to educating young females about the importance of physical activity in their physical and psychological health and wellbeing and offer a safe environment to apply these learnings. By providing better access to programs such as this, the course of young females’ lives can truly be changed for the better.

If you need help getting started, talking to an ESSA accredited exercise professional is a great place to start. You can find one near you here.

Written by Gabi Gildea. Gabi is an Accredited Exercise Physiologist at Science of Fitness.

Two reasons to make the most of exercising this winter

Two reasons to make the most of exercising this winter

Today, we hope to get you to think outside the box when it comes to exercising in winter. Sure, it’s cold, there are some great reaons to start training and achieving your health goals, no matter what season we’re in!

It’s typical of the fitness industry to thrust their marketing campaigns in your face in the early phases of spring encouraging you to “get fit for summer”. We see two problems with that. Firstly, there’s nothing worse than trying to start out a good training routine in overcrowded gyms that don’t allow you to get the most out of the experience. Secondly, fitness and health should not be seasonal. The desired rewards take consistent micro efforts rather than sporadic macro efforts.

This brings us to two major opportunities that come with getting stuck into your physical exercise during winter (when the weather is colder and the motivation lowers).

1. Increase your aerobic fitness

A major limiting factor of exercising in the summer months is temperature. Going out for a lunchtime run probably does more harm than good and leaves you worse off for the rest of the afternoon.

On the contrary, exercise in cooler temperatures has shown to have a positive influence on endurance activity. Research has found that time to exhaustion is at its lowest at 3 degrees Celsius (as opposed to 10 degrees or 30 degrees).

Additionally, it’s evident that a good level of aerobic fitness is one of the best ways to mitigate fatigue when performing endurance exercise in warm temperature.

So, if you’re looking to build your aerobic fitness (through running, cycling etc.) start in the winter months. It’ll be easier and it’ll set you up nicely for when things heat up again.

winter exercise

2. Develop exceptional habits

If consistency is something you struggle with, then training in winter should be your go to! Consistency and discipline are simply skills and if you want to develop a skill, you need to practice it.

How many times have you heard or said, “I want to get really fit this summer”?

Everybody seems to madly rush into exercising when this time of year is on the horizon. Gym memberships increase, the gym floor becomes incredibly busy, and more feet are hitting the pavements.

Then March comes around. The mornings become slightly cooler, the sun rises a little later and suddenly numbers start to dwindle again. This trend has been the norm since “exercising” became a thing. What most don’t realise is that succumbing to the comfort during the winter months makes you better at taking the easy option and can compromise your ability to build good habits in the long term.
Neurobiologist and Stanford Professor Andrew Huberman suggests “leaning into discomfort/stress” to improve your tolerance.

Waking up early on a cold winter’s morning to train is not easy. However, by doing it, you improve your tolerance to the more difficult circumstances. As winter passes and mornings start to become more palatable, you’ll probably have less difficulty maintaining your already established good training habits.

Ready to get moving?

So, this winter, grab a friend or book yourself in with an ESSA registered exercise professional and commit to making long lasting changes. Through adopting consistent micro efforts, you’ll build good habits and create a healthy lifestyle that can be enjoyed all year round.

Written by Kieran Maguire. Kieran is an Exercise Scientist at Science of Fitness, Brisbane

Boost your Brain – why movement is medicine for your mind!

Boost your Brain – why movement is medicine for your mind!

Our brain is central to everything we think, feel, and do. Most people know that exercise is good for our body, but many are unaware of the powerful impact exercise has on the health of our brain. Exercise can increase blood flow to the brain, make our brain cells more active, strengthen connections between different brain areas and even make areas of the brain bigger, all of which can improve how well it works and protect it from disease.

FOUR WAYS EXERCISE CAN BOOST YOUR BRAIN

1. Improves cognition (thinking skills)

Just like our heart and lungs, our brain is an organ and exercise can improve its performance. While our brain is responsible for many things, one set of skills that can be powerfully improved by exercise is our cognition, or thinking skills. These are the mental processes our brain performs so we can learn, understand, and interact with the world. This includes things like our ability to focus, remember, plan, and problem solve.

Research shows that just 10-20 minutes of moderate intensity exercise (like a brisk walk around the block), can have an immediate positive effect on our ability to focus. Studies have also shown that people who exercise regularly have greater activation in the frontal lobe and perform better at the thinking tasks controlled by this region of the brain such as planning, problem solving, and decision making. Exercise can also have a powerful positive effect on our ability to control our behaviour, whether it be eating that block of chocolateendlessly scrolling online, or managing more problematic behaviours such as alcohol and substance use.

2. Improves memory

Another important thinking skill which can be improved by exercise is our ability to learn and remember. These skills are fundamental for success at work, study, and in everyday life. Exercise is thought to improve our memory through the powerful effect it has on the health of the hippocampus, a small brain area deep within the temporal lobes of the brain. Studies have shown that exercising at higher intensities (exercise that makes you huff and puff) can make the hippocampus bigger, the cells in the hippocampus healthier, and make the connections between the hippocampus and other areas of the brain stronger. Importantly these improvements in the health of the hippocampus have been linked with improvements in our ability to learn and remember.

3. Reduces your risk of brain disease (including dementia and stroke)

In Australia, the impact of poor brain health is becoming increasingly important, particularly with our aging population. As brain-related disorders are more common in older adulthood, the number of people living with significant disability and reduced quality of life is increasing rapidly. Over 70,000 Australians are diagnosed with brain-related disorders every year. This includes conditions like stroke and various types of dementia such as Alzheimer’s and Parkinson’s Disease. Exercise can directly reduce many of the risk factors associate with these conditions including obesity and high blood pressure. Studies have shown that living a physically active lifestyle can reduce the risk of developing dementia and stroke by between about 20-30%.

4. Can help manage symptoms in those with brain disorders

In addition to reducing the risk of developing brain-related disorders, exercise can be used as a tool to help manage symptoms. Following a stroke, exercise can significantly reduce the risk of having another stroke and improve physical functioning and quality of life. Exercise has been shown to slow the progression of various forms of dementia including Alzheimer’s Disease and can also improve symptoms of depression and anxiety, which often co-occur with these conditions. The type of exercise most suited to managing the symptoms of brain-related disorders depends heavily on the condition, symptoms experienced, stage or severity of the disease, and any other health conditions a person may be experiencing, so it is important to speak to an exercise professional (such as an Accredited Exercise Physiologist) before using exercise as a tool to manage symptoms.

WHAT EXERCISE IS BEST FOR BRAIN HEALTH

single bout of exercise can have an immediate positive effect on our brain, but exercising over weeks, month, and years, has an accumulative effect where the changes in our brain health become more permanent. While any exercise is better than no exercise, not all types of exercise have the same effect on brain health. A rapidly growing body of evidence has shown that it’s important to consider how often we exercise, as well as the type and intensity of the exercise we do. More moderate intensity exercise like a brisk walk, slow jog or leisurely cycle, can have an immediate positive effect on our thinking skills. Exercising regularly at more vigorous intensities (anything that makes you huff and puff to the point where it becomes slightly difficult to have a conversation) and doing weight bearing strength exercises can trigger biological changes that improve the health of our brain and the size of certain areas of the brain. But timing is important too because very intense exercise, that wears us out, can make it harder to think in the short term.

Remember that doing any physical activity is better than doing none. If you currently do no physical activity, a session a week is great, and then you can gradually build up to the recommended amount.

For adults, this means:

  • Be active on most, preferably all, days every week
  • Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week
  • Do muscle strengthening activities on at least 2 days each week

Something is always better than nothing!

HOW TO GET STARTED

If you’re new to exercise, it can be overwhelming and hard to know where to start. That’s especially true if you’re living with an injury or a health condition.

Accredited Exercise Physiologists (AEPs) are university-qualified health professionals who specialise in prescribing exercise for those with injuries, chronic pain, mental health issues, chronic conditions, or brain conditions like dementia.

They are also trained in behaviour change and can help you create healthy habits and make long-term lifestyle change.

To find an Accredited Exercise Physiologist near you, click here.

Written by the team of experts at BrainPark.

Is it safe to exercise if you have scoliosis?

Is it safe to exercise if you have scoliosis?

Scoliosis is actually 3D deformity of the bone and intervertebral discs. It causes wedging of the vertebrae and discs, where one side is narrower and one is wider. This changes the shape of the spine to cause lateral curvature with rotation.

Scoliosis is diagnosed when you have a lateral curvature with a cobb angle of more than 10 degrees (combined with rotation).

What Causes Scoliosis and who does it affect?

There are many other things that can cause scoliosis, such as Cerebral Palsy, Spina bifida, Marfan syndrome and Syringomyelia. That said, 80% of cases are idiopathic, which means there’s no known cause.

Scoliosis can affect children and adults. In children, it normally starts to appear when they undergo the most accelerated growth of their spines. This is usually around 11-12yrs for girls and 13-14yrs for boys.

How do you diagnose Scoliosis?

There are some postural features that are generally present in people with scoliosis.

  • Shoulders asymmetrical
  • Prominent or uneven scapulae
  • Visible curve of the spine
  • Hips asymmetrical
  • Waist asymmetrical

To confirm the diagnosis, a full spinal PA Xray is needed.

If you are concerned you or your child may be at risk of scoliosis, it is important to contact a qualified health professional for an assessment and where necessary accurately measure the degree of curve, predict the likelihood of progression and rule out any underlying pathology.

What treatments are available for Scoliosis?

There are four primary treatments available for scoliosis. The first is observation, which involves structured and timed follow ups (not just a ‘wait and see’ approach). In addition, treatment can include Physiotherapeutic Scoliosis Specific Exercises (PSSE), bracing and Vertebral Body Tethering (VBT) or Spinal fusion.

There are four key factors that should determine the appropriate treatment, these are:

1. The physical maturity of the patient
2. The severity of the spinal curvature
3. Stability of Spine (in mature spines only)
4. Coronal and sagittal balance

Is it safe to exercise?

Yes! Exercise is great to keep the spine healthy and flexible.

Physiotherapeutic Scoliosis Specific Exercises (PSSE) are specific exercises designed to help. They must have four main components:

  • Active self-correction in 3D
  • Stabilisation of the corrected posture
  • Integration into activities of daily life
  • Patient education

They must be taught be a health professional specifically trained in PSSE.

In addition to PSSEs, other forms of exercise and movement are encouraged. There is some evidence to support the fact that if children are participating in sport four or more times a week (as addition to their scoliosis specific rehabilitation), they’re more likely to achieve better outcomes.

Some non-specific exercises that may be an appropriate include Pilates, walking and team sports. But again, each patient should be managed individually and there is no one size fits all approach.

If you or your child has been diagnosed with scoliosis, and Accredited Exercise Physiologist can help to prescribe suitable PSSEs to help you move safely. To find a qualified health professional near you, click here.

Written by Tessa McLeod. Tessa is an Accredited Exercise Physiologist working at ScoliCare.

Speed training for football players

Speed training for football players

When you’re watching a game of football, it’s usually high-speed movements that drive match determining plays.

Fast attacking players terrorise defenders, put points on the scoreboard and excite crowds. Fast defenders, on the other hand, can more effectively shut down their opposition and recover from errors.

Football coaches recognise the value of speed but are often reluctant to, or incorrectly, include speed development in their programs.

Let’s break down the misconceptions about football player’s speed training to increase your speed and, in doing so, up your game too!

How speed is used as an identifier of talent in football  

Speed is regularly a key criterion in talent identification. Fast players are selected ahead of ‘skilled’ players as it’s a widely held notion that game skills can be taught but speed is something you’re born with.

Of course, there is a genetic ceiling on speed as with all physical attributes, but speed should be considered no less coachable than other facets of football. Many football coaches avoid speed training because it’s considered to be either too technical, too dangerous, or out of a belief that the game itself is enough for optimal speed development.

Football players speed training image

How speed training will help your game

Footballers are often fast but inefficient movers. Speed is not about fast feet or running ‘on your toes’, but rather improving your overall mechanics and force application to the ground.

Speed training not only improves performance but is also the most effective exercise-based strategy to prevent muscle injuries in footballers.

Speed training helps:

  • Enhance a player’s acceleration and top end speed
  • Increase their speed reserve
  • Delay fatigue
  • Decrease their risk of injury by reducing energy leaks

Players should strive to master a basic technical model to enable safer speed stimulus exposure at training. Obviously, during the game there will be differences as most players will not resemble a 100m sprinter due to constraints such as the ball and opponents.

Breaking down football player’s speed training misconceptions


Misconception 1: “You can’t train speed”

Yes, you can! If you see an expert that is. This misconception makes it difficult to convince a player that speed is trainable when they believe they are slow or have been repeatedly labelled slow in the past.

All players can push their speed ceiling higher and will benefit from a progressively overloaded speed development program.

Misconception 2: “Fast football players don’t need sprint training”

The physical attributes providing fast players their speed edge can also make them more susceptible to injury. These ‘fast’ players need regular speed exposure the most to help protect them from injury as they hit high speeds more often in training and games.

Explosiveness and sprinting efficiency cannot be maximally developed through just playing the game as the ball constrains intensity. No training modality improves speed as much as sprinting itself.

Misconception 3: “Speed looks the same for everyone”

Improved on field ‘football performance’ is the goal. However, it’s important not to remove qualities that make a player fast or limit their movement options. If the players technical deficiencies are unlikely to lead to decreased performance or injury, then avoid overcoaching. Adjustments may sometimes be more for aesthetics than function.

An accredited exercise scientist’s approach to speed

At M E Hughes AES Football, I provide players with the speed development stimulus they are missing. The overwhelming majority of players I work with have never experienced a true speed session.

One minute recovery per 10m of maximum velocity sprinting is inconceivable in many team settings and the culture shock is evident on my players faces when sufficient rest time is implemented during our sessions.

Sprinting is extremely taxing on the nervous system and once fatigued, the likelihood of developing speed diminishes.

It becomes a conditioning exercise if insufficient recovery between reps is provided for adaptation (due to time constraints, curriculum demands or a football coach’s lack of understanding of speed fundamentals).

Adding speed training to your football training sessions

Matt incorporates the same fundamentals into his speed sessions with footballers from all codes.

Here’s what a typical M E Hughes AES Football session includes:

Basic drills:

  • Mini band activation, technical drills, injury prevention
  • Constraints based and resistance activities (e.g., wicket drills, sleds)


Speed training:

  • Progression to maximal velocity sprints utilising various starting positions
    • Example: falling, push up, rolling
  • Maximal velocity sprints
    • 30 – 60m reps
    • Volume: 200m – 300m in total
    • 1 minute rest per 10m sprinted
  • Cool down and feedback
    • Timing gate metrics on testing days

If you’re looking to take your game to the next level, an Accredited Exercise Scientist or Sports Scientist can help to boost your performance. To find a one near you click here.

Written by Accredited Exercise Scientist, Matt Hughes from M E Hughes AES Football.

Exercise services for rural and remote Australians

Exercise services for rural and remote Australians

If you live in rural or remote Australia, we don’t have to tell you about the strains on resources – be it limited supply or having to travel hundreds, if not thousands of kilometers, to access specialised services.

The difference between living and working rurally compared to in a metropolitan area can be miles apart (quite literally!).

This can be the same for accessing exercise services from professionals, such as Accredited Exercise Physiologists (AEP) or Accredited Exercise Scientists (AES), in small remote communities compared to urban areas.

We spoke to Yerik Noorie about the challenges rural communities are faced with relating to limited exercise services and got a taste of what it’s like to work as an AEP in Longreach, Central Queensland.

HOW PROVIDING EXERCISE SERVICES DIFFERS IN RURAL AND REMOTE COMMUNITIES

Sense of community 

The career as an AEP is extremely rewarding, particularly in rural and remote regions where you’re able to service members that would otherwise not receive treatment. There is a sense of community living in a small town which is conducive to a unique AEP-patient relationship.

The nature of our profession allows us to devote greater time to one’s needs and ultimately, provide better follow up care.

AEPs travel to you! 

Generally, rural and remote AEPs are required to travel within a designated area of nearby communities to provide exercise services to a handful of communities.

The demanding nature of work and limited resources requires health professionals to be adaptable and operate with utmost care and efficiency, adopting a generalist approach.

Drawbacks of rural and remote

Unfortunately for some regions, the frequency of visits can be limited resulting in community members having to wait a month between treatments.

Within that time, many individuals begin to decline as they may require greater follow up care which highlights the need for significant patient education.

COMMON CONDITIONS TREATED BY EXERCISE SERVICES

We’re exposed to a range of clients with varying pathologies in rural communities. Most conditions we treat are cardiopulmonary, musculoskeletal and metabolic concerns. It is also not uncommon to manage pre- and post-operative cancer, neurological, renal and mental health related conditions.

Another common goal we work towards is prolonging independence for older adults and allowing them to stay active in the community.

BENEFITS OF EXERCISE

There is strong evidence to support physical activity and exercise as a means of improving our health profile. AEPs can use exercise to reduce disease risk and address modifiable risk factors to improve functioning and quality of life.

For the elderly population, this means maintaining their autonomy to live independently and assisting with their ability to complete activities of daily living (ADL).

Helps treat musculoskeletal injuries

Many individuals in these regions are susceptible to musculoskeletal injuries that significantly impacts their ability to work. The arduous and repetitive nature of work in the outback predisposes one to musculoskeletal complications. We’re able to provide these members with strategies and movements to continue working with reduced pain, improved fitness and provide them with additional resources to address their comorbidities.

WAYS TO INCREASE ACCESS TO EXERCISE PHYSIOLOGISTS IN RURAL AND REMOTE AUSTRALIA

It’s all about raising awareness of who we are, what we do, and how we can help people living in rural communities. Some individuals may be hesitant to see us professionally due to the word, ‘exercise’ in our name. So, breaking down misconceptions and bringing awareness to the fact that physical activity can come in many forms with something available for everybody is the first step.

AEPs could also benefit from greater awareness from GPs. As allied health professionals, AEPs can work with GPs to provide patient-centered care and treat individuals as a whole whilst inadvertently lessening the burden on the healthcare system.

LIVING IN RURAL AUSTRALIA? HERE’S HOW YOU CAN ACCESS EXERCISE SERVICES…

Rural and remote Australians can access AEP services with ease due to the large funding bodies in certain locations. The majority of outback Queensland is government funded, particularly more remote areas. Therefore, individuals do not have to pay out of pocket allowing more people to access our services that may not otherwise be able to.

To find an AEP near you, chat to your GP or use this search function on the Exercise & Sports Science Australia website.

Written by Yerik Noori. Yerik is an Accredited Exercise Physiologist working for the North and West Remote Health. 

What you need to know about exercise and low iron levels

What you need to know about exercise and low iron levels

Iron deficiency is somewhat of a “silent epidemic” because the symptoms are often overlooked as “day-to-day” tiredness. If you’ve been diagnosed with low iron, you can surely relate to the feeling of fatigue that go alongside it.

So, what’ exercise got to do with it? Well, a bit, as it turns out.

We take a look at what causes low iron and how training load can affect your iron levels.

What is iron and why do we need it?

Iron is an essential dietary mineral that our body needs to synthesise proteins that transport oxygen around our body, and to form various enzymes required for our body to produce energy. Like many things in life, we often don’t acknowledge how important it is until it’s missing (or in this case, we become iron deficient).

Given the role of iron in oxygen transport and energy production, it’s not surprising that iron deficiency characteristically manifests as feelings of fatigue, lethargy and poor concentration. In active individuals, it can also be identified when workouts are perceived to become more difficult compared to usual.

Within our body, about two-thirds of the body’s iron is found within the oxygen-transport protein, haemoglobin, contained in our red blood cells. A further 10% bound to the muscle’s oxygen transport protein, myoglobin, and 5% in enzymes used in energy metabolism. Any remaining intracellular iron is converted into its storage form, serum ferritin. The body is able to mobilise serum ferritin to support itself if we aren’t consuming adequate iron, but if this occurs chronically, we may become iron deficient and oxygen transport and energy production begin to get compromised.

What causes low iron?

Unfortunately, the body cannot create its own iron when it’s necessary. Therefore, daily dietary intake is essential to acquire and counteract our daily losses to sustain a healthy iron balance. Though seemingly simplistic, replenishing our iron can be somewhat challenging because our body typically only absorbs ~2 – 35% of the iron we eat, dependent on the source. Therefore, to achieve a healthy iron balance, adult males are recommended to consume 8 mg of iron per day, and pre-menopausal adult women are recommended to consume 18 mg of iron per day (to account for menstruation).

Intuitively, if our dietary iron intake doesn’t offset our iron losses, it results in a negative iron balance. Initially, this will cause our body to utilise out iron stores, but in time, our stores will become near deplete and iron deficiency will ensue.

Who is at risk of iron deficiency?

Beyond the low, innate risk of iron deficiency we are all subject to, it is widely recognised that females, and people who follow restrictive dietary patterns are at relatively higher risk of developing iron deficiency. The primary explanation for this is that additional iron is lost during menstruation and higher daily iron intake is required to counteract these losses.

Likewise, if not managed appropriately, restrictive diets may, intentionally or unintentionally, lead to insufficient energy intake, and in parallel, insufficient dietary intakes of several micronutrients, including iron. More specifically, vegetarians and vegans are at increased risk due to the disparity in absorption rates of the two forms of dietary iron. Haem iron, sourced from animal-based food, is absorbed considerably better than non-haem iron, predominantly found in plant-based food (15-35% absorption vs 2-20% absorption, respectively). Therefore, while plant-based diets may achieve high iron intakes, our body absorbs a smaller amount of that (non-haem) iron. Therefore, it is always advised to consult trained dietetics personnel when making changes to your diet.

How can exercise impact iron levels?

There is no doubt that iron, and its roles in oxygen transport and energy metabolism, is fundamental to our exercise capacity. However, beyond the typical 1-2 mg of iron we normally lose each day, there are also several exercise-induced avenues of iron loss that likely account for an additional 3-5 mg of iron loss per day.

These pathways for iron-loss include sweating, gastrointestinal bleeding, microscopic amounts of blood lost through urine (haematuria) and the destruction of red blood cells via weight-bearing activity (haemolysis). This is compounded by the challenge to replenish these lost iron stores via dietary iron when its absorption is so low.

Thus, it is not surprising that avid exercisers are particularly vulnerable to iron deficiency. Added to the already low absorption rate of iron from the diet, scientists have recently shown a strong association between exercise and the body’s key iron absorption regulator, the hormone hepcidin.

Hepcidin is produced by the liver and acts to reduce the absorption of dietary iron and reduce the body’s capacity for iron recycling. Research consistently shows a 2- to 4-fold increase in hepcidin levels about 3 hours following exercise, suggesting that there may be a post-exercise period of reduced iron absorption. This post-exercise hepcidin response and secondary decrease in iron absorption, further complicates replenishing taxed iron stores for active individuals.

So what does this mean for athletes or people with high training volumes?

Athletes, particularly endurance athletes, are generally endeavouring to incite physiological adaptations that may only be maximised in the presence of adequate iron supply (e.g. increased haemoglobin for improved oxygen transport). Their increased iron demand, coupled with the several avenues of iron loss they contend with during exercise makes them more susceptible to iron deficiency.

Despite it being commonly acknowledged that athletes have a greater iron requirement, there is yet to be any athlete-specific dietary iron recommendations established to help them maintain healthy iron balance.

Regardless, athletes are discouraged from taking iron supplements without consulting a doctor.  Instead, it is advised that athletes have regular annual, standardised iron screening to ensure early detection of negative iron balance. Female athletes, or athletes with a history of iron deficiency, should aim to get an iron screening every 3-6 months.

Should you consider iron supplementation?

Clinically, early stages of iron deficiency are identified when our iron stores (serum ferritin) fall below 35 μg·L-1. The more severe stage of iron deficiency, known as iron deficiency anaemia, established when haemoglobin falls below 12.0 g·dL-1.

Increasing dietary iron intake is typically the initial, and most conservative treatment for low iron, and should commence with a complete dietary analysis by a qualified dietitian. However, for a number of reasons outlined above (poor absorption, dietary preference, exercise, menstruation), it may not always be possible to meet your iron requirements through diet alone.

In these cases, iron supplementation should be considered in consultation with a doctor. Following a nutritional intervention, practitioners will generally recommend daily oral iron supplementation for 4-6 weeks. If you identify with any of groups considered to be at increased risk of iron deficiency (i.e. females, restrictive/plant-based diets, regular exercise), or begin to experience tiredness, lethargy, dizziness or poor concentration, I would encourage you to speak to a doctor about having your iron status checked.

Tips for improving iron levels

Need to boost your iron levels? Consider the following…

Consult a trained dietitian

I will always advocate to consult trained dietetics personnel if you’re looking to change/improve your overall diet or iron intake. While it is often a case of simply being more aware of your personal iron requirements and which foods are rich sources of iron, nuances around iron absorption and the timing of iron intake can make improving your iron status more complex.

For example, dietary iron absorbed from plant-based sources (non-haem) is profoundly influenced by the interaction of several iron-binding compounds commonly found in the diet. In some instances, these act to promote iron absorption, though more frequently proceeding to inhibit iron absorption.

Some common examples of food-constituents that decrease non-haem iron absorption are

  • phenolic compounds, including polyphenols and tannins contained in tea, coffee and other plant foods
  • phytates: found in whole-grain cereals, legumes and nuts
  • calcium: found in dairy food and green leafy vegetables.

Though not always practical, it is recommended to avoid an abundance of these foods while consuming your high-iron foods in order to maximise iron absorption. On the contrary, ascorbic acid, more commonly known as vitamin C, is the most powerful promoter of non-haem iron absorption and should coincide with iron intake if possible.

Timing matters

Research has shown that hepcidin (our iron regulatory hormone) tends to be lower in the morning compared with the afternoon. This suggests that iron absorption is likely also going to be greater in the morning.

Furthermore, in a study that investigated how the timing of exercise influenced iron absorption, researchers noted that the greatest absorption of iron was seen when athletes consumed a high dose of iron within 30 minutes of finishing exercise (before hepcidin increased at ~3 hours after exercise).

Therefore, a contemporary strategy to improve iron levels is to consume high iron-containing foods/supplements in the morning, rather than in the afternoon, and if exercising in the morning, consume them as close to finishing exercise as possible.

Written by Rachel McCormick. Rachel is an Accredited Exercise Physiologist and has recently finished a PhD looking at iron supplementation in endurance athletes.

How exercise can help those with Psychosocial Disability

How exercise can help those with Psychosocial Disability

A psychosocial disability is often described as a disability that may arise from a mental health issue. The word psychosocial relates to interaction of social factors, individual thought, and behaviour. Common psychosocial conditions include depression, anxiety, bipolar, schizophrenia and many more. For those living with psychosocial disability, exercise can be incredibly valuable.

How can exercise help those with psychosocial disability?

If exercise was a pill, it would be the most prescribed medication worldwide. The benefits of exercise for physical health are well documented, with exercise being effective at improving health markers such as strength, fitness, flexibility, balance and motor control.

But what about mental health? What about social interaction and quality of life?

At Exercise Healthcare we understand that individuals with psychosocial conditions not only what to improve their physical health, but also want to improve their confidence, their self- esteem, mental health, cognition, self-efficacy and independence.

Data from the Australia Institute of Health and Welfare suggests approximately 72% of individuals aged 15 and over with a disability do not engage in enough physical activity for their age. This is in comparison to 52% of individuals without disability.

This data highlights the need for government agencies, private businesses and organizations to establish and implement strategies that ensure positive, quality experiences in sport and physical activity for individuals with disability.

When individuals with psychosocial disabilities are offered a chance at engaging in social activities, whether it be a supervised program at a healthcare facility or joining a local sporting team, they benefit from the opportunity.

How can an exercise physiologist help?

Accredited Exercise Physiologists (AEPs) are in a unique position to facilitate improvements in both physical and mental aspects of wellbeing. AEPs help individuals with psychosocial disabilities achieve their maximum potential for physical independence, health, wellbeing and quality of life, by minimizing the effect of their physical impairments and improving movement capacity.

An Exercise Physiologist not only targets physical deficits, but can help improve mental health, cognition and memory. An AEP may prescribe safe and intensive individualized aerobic exercise protocols as this method has proven to have beneficial effects on mental health, helping to reduce anxiety, restlessness and fatigue through upregulation of neurotransmitters such as dopamine, serotonin and norepinephrine, and many other mechanisms.

AEPs are trained to prescribe exercise to improve health outcomes similar to how a doctor is trained to prescribe medication. As part of their training, AEPs must demonstrate the ability to understand and explain how and why an exercise works in the context of a long-term evidence-based program.

Additionally, AEPs can help individuals with a psychosocial disability gain access to Assistive Technology by writing a detailed report. Assistive Technology includes physical support items that help participants gain easier access to quality exercise, such as a bicycle, treadmill, smartwatch, arm ergometer and many more!

By maintaining the strength and function of the body through structured exercise programming and load management, this allows for a reduction in long-term negative health outcomes and a reduction in subsequent costs.

Not only does this intervention reduce negative health outcomes, but for every $1 a consumer spends on Exercise Physiology intervention, they receive $10.50 back in well-being benefits, improved productivity and reduced health system exposure.

How To Access NDIS Funding?

To access NDIS funding, participants can call 1800 800 110 to make an Access Request, or you can complete and submit the Access Request form via email

Additionally, AEPs help NDIS participants access necessary funds by providing your NDIS provider with a detailed report based on the results of a 1 on 1 assessment. This report acts as a support to help and guide NDIS participant planning and funding and is often used in conjunction with reports from other Allied Health professionals such as Psychologists, Occupational Therapists, Podiatrists and Dieticians.

The NDIS website can provide you with more information on applying for funding.

A Client Case Study

Mr John Smith arrived at our EHA clinic in August 2020, presenting with Schizophrenia and Clinical Anxiety. Once an active basketball player, Mr Smith had seen his weekly exercise volume and exercise capacity slowly diminish overtime, to the point where he was completing less than 30 minutes of physical activity per week.

After several weeks of seeing an Exercise Physiologist, Mr Smith asked to increase his appointments to twice a week, symbolizing a major improvement in weekly exercise volume, confidence and community involvement. Mr Smith realised he was not only improving his strength, fitness and function, but he also loved being in a positive, encouraging environment. It was unlike any gym or training facility he had previously been to.

As the weeks went by, Mr Smith went from strength to strength, and began taking daily walks up to 2 hours at a time. Through conversation, it was discovered that Mr Smith enjoyed bicycle riding in his youth, however had been unable to ride for many years due to faulty equipment and lack of disposable income.

Identifying a great opportunity to increase weekly exercise volume, independence and community involvement, Mr Smith’s AEP constructed a detailed Assistive Technology report to provide Mr Smith with a high-quality bicycle, which he now rides to and from our healthcare facility, and recreationally on weekends.

Mr Smith continues to one of the great EHA participants and has seen his aerobic capacity improve from being classified as “poor” to “superior” in his age category, reducing his risk of negative cardiovascular health outcomes dramatically.

Getting help

If you, or someone you know, are living with a psychosocial disability, an exercise physiologist can help you to start your movement journey. To find an Accredited Exercise Physiologist near you, click here.

Written by Carl Bright. Carl is an Accredited Exercise Physiologist at Exercise Healthcare Australia.

Athletes guide to returning to sport post-COVID-19

Athletes guide to returning to sport post-COVID-19

2020 and 2021 have NOT been conducive to sports. If it wasn’t catching COVID-19 itself, the mandated lockdowns and travel bans were enough to throw a spanner in the works for athletes in Australia and worldwide.

It’s fair to say the ongoing absence of, or at least disruption to, sports have caused many Australian athletes to experience an unforeseen decline in physical activity. Not to mention the potential take-up of poor dietary habits, and the consequent loss of athletic performance.

Are you one of the many athletes recovering from COVID-19 and eager to make an effective return to your sport? If so, it’s important to know that your recovery and eventual return to sport will likely be different from your usual turnaround after contracting a common cold.

We spoke to Accredited Exercise Physiologist (AEP) Toby Edmanson from Queensland Sports Medicine Centre about the dos and don’ts for athletes to consider when trying to get back to their pre-COVID-19 athletic self.

Getting back into sport after COVID-19

There’s no easy fix to get you back to your pre-COVID-19 athletic condition. Exhausting your body’s systems whilst experiencing symptoms, or even after the absence of symptoms, may be detrimental to your health.

It is prudent to follow a scientifically guided, measured approach to the re-establishment of your athletic performance. An incremental strategy will help to maximise health outcomes for all athletes.

While an overly conservative approach to your return to sport will delay competition, an overly hasty return may result in adverse health outcomes. With both extremes in mind, let’s break down what you need to be aware of to get back to your pre-COVID-19 physical condition as an elite athlete.

Everyone is different. What works for some may be completely different for you

Everyone experiences COVID-19 slightly differently. However, there are common symptoms among most individuals, such as fever, cough, tiredness and loss of taste or smell. Left untreated, these symptoms may result in more severe illness and long-term complications such as chronic fatigue, myocarditis, shortness of breath and/or heart palpitations.

These factors can increase your risk of developing ‘post-exertion symptom exacerbation’. This refers to continuing symptomology for 3 – 9 months. For the most effective return to sport possible, you must be aware of your individual circumstance either asymptomatic or symptomatic.

Athlete running post-COVID-19

Identifying your level of risk post-COVID-19

The Australasian College of Sport and Exercise Physicians has released a position statement detailing a framework used to assess your return to physical activity post-COVID-19. Firstly, you should identify which level of risk you are, i.e. low, intermediate or high, to determine the appropriate course of action.

Low-Risk

    • You experience mild or no symptoms
    • You experience only upper respiratory symptoms (cough)
    • You are a younger athlete
    • You have recreational exercise goals

Recommended Actions

    1. You should have 10 days of deliberate rest from the onset of symptoms
    2. You should be at least seven days symptom-free before exercising
    3. You should no longer require any medications such as paracetamol


Intermediate-Risk

    • You experience symptoms for 7 days
    • You experience chest pain
    • You are an elite or endurance athlete
    • You have a history of asthma or chronic fatigue

Recommended Actions

    1. Visit your General Practitioner (GP) to discuss whether an ECG is needed to test for levels of Troponin and Chemokine Receptors (CKR) in your blood
    2. If the tests above are abnormal, you should take the recommended actions from the High-Risk classification


High-Risk

    • You have been hospitalised or in ICU due to COVID-19
    • You experience prolonged chest pain with rest and minimal energy exertion
    • You have a history of cardiac arrest

Recommended Actions

    1. Visit your GP to discuss whether an ECG is needed to test for levels of Troponin, Chemokine Receptors (CKR) and Brain Natriuretic Peptide (BNP) in your blood.
    2. If recommended by your GP, consult with a Cardiologist who can administer an echocardiogram and stress test
    3. If recommended by your GP, consult with a Respiratory Physician for a Pulmonary Function Test and chest CT scan
    4. Consult with an Accredited Exercise Physiologist (AEP) who can prescribe an individualised, progressive exercise program and undertake further assessment to ensure a safe return to physical activity. Click here to find an AEP near you.

*This is general advice to get you started. It is recommended to seek individualised medical advice from your General Practitioner or healthcare provider.  

Once you have identified your risk level and taken the associated actions, you’re ready to gradually return to physical activity. Although each phase has recommendations as to the intensity, duration and volume of exercise, there are no specific timeframe requirements as this will depend on your pre-COVID-19 fitness levels.

Assess your individual circumstances and how comfortable you feel through each phase and remember to be kind to your body in the recovery process!

Watch out for Red Flag Symptoms!

It’s important to be aware of key red flag symptoms. If you experience any of the below, take the recommended actions from the High-Risk classification above. These symptoms are:

  • Chest pain or palpitations
  • Breathlessness, out of proportion with expected recovery periods
  • Thrombosis symptoms, e.g. pain and swelling in one or both legs

5 Phases of the COVID-19 Recovery Process

5 Phases of the Recovery Process for athletes post-COVID-19

Phase 1: Returning to school or work

The first phase of the recovery process is returning to school or work. That is, reintroduce yourself to normal daily routines, sleep/wake cycles and normal activities of daily living, absent of exercise.

Phase 2: Returning to light activity

Then, return to “light” activity. This phase of the recovery process recommends starting with 15 minutes of light-intensity exercise (i.e. 40-55% HRMax, or RPE 1-2) on 2-3 days per week. The 15 minutes of exercise remains constant, but you may gradually increase the intensity to moderate-intensity exercise (55-70% HRMax, or RPE 3-4). The recommended modalities of exercise in this phase are walking, light jogging, or a stationary bike.

Phase 3: Introduce progressive exercise training

The next phase is the introduction of progressive exercise training. Start to increase the duration of the current exercise modality to 30 minutes. Then, introduce bodyweight resistance exercises on 1-2 days per week kept at a low volume (i.e. 4-6 repetitions by 2 sets). It’s important in this phase that you remind your muscles how they work and that you pay close attention to having adequate recovery (i.e. sleep and nutrition).

Phase 4: Increase training volume

In the next phase, you should steadily increase your training volume. It is recommended to re-introduce sport-specific training and higher intensity drills such as running and ball drills. It’s important to pay attention to the coordination and skill progression requirements of these drills. In your resistance training, increase the manageable load to the weight you are navigating. Depending on your pre-COVID-19 condition, you may exercise 3-5 days per week, with at least 1-2 resistance training sessions.

By this stage, you should regain pre-COVID-19 confidence in your skills and exercise tolerance. Again, it is important to have sufficient recovery and monitor for any symptoms.

Phase 5: Return to pre-COVID-19 exercise levels

In the final phase, you should return to all pre-COVID-19 exercise levels. In conjunction with your coach, you may progress your resistance and sport-specific training accordingly. Remember to monitor for “red flag” symptoms or concerns upon your full-scale return. An Accredited Exercise Physiologist can help guide you through an individualised, progressive training program.

Read more about exercising after having COVID-19 here.

References:

Baggish A, Drezner JA, Kim J, et al Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes British Journal of Sports Medicine 2020;54:1130-1131.

Elliott N, Martin R, Heron N, et al Infographic. Graduated return to play guidance following COVID-19 infection British Journal of Sports Medicine 2020;54:1174-1175.

Jewson J, McNamara A, Fitzpatrick J. Life after COVID-19: The importance of a safe return to physical activity. Aust J Gen Pract 2020;49 Suppl 40. doi: 10.31128/AJGP-COVID-40.