Body mass, BMI, body composition, waist circumference and the determinants of health – Just how important are the numbers in your assessments?
In Australia 67% of adults are overweight according to the AIHW, the Australian Government agency for health and welfare data. To repeat the significance in this statement, that is 2 out of 3 adults in Australia who have a BMI classed as overweight or obese. This factor alone has in the last decade been ranked as the number one cause of disease burden in Australia. Not only that the World Health Organisation has estimated that of all non-communicable diseases those related to overweight and obese populations make up around 90% of Australia’s deaths annually. If these aren’t immediately significant enough for you, I want to outline within this write up the importance of all the measurements you complete with an Exercise Physiologist and other health professionals, and a summary of some of the changes you can make to positively affect your physical health and wellbeing.
What are the measurements you will have taken by an Exercise Physiologist?
“The weight of a person or thing is how heavy they are, measured in units such as kilograms, pounds, or tons.”
“Body Mass Index is a measure of body fat, that is the ratio of the weight of the body in kilograms to the square of its height in metres.”
“The different components (or "compartments") of a human body. The selection of compartments varies by model but may include fat, bone, water, and muscle.”
“The measurement around the narrowest point of the abdomen, or the midpoint between the lower border of the rib cage and the iliac crest. Used as an indicator for abdominal obesity.”
What are the outcomes of each of these measurements?
Body mass and BMI go hand in hand and as you can imagine, as the weight increases or decreases so does the number in the BMI score. The current trend for Australians is that we each gain an average of 300grams to 500grams with every year. Those increases yearly align with the rapid increases we’ve seen in our country the last 2 decades of overweight and obese individuals, again these have seen an increase of between 14% to 27% across different age brackets as recorded by AIHW.
Having an overweight or obese BMI attributes to 30 diseases, including 17 types of cancers, 4 cardiovascular diseases, 3 musculoskeletal conditions, type 2 diabetes, dementia, asthma and chronic kidney disease. Here is a table of the classes of BMI for reference, with the healthy range being <25kg/m2.
When recording body composition in our clinic the results measured include fat mass (both total fat mass and visceral fat), muscle mass, bone density, and body water to name a few. If your goal is weight loss than the figure you want to decrease is your fat mass. The other components such as muscle mass, bone density and body water can help flag and monitor other conditions such as osteoporosis, muscular atrophy, and more.
When considering body fat here is a representation of what ranges are considered healthy:
Within this component, there is increasingly more evidence supporting that the visceral body fat represents higher risks of cardiovascular and metabolic risks. This is the fat that is deposited around the organs. Independent of otherwise healthy organs, visceral body fat continues to present cardiovascular risk and metabolic risk when it makes up for >10% of the total body fat count. Here’s a guide on where these numbers should sit on the scale 0-59:
When measuring waist circumference, the aim is to guide health professionals on risk levels associated with abdominal fat and total body fat that may be increased. The evidence surrounding measuring waist circumference for these risks is increasingly more valid for quantifying health risks; the current guidelines for these are below:
In the previous decade in Australia, the trend for our waist circumference as we age is accelerating by 0.42cm every year, not dissimilar to the increase in weight discussed earlier. This makes for a compelling correlation. When looking at reliability of these measures, waist measurements applied with other data such as waist to hip ratio, waist to height ratio or coupled with a BMI score, these demonstrate a good strength of correlation coefficient of at least 0.82 across the board. The correlation being how strongly linked the result is to cardiovascular and metabolic risk factors, and scored from -1.00 to +1.00.
What can be done to reduce your risk of illness if you are outside these healthy ranges?
At the risk of repeating everything you’ve heard from your doctors, family, friends, or out in society; increase your physical activity and change some of your eating habits. Specifically try meet these guidelines:
Accredited Exercise Physiolgist
With age comes more wisdom, knowledge and experience!
But unfortunately, pain also increases with age. 1 in 5 (20%) people aged 65–74 reported having chronic pain, increasing to 22% of those aged 75–84 and 24% of those 85 and over.
I truly believe knowledge is power and with changes in understanding around persistent pain let's have that understanding widespread. That is what the purpose of this blog is, to help the older and wiser population understand pain and how we can help.
It's Like an Alarm on Your Car
Persistent pain management has progressed immensely over the last 10-15 years. From a completely biomedical approach (I hurt because the body tissues are damaged) to a more contemporary model based on the most recent research that tells us that pain is a protection mechanism for the body to prevent injury or damage.
In simple terms, pain is the alarm system of the body, it gives us a protective buffer and reminds us not to do too much too soon. It is a safeguard to keep our body and its tissues safe. It is a normal response to potential danger and is always 100% real!
What do I mean? Ever reversed your car into a pole? Before you hit the pole, the car beeps at you and warns you of the danger behind you. Well, this is like pain. As you get closer to the pole the car beeps faster and faster and eventually if you ignore it, you hit the pole and injure the car (ouch).
Once injured, the sensitivity of this alarm goes up, things that might not have hurt before, do and things that would only hurt a little, hurt a lot. This is for protection and to promote healing.
Usually, as the body heals the sensitivity decreases and everything goes back to normal. Think of being sunburned and getting in a hot shower. That burns doesn't it? But once the body heals from sunburn that same shower doesn't hurt anymore.
The overprotective Alarm
Now you have a grip on why pain is needed. Let's dive into when it hangs around! This is caused by an over-sensitive pain system.
What this means is that the pain system that had increased its sensitivity due to an injury has not returned to normal, even though normal healing has taken place, pain has continued. This is unhelpful and prevents recovery.
Think of the beeping car. The car beeps faster and louder even though you aren't in danger of hitting the pole.
Unfortunately, I can't answer why the pain system may stay in overprotective mode but there are some things I can tell you:
How does exercising turn the alarm down?
We here at Optimum EP advocate strongly for exercise because we know the huge amount of benefit someone can see in all aspects of their health. And you guessed it, Exercise can be a helpful mechanism for perisitent pain also.
This proces is called exercise hypoalgesia which simply means engaging in exercise can help alleviate or decrease painful symptoms. This happen several different ways including:
Now disclaimer incoming: Exercise may not completely alleviate pain, BUT it can significantly improve pain management, reduce the need for pain medications, and enhance overall well-being.
Haven’t convinced you yet?
Now if you are struggling with the idea of exercise for pain management let me indulge in a little advocating.
Exercise is the most powerful intervention in which can simultaneously help management huge range of different chronic conditions and give you a enormous amount of benefit in one action.
“If exercise was made into a pill, it would be the most prescribed pill in the world.”
Read that one again.
Exercise is so powerful in some cases research has shown it to out-perform medication.
And guess what, it is all natural, anyone can do it and it is free.
Now I am going to list 10 different ways exercise can help you aside from pain management:
Tips for starting!
The key to successfully starting an exercise program with persistent pain is to:
The journey is unique for each person, so there's no need to rush. In fact, taking the time to build a solid foundation is often the path to long-term success. Seek the guidance of one of our Accredited Exercise Physiologist to tailor your exercise plan to your specific needs and limitations.
Remember, the most important thing is to start, keep moving forward at your own pace, and celebrate the small victories along the way.
Accredited Exercise Physiologist
Is your step count or activity minutes on your activity tracker (planned exercise) better for your health?
We often get asked this question in our consultations with clients… Are steps or activity minutes better for your health?. Many clients focus on the steps they achieve each day. But is this the best indicator of health and longevity, or are the activity minutes that you do (or that your watch tracks) better? In this blog we go into the research behind both steps and activity minutes, and give you the information on what to strive for.
The 10,000 steps concept was initially formulated in Japan in the lead-up to the 1964 Tokyo Olympics. However, there was no real research to support the target, instead it was a marketing strategy to sell pedometers.
In Australia, the average adult accumulates about 7,400 steps a day of incidental activity (ie, non planned activity that we do throughout the day performing daily activities). Therefore, an additional 3,000 to 4,000 steps undertaken through dedicated walking will help you to reach the 10,000-step goal.
Is 10,000 steps per day enough to achieve any health benefits?
Research recently has shown that people taking 10,000-steps or more a day have a 46% lower risk of early death. Other studies have also shown that people who took more than 5,000 steps a day had a much lower risk of heart disease and stroke than those who took less than 5,000 steps. And, each 1,000-step increase per day reduced the risk of dying prematurely of any cause by 6%.
Activity classifications from steps alone
A study by Catrine Tudor-Locke & David R. Bassett Jr have suggested a classification for pedometer-determined physical activity in healthy adults:
<5000 steps/day - may be used as a ‘sedentary lifestyle index
5000–7499 steps/day - is low active
7500–9999 - likely includes some intentional activities - somewhat active
≥10 000 steps/day indicates the point that should be used to classify individuals as ‘active’.
>12 500 steps/day are likely to be classified as ‘highly active’.
However, is just being active through steps as good as higher intensity exercise (ie active minutes) where your heart rate is elevated?
Active Minutes/Planned Exercise
Just tracking steps does not measure the intensity of your activity. Your heart rate may be quite low the entire time, which is not challenging your heart and body to get optimal health benefits. Aerobic exercise and activities that raise your heart rate, along with strength training are both key components to living a long life. Activities that increase your heart rate are shown to significantly lower your risk of heart disease, which is the number one cause of death around the world.
The graph below shows this in graphical form. To understand it better, we need to understand what a MET is. A MET is a metabolic equivalent which is a ratio of your working metabolic rate relative to your resting metabolic rate. Metabolic rate is the rate of energy expended per unit of time. It is one way to describe the intensity of an exercise or activity.
One MET is used to describe your intensity level whilst at rest, so a MET of 2 means you are working twice as hard as if you were resting, MET of 3, 3 times as hard, etc. Calculation of METs takes into account a number of factors, but as an example for a 70kg person, moderate intensity exercise is between 3 and 6 METs and may involve swimming laps at a leisurely pace or golf, whereas at 6 and above METs it could include walking very briskly at just over 7 km/hr (6.3 METs), cycling at 24 km/hr (8 METs) or jogging at 11.3km/hr (11.5 METs).
As the graph outlines, the relative risk of death for all population groups is decreased with regular higher MET activities.
The bottom line, all movement is good, but the higher the intensity of exercise, the greater the health benefits and the lower your relative risk of death is.
Accredited Exercise Physiologist, Diabetes Educator
Mental health is a critical aspect of our overall well-being, but it is often overlooked or stigmatized. According to the Australian Bureau of Statistics, one in five Australians experiences a mental health condition in any given year. People living with mental health illness have a 15-20 year reduced life expectancy compared to the rest of the population primarily due to an increase in cardiovascular disease.
Fortunately, there is growing evidence that exercise can have a significant positive impact on mental health. Regular physical activity has been linked to a reduction in stress, anxiety, and depression symptoms, as well as an improvement in mood and cognitive function. In fact, the 2018 HUNT study showed that 12% of cases of depression could have been prevented with just 1 hour of exercise per week. Further research found physical activity can reduce the odds of depression development by 17%. Furthermore, Studies have found exercise can be just as if not more effective than some medications in treating Depressive symptoms.
The COVID-19 pandemic has also exacerbated mental health challenges, with many people experiencing increased stress, anxiety, and depression due to social isolation, economic uncertainty, and health concerns.
Exercise plays a critical role and below will give some insight into exercise and mental health.
Understanding Mental Health
Mental illness refers to a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour, usually associated with distress or impairment in important areas of functioning (WHO 2022). Mental health encompasses a range of conditions from mood disorders, anxiety and depression to more severe and persistent conditions such as bipolar disorder and schizophrenia. Mental health disorders can have a significant impact on daily life, including relationships, work or school performance, and quality of life.
The Connection Between Exercise and Mental Health
Exercise is believed to work through several mechanisms including:
Types of Exercise for Mental Health
While any type of exercise can provide mental health benefits, certain types of exercise have been shown to be particularly effective. Here are three types of exercise that have been well-studied for their mental health benefits:
A. Aerobic exercise: Involves activities that increase your heart rate and breathing, such as running, cycling, or swimming. Aerobic exercise has been shown to reduce symptoms of depression, anxiety, and stress, and improve cognitive function and self-esteem.
The recommended frequency for aerobic exercise is 150 minutes per week of moderate-intensity exercise, such as brisk walking, or 75 minutes per week of vigorous-intensity exercise, such as running.
B. Resistance training: Involves exercises that use weights or resistance to build muscle strength and endurance. Resistance training has been shown to improve mood, cognitive function, and self-esteem, and reduce symptoms of anxiety and depression.
The recommended frequency for resistance training is at least two days per week, with a focus on all major muscle groups.
C. Yoga and mindfulness practices: Yoga and mindfulness practices, such as meditation and deep breathing, have been shown to reduce stress, anxiety, and symptoms of depression, and improve overall well-being. These practices focus on breathing, movement, and mindfulness, and can be done in a class or on your own.
The recommended frequency for yoga and mindfulness practices varies, but even a few minutes per day can provide benefits.
How to Incorporate Exercise into Your Mental Health Routine
Incorporating exercise into your mental health routine can be challenging, but it's worth the effort. Here are some tips to help you get started:
In conclusion, exercise is a powerful tool for improving mental health and well-being. Through a combination of aerobic exercise, resistance training, and mindfulness practices, exercise has been shown to reduce symptoms of depression, anxiety, and stress, improve cognitive function, and boost self-esteem. Incorporating exercise into your mental health routine may take some effort, but the benefits are well worth it. By starting small, choosing activities you enjoy, and being consistent, you can create a routine that supports your mental and physical health. So next time you're feeling stressed or down, try incorporating some exercise into your day - your mind and body will thank you.
Accredited Exercise Physiologist
It’s the happiest time of the year…. And definitely the busiest for most of us too. With Christmas, School Holidays, Harvest, Frantic present shopping, busy work lives and all the day to day chores, it is easy for other things in life to slip by the wayside over this period. One of the most common includes exercise and our daily movement! It is easier to convince ourselves that we don’t have time to fit it in, than to make it work. BUT… today I am going to let you in on 4 fun and easy ways to get your movement in without even having to try.
1. GET WET
We all love a water fight or a swim in the pool on a hot Summer's day. Don’t just watch the kids playing, get involved! Both you and them will have a blast and it won’t feel like exercise at all chasing each other around the backyard as water bombs fly over your head.
2. BUY AN OUTDOOR GAME
Give the gift of movement that the whole family can enjoy together this Christmas. Sometimes the simplest things can be the most fun so why not give totem tennis, corn hole, Finska or even good old fashioned chasey a go to get everyone up on their feet this Holidays.
3. SEE THE CHRISTMAS LIGHTS BY FOOT
Why not get the family in the Christmas Spirit by taking a walk one night to admire all of the Christmas lights around your street, block or even the whole town! Not only will you save yourself the fuel money but your body will love you for the extra steps in your day too. Plus the kids will be so entertained looking at the Christmas lights they won’t even notice that they are walking.
4. MAKE IT A TRADITION
Why not start an active tradition that the whole family can get involved in to get moving around the holiday season. It might be an annual tennis tournament, a backyard cricket bonanza, a bike ride together on christmas morning! The possibilities are only limited by your imagination. Tailor it to your family and the things you love to do and everyone will be having a blast.
Remember not to be too hard on yourself over the Holiday Period if you haven’t hit your usual physical activity goals. It is important to give your body time to rest, a chance to have fun with family and acknowledge all the hard work you have put in and the goals you have achieved over the last 12 months.
Accredited Exercise Physiologist
It is recommended that women with Gestational Diabetes Mellitus (GDM) should undertake both aerobic and resistance exercise at a moderate intensity, a minimum of three times a week for 30-60 min each time, but what type of exercise should you be doing and how does it help you and your baby??
The main goals of the management of GDM are to reduce hyperglycemia (high blood glucose levels) and therefore reduce the side effects of having high blood glucose levels. Management may include medication, dietary support and exercise.
From Padayachee C, Coombes JS.
Exercise is a powerful tool to assist in keeping blood glucose levels within the optimal range. However, some women avoid exercise during pregnancy as they are unsure of the benefits, or are worried about the risks of exercise to them and their unborn child. The good news is that exercise, when prescribed appropriately, is both safe and beneficial for women with GDM, and is an integral part of the overall treatment for GDM.
How Does Exercise Help My GDM?
When you have GDM your blood glucose levels are higher than normal. Exercise can help to reduce your blood glucose in two ways:
Through the methods listed above, exercise has been shown to be beneficial for women with GDM by reducing or delaying the need for insulin as a treatment for GDM. Improved blood glucose levels during pregnancy are also important, as high blood glucose levels increase the risk of poor health outcomes for both mum and bub, and ladies are also at increased risk of developing type 2 diabetes later in life.
Other benefits of exercise during pregnancy??
Exercise is beneficial in helping your mind and body in a number of ways including:
When shouldn’t you start an exercise program during pregnancy?
There are some conditions that require special treatment, and/or for you to be screened and checked by your doctor or specialist before commencing exercise. These include:
Seek medical advice regarding your suitability for exercising if you have any of the above.
What exercise can you do, and at what intensity??
Examples of aerobic exercise are: walking, running, swimming, cycling
BMI=body mass index
Examples include: multi-joint exercises, large muscle groups using dumbbells, resistance bands and body weight. Modified push ups or chest press, squats, resisted row, hip exercises, bicep curls, tricep pulldowns
Precautions for Exercising with GDM
Pregnant women with GDM who are taking insulin also need to be cautious of hypoglycaemia (low blood glucose levels). It is best to talk to your Exercise Physiologist or Credentialed Diabetes Educator to work out an exercise action plan that is tailored for you. Be mindful that the glucose lowering effect of exercise lasts for days, and that a hypoglycemic even (low blood glucose levels) is possible up to 24 hours post exercise.
The bottom line …
All pregnant women should participate in exercise during pregnancy, whether they have gestational diabetes mellitus, type 2 diabetes or no diabetes, unless they have a health condition that excludes them from doing so. Exercise has benefits for mother and unborn child and for ladies with GDM exercise is an integral part of your diabetes treatment, and health and wellbeing during your pregnancy. For specific advice in tailoring an exercise program for you, speak to our resident Accredited Exercise Physiologist and Credentialled Diabetes Educator, Lisa, to ensure you are exercising safely, and get the most from your exercise program.
Accredited Exercise Physiologist & Credentialled Diabetes Educator.
With the weather getting better and the golf season nearly upon us I thought it would be a great time to write a blog on the benefits of why getting in the gym can improve your golf game!
Have you ever noticed that you get fatigued towards the end of your round and the way your playing starts to go south? Maybe you have been rusty for the first hole or two but then you start to hit the ball okay when you have warmed up.
Do you practise a lot and the golf game never gets any better or do you regularly have injuries that disrupt your golf game?
Of course I am not under the illusion that getting in the gym and completing specific exercises will automatically lower your golf score and I don't think you are either, however it is something that can contribute to improvement and longevity!
A larger driving distance / Technique improvements / Skill improvements
The golf game is largely thought to be a technical game of skill, technique and patience however now there is certainly a view that strength and power are a fundamental part of someone's golf game!
Improving your strength and power can mean you can create more force from your swing which would increase your club head speed which means a larger force applied to the ball for the ball to fly further.
Also by being in the gym you can improve the way your body moves during certain tasks, for instance the golf swing, by having a better movement pattern this will help you to remain consistent when swinging and impacting the ball.
By being in the gym you can also help with your motor control and hand and eye coordination which helps with those tricky chip shots around the green!
In actual fact this has been studied. Back in 2012 it was found that an 18 week strength training program completed by low handicap golfers improved strength and power after the first 6 weeks and following skill specific training their golf performance also improved after the 12 week mark!
Injury and illness risk reduction
Golf is a rotational sport in which someone will swing to one side of the body up to 100 times throughout a round and practice by swinging to one side of the body. This can create imbalances from the working side and non-working side which can increase the injury risk to a golfer. Strength training helps to reduce these imbalances and therefore reduce injury risk.
By completing strength training you are increasing the tolerance of your tissues which in theory means less likely to be injured as your muscles, tendons and ligaments can sustain more force.
Away from the golf course strength training and exercise in general we know reduces your risk of developing, or plays a major role in the management of, chronic health conditions. More time at the doctors or not feeling well means less time on the course.
So with all this in mind! Training in the gym is an important part of staying on the course and we all know absences from the course can wreak havoc on your golf game!
Reduce fatigue on the last couple of holes!
Golf can take quite some time, in some cases can take 5-6 hours, this is a long time! It is not uncommon to see the golfers at the end of their round fade out.
What strength training does is to help with muscular endurance which means you are better prepared to last the whole 18 holes. More importantly, muscle endurance helps with consistency which means the last swing is as good as the first!
Essentially strength fights fatigue and allows you to last the whole 18 holes easier.
I know all this information but what next?
Now that you know what you can gain from getting in the gym from a golf perspective and if I'm going to be honest just by engaging in some kind of resistance training you may find some great benefits. However there are specific aspects of human performance that you want to train and certain training types that you should use in order to get the best out of training and to see the biggest improvement in your golf game.
All golfers, professional or your weekend warrior, should complete some flexibility, strength, balance and power training in order to achieve optimal benefits for your golf game.
Specific aspects of human performance include lower limb strength and power in particular using one leg exercises and trunk rotational strength and power allowing for better strength and speed of the swing. Training should also incorporate lower limb and trunk rotation strength and power together to create optimal muscle synergy as during the game of golf everything works together to send the ball down the fairway and straight!!.
A couple of general beginner exercises to get you started below!
There you go! Backed by evidence is the use of resistance training in the gym to improve your strength and power and in turn your golf game. At the end of the day, the more time you can spend on the course the better in my opinion and the better you play the more fun you have!
Accredited Exercise Physiologist
Are you worried that if you start weight/ strength training that it will make you look bulky, too masculine or even like a bodybuilder? Well we are here to debunk that myth and let you know that is not the case! Weight training will actually cause you to tone up, decrease body fat and accentuate your curves for all the ladies reading!
Here are 4 reasons why strength training should be a part of EVERYBODY’S routine and also why you won’t turn into Arnold Schwarzenegger either!
1. Muscles aren’t made overnight.
Increased muscular hypertrophy and size is actually quite difficult to achieve and takes prolonged periods of time, consistency and dedication so it won’t happen the first time you pick up a dumbbell! It takes up to 3 months just to recognise any significant changes in strength or muscle size. To reach “body-builder” levels you would have to be training and eating in extreme fashions for years, we guarantee you it won’t happen to you by accident.
The reassuring news is that to maintain and even increase our muscular strength and endurance we only have to be lifting weights on 2 days of the week. These improvements will help you with day to day activities (think lifting the kids/ grandkids, lifting pots/ soil in the garden or even just carrying the shopping bags!), increase your energy levels and confidence.
2. Six packs are made in the kitchen.
If you have ever heard this saying before you might already know that having a toned figure will be the outcome of both what exercise you are doing and the food you are eating. To reach bodybuilder status you would have to be consuming an extreme amount of food to keep up with the demands of your body. In the opposite sense to reveal the toned muscles you have built up through strength training you will need to reduce your body fat that sits above them. This is achieved predominantly through diet, weight loss is approximately 80% diet and 20% exercise.
3. Weights help to shape your body.
Have you previously spent hours in the gym on the treadmill, cross trainer and bike trying to burn every ounce of body fat off, only to realise it still has not produced the figure you were hoping for? Creating a strong muscular foundation creates that “perkier” bum, toned arms, better posture and so much more. Increasing muscle mass helps to tone all over the body even without losing significant amounts of body fat.
4. You’ll burn more calories without even trying.
Lifting weights doesn’t only impact the size and strength of your muscles… It improves a number of other physiological aspects too! Bone density, joint health, metabolism, brain health and energy levels all improve with weight training just to name a few! We also know that lean muscle mass burns more calories throughout the day regardless of what you are doing, when compared to fat mass. This means the more muscle you have, the more energy/ calories you will burn!
So, if you have been avoiding the weights, now is the time to go and pick them up! What are you waiting for?
Accredited Exercise Physiologist.
How does someone know how aerobically fit they actually are? How do you determine if your aerobic program is helping to improve your fitness? Does having a better aerobic fitness level improve your health? Follow along to find out these answers!
Being aerobically ‘fit’ or as ‘fit’ as someone can be is a widely accepted goal that everyone should be working towards and is something that is expressed by general practitioners regularly.
Being aerobically fit is not just for people who play sports, enjoy running or cycling. People who are more physically active throughout their day or have a more active job also have a higher aerobic fitness.
We know this because we can measure aerobic fitness or aerobic capacity and find out the Vo2 max of someone.
What is Vo2 max
Vo2 max refers to the amount of oxygen one can bring in, transport and use during a single minute of maximal exertion. Knowing this helps to determine how one's heart, lungs, blood vessels and muscle cells work together.
Oxygen is used by the body even at rest, but add in movement and the body starts to use more and more oxygen with increasing intensity. Oxygen is needed at rest because it is used in the production of energy the body needs to survive. When exercising or movement beyond resting the body needs more energy and therefore more oxygen, as the intensity of exercise increases the amount of energy production increases and, you guessed it, the amount of oxygen needed increases.
Vo2 max is a way of measuring the body's ability to use oxygen and is measured while exercising when the oxygen demand is the highest, at high intensity. Vo2 Max is referred to as the measure of aerobic capacity or cardio-respiratory fitness.
Why is a good Vo2 max important?
It has been widely researched that cardio-respiratory is linked with health and particular cardiovascular disease. In fact, low cardio-respiratory fitness is associated with 2-5x greater risk of cardiovascular disease or all-cause mortality, independent of other cardiovascular disease risk factors. That to me is a very motivating factor behind keeping fit.
What is a good Vo2 max?
Vo2 max is expressed as either an absolute number or a relative number. The absolute number does not take into account a person's size and while the relative number does.
It is hard to compare absolute Vo2 max as everyone is different and everyone weighs differently. Most of the time Vo2 max will be expressed as a relative value which is in ml/kg/min. This means relative Vo2 max will give you the amount of oxygen, in milliliters, you can bring in and utilise per kg of body weight per minute.
The following guidelines are taken from the American College of Sports Medicine. These guidelines help compare and understand where someone's aerobic capacity may be as compared to the age and gender.
How to measure it
The most accurate measurement for Vo2 max is completed in a laboratory where gas analysis is available. To measure Vo2 max using gas analysis, a graded exercise test (GXT) is completed. During the test a subject will ride on a bike or walk/run on a treadmill at increasing intensity, the intensity will increase every 2-3 minutes. Gas analysis is used to accurately measure the amount of oxygen inhaled vs the amount of oxygen and carbon dioxide exhaled while completing the test. The test is completed when maximal oxygen uptake is achieved.
Here in the clinic we don't have gas analysis so, to find out someone's aerobic capacity (Vo2 max) we use a treadmill/bike test where a subject will walk/run/ride while increasing the intensity every 1-3 minutes. During the test we monitor heart rate, rate of perceived exertion and the given workload. The test can be completed to a maximal effort or to a sub maximal effort depending on the subject. From the data we receive we can accurately measure Vo2 max using data driven equations from the American College of Sports Medicine.
From this method we can then individualise our aerobic programs to suit exactly the level of the subject which then helps to directly improve their health.
If you have any questions pop up throughout this blog please don't hesitate to ask.
Accredited Exercise Physiologist
Anterior Cruciate Ligament (ACL) rehabilitation and when is the best time to see an Exercise Physiologist?
An ACL injury can be a really horrible injury and happens a lot in contact ball sports but can also happen not participating in sport. After an ACL injury more than likely you would go see a doctor ( maybe a sports doctor) and there is a good chance he will do some tests on you around your knee to inform the course of action from there. If there is a suspected ACL injury you will be sent for some imaging to confirm the doctor's thoughts.
There is more than one course of action for you to take and this is dependent on your goals and what you want to get back too, this is for you and your doctor/surgeon to discuss.
We now know that an ACL reconstruction immediately following an ACL injury does not necessarily mean a better outcome furthermore surgery may not be the answer in individual cases as a favourable outcome can be achieved without surgery. Not to mention the option or ability to have surgery after trying rehabilitation alone first.
As EP’s we can work with physios and the treating doctor or surgeon to provide care and a path for rehabilitation back to what you love doing!
What is the ACL and ACL injury?
The ACL is a ligament in the knee that provides crucial stability to the knee joint. As seen in the picture below it is in the middle of the knee attaching from the thigh bone to the shinbone. The ACL prevents the shinbone from moving forward on the thigh bone.
An ACL injury is a tear/rupture or strain of the ligament from some form of forceful impact that strains the ACL more than its current capacity.
Other injuries commonly happen with an ACL injury, some examples of these may be meniscus injuries, trauma to cartilage, some bone trauma, injuries to other ligaments and some trauma to the joint capsule itself. These other injuries also affect injury prognosis and rehabilitation.
A major factor in ACL rehabilitation is that the process should be outcome based, rather than time based. This means the progression should be based on achieving outcomes that we understand mean readiness for the next phase. This means that specific and valid outcome measures are being used to track progress and guide rehabilitation.
Furthermore the program for rehabilitation should be specific to the injured person, everyone's injury is different, everyone responds differently to treatment and everyone has different goals they want to achieve following injury or surgery.
Phases of ACL rehabilitation
There are 5 phases of general ACL rehabilitation:
Returning to sport?
A more sport specific rehab protocol is the Melbourne ACL Rehabilitation Guide 2.0, this protocol was created by specialist sports physiotherapists that have worked with Olympic teams and elite AFL, netball, soccer and rugby teams, they also do research in the knee rehabilitation space. This guide is very specific and is outcome based and can be tailored to individuals and their goals.
The Melbourne ACL Rehabilitation Guide 2.0 is similar to your general ACL rehab however they have included a return to sport phase which essentially assesses your readiness to return to sport both physically and psychologically. The phases are: Pre op, Phase 1 - Recovery from surgery, Phase 2 - Strength and neuromuscular control, Phase 3: Running Agility and landings, Phase 4: Return to sport, Phase 5: Prevention of reinjury.
When is the best time to see an Exercise Physiologist (EP)?
Well technically speaking you can begin rehab with an EP for the initial phases of treatment and throughout the whole rehabilitation process. This should be dependent on the experience of the EP dealing with ACL’s and known knee injuries.
However I would suggest seeing a physio for the early phases of rehab as generally they have more experience around ACL and acute knee injuries as acute muscle and joint injuries is what they specialise in.
The best time to see an EP I feel would be either at the intermediate phase or the late phase of rehab, or somewhere in between. EP’s are well equipped to apply principles that govern strength and conditioning and apply these to rehabilitation as this is an EP’s role in musculoskeletal conditions or injuries. After all, the late phase and prevention phases of ACL rehabilitation are primarily strength and conditioning. This would all depend on the individual and the treating physiotherapists preference. All I will say is make sure you are getting sufficiently challenged and measured throughout the entire process and in particular the late stages.
ACL rehabilitation is a long process, a long wait to get back to sport or the activity you enjoy! So make sure the process is worth it, you minimise any complications and reduce the risk of a re - rupture!
If you need any help with your rehabilitation or want to know more please ask!
Accredited Exercise Physiologist.