Just 8 weeks of yoga benefit rheumatoid arthritis

Published

New research, published in the journal Restorative Neurology and Neuroscience, finds that an 8-week regimen of intensive yoga eases both the physical symptoms of rheumatoid arthritis and the psychological distress that usually accompanies the condition.

Dr. Rima Dada, Ph.D., who is a professor in the Department of Anatomy at the All India Institute of Medical Sciences in New Delhi, led the new research.

Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects approximately 1.3 million people in the United States. The disease is most likely autoimmune, which means that the immune system mistakes the body’s own tissues and cartilage as foreign and attacks them.

While there is no cure for RA, there are a variety of medications available. However, as Dr. Dada and her colleagues explain in their paper, recovery depends on various factors, some of which are psychological.

Depression, for instance, often occurs alongside RA, and it can negatively affect a person’s outcome.

In this context, Dr. Dada and team wondered if a yoga-based mind-body intervention could ease depressive symptoms in RA and help achieve remission of this chronic disease.

Yoga aids remission at cellular level
To find out, Dr. Dada and colleagues examined the effects of practicing yoga intensively in 72 people with RA.

The scientists divided the study participants into two groups. Both groups continued to take disease-modifying antirheumatic drugs (DMARDs), which are the drugs doctors typically prescribe for this condition.

Also, one group engaged in 120-minute sessions of yoga five times a week, for 8 weeks. The two main outcomes the researchers assessed were disease activity and depression severity.

After the intervention, improvements in markers of neuroplasticity, inflammation, cellular health, and cellular aging — such as oxidative stress — showed that yoga had a positive effect on those who practiced it.

Dr. Dada and colleagues conclude, “Yoga, a mind-body intervention re-established immunological tolerance by aiding remission at molecular and cellular level along with significant reduction in depression.”

“Thus in this inflammatory arthritis with a major psychosomatic component, yoga can be used as a complementary/adjunct therapy.”

The study’s lead author reports, “Our findings show measurable improvements for the patients in the test group, suggesting an immune-regulatory role of yoga practice in the treatment of RA.”

“An intensive yoga regimen,” she continued, “concurrent with routine drug therapy induced molecular remission and re-established immunological tolerance. In addition, it reduced the severity of depression by promoting neuroplasticity.”

She goes on to explain the mechanisms responsible for these beneficial effects. “Yoga facilitates the mind’s capacity to affect bodily function and symptoms mediated through a variety of downstream pathways and bring about natural immunological tolerance.”

The researcher notes that people could supplement standard RA drugs “with alternative and complementary interventions like yoga to alleviate the symptoms at both physical and psychosomatic levels.”

“Our results provide evidence that yoga positively modifies the pathobiology of autoimmunity at cellular and molecular levels by targeting mind-body communications,” she says.

“Further research is needed for the exploration of possible mechanisms underlying the cumulative effect of yoga on multiple pathways at a cellular level.”

Dr. Rima Dada

Association of yoga exercises and vertebral compression fractures

Yoga has gained increased popularity for the promotion of both mental and physical health. A 2012 national survey found that approximately 10 percent of U.S. adults (21 million) practiced yoga. Matthew T. Drake, M.D., Ph.D., with Endocrinology, Diabetes, Metabolism, and Nutrition at Mayo Clinic’s campus in Rochester, Minnesota, says: “Importantly, yoga has found significant traction among more older adults, with a recent report that more than 20 percent of U.S. yoga practitioners are older than 60 years, perhaps in part due to reports that the regular performance of yoga has the potential to improve balance and to limit falls.

“The relative safety of yoga in at-risk populations, however, remains largely undetermined. Thus, between 2001 and 2014, nearly 30,000 visits to U.S. emergency rooms were related to yoga-associated injuries, with 13 percent of injuries occurring in those age 65 years or older. Further, injury rates in the older adults increased from 6.9 to 57.9 per 100,000 participants over this same time frame.

“However, it has been difficult to estimate and characterize the yoga-specific associated risks, define the at-risk populations for yoga-associated injuries, and identify potential protective measures to limit injuries.”

Mehrsheed Sinaki, M.D., M.S., with Physical Medicine and Rehabilitation at Mayo Clinic’s campus in Minnesota, comments: “Whether the effects of yoga on the skeleton are beneficial or harmful remains a subject of debate. While a recent report suggested that daily yoga exercises may increase bone mineral density over two years, it was not clear that fracture risk was diminished. Further, a recent systematic review identified the musculoskeletal system as the most common site of yoga-associated injuries.

“Given both that many yoga exercises involve significant spinal flexion, extension and torsion and that many yoga adherents are aged and thus likely to be at increased fracture risk, it is of potential concern that some yoga exercises may surpass the biomechanical competence of the spine and result in vertebral compression fractures (VCFs).”

Jad Sfeir, M.D., with Endocrinology, Diabetes, Metabolism, and Nutrition at Mayo Clinic’s campus in Minnesota, explains: “To address this concern, we recently published a study in the European Journal of Physical Rehabilitation Medicine where we evaluated 33 consecutive patients with back pain that began after yoga exercise. Plain radiographs and medical records were reviewed to ascertain the relationship between the development of acute pain with associated VCFs and the yoga exercise. Nine patients met all criteria. All patients described a yoga-associated spinal flexion exercise as causative of the acute back pain that preceded their VCF diagnoses.

“Consistent with the increased popularity of yoga in the general population, six of the nine people had initiated yoga without a medical recommendation. Collectively, the group included eight women and one man. Median age was 66 years (range, 53 to 87 years), and eight people were Caucasian. The primary basis for presentation in all people was back pain, which ranged from four to 48 months in duration. VCF occurred one to 72 months after yoga exercise initiation, with four patients having fractures within one year of starting yoga. VCFs were identified in the thoracic (n = 6), lumbar (n = 4) and cervical (n = 1) spine.

“Dual energy X-ray absorptiometry (DXA) assessment performed at a median of 10.5 months prior to the index VCF showed that only four patients had osteoporosis by bone mineral density criteria, while one additional patient was classified as having osteoporosis due to a history of a prior fragility fracture. In only one patient was a secondary cause (primary hyperparathyroidism) for osteoporosis identified. Notably, four patients sustained a VCF in the setting of normal or near-normal bone mineral density.”

Dr. Sinaki highlights: “Spinal flexion exercises are common in yoga and produce increases in both torque pressures and compressive mechanical loading forces applied to individual vertebral bodies. These forces may be additive or multiplicative and result from a diminished ability of the intervertebral disks to absorb the simultaneous combination of forces from upper body weight, spinal flexure muscle contraction and spinal longitudinal ligament strain.

“Importantly, these issues may be particularly acute in older people, in whom age-associated degenerative changes in the intervertebral disks are common. While there is good evidence that appropriate exercise and rehabilitation programs can significantly reduce fracture risk, the incorporation of safe exercise practices is essential for balancing progressive skeletal loading activities within biomechanical limits. Accordingly, the implementation of personalized exercise programs, ideally aimed at strengthening both the back extensor and core abdominal muscles to increase overall balance and stability while simultaneously avoiding excess spinal strain, becomes crucial.

“The figure demonstrates yoga poses that generally should be avoided in at-risk patients given the extreme flexion, extension and torsional strains involved. Also included in the figure are yoga poses that will increase balance and muscle strengthening without imposing significant spinal forces.”

Dr. Drake concludes: “In sum, yoga has unfortunately been misconceived as a one-size-fits-all prescription based on scientific and media reports that continue to advertise yoga as a purely bone protective activity. Instead, the cornerstone for fracture prevention and benefit from yoga should be the appropriate selection of patients and provision of an appropriate yoga poses prescription.”

For more information

Sfeir JG, et al. Vertebral compression fractures associated with yoga: A case series. European Journal of Physical and Rehabilitation Medicine. In press.

The 10 Biggest Fitness Myths

By Gretchen Reynolds

Does stretching prior to a run prevent injuries and improve performance? Does guzzling water prevent cramps? Here’s the truth about the top 10 fitness myths.

Chances are some bogus training advice has wormed its way into your fitness regimen. Time to root it out. Here are the ten performance myths holding you back, from pre-race stretching to the evils of high-fructose corn syrup. Plus: Three truisms that are still up for debate.

Myth #1: Stretching Prevents Injuries

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Static stretching decreases short-term muscle strength. (Inga Hendrickson)

Myth: Stretching Prevents Injuries
Truth: It could ruin your 10K time

In 2010, researchers at Florida State University asked ten male athletes to stretch for 16 minutes, then run for an hour on a treadmill. In a later session, the same crew sat quietly for 16 minutes, then hit the treadmill for the same duration. Without the pre-run stretch, the men covered more distance while expending less energy. The researchers’ blunt conclusion: “Static stretching should be avoided before endurance events.”

Still, the pregame ritual endures. Most of us were taught by our third-grade PE ­teacher that we need static stretches—like touching your toes and holding for 30 seconds—to be fast and flexible. Most physiologists now believe that when you elongate muscle ­fibers, you cause a “neuromuscular inhibitory ­response,” says Malachy McHugh, director of research for the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City and an expert on flexibility. By triggering this protective ­counter-response in the nervous system, which tightens the muscle to prevent it from overstretching, you render yourself less ­powerful. In ­experiments, static stretching temporarily decreased strength in the stretched muscle by as much as 30 percent, an effect that can last up to half an hour.

But stretching prevents injuries, right? Actually, in several large-scale studies of athletes and military recruits, static stretching did not reduce the incidence of common overuse injuries such as Achilles tendino­pathy and knee pain.

Your Move: The jury is still out on the best pre-workout alternative, but dynamic stretching, which incorporates a range of body movements rather than muscle isolation, doesn’t stress tissues to the point of activating the nervous system’s protective instincts. If you’re a diehard stretcher, use this five-minute dynamic-stretching routine to warm you up for the race:

  1. Jumping jacks (set of 20)
  2. Skipping, forward and backward (one minute)
  3. High-leg marches: walk forward, ­kicking each leg up in front of you with knees locked, like a tin soldier (one minute)
  4. Kick your own butt: hop on one leg, kicking the other leg backward, touching your buttocks (set of ten per leg)

Myth #2: Running Barefoot Is Better

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Going barefoot isn’t a cure-all. (Inga Hendrickson)

Myth: Running Barefoot Is Better
Truth: It all depends on body type and discipline

Shoes alter how we move. As soon as you put toddlers in cute little loafers, their walking changes: they take longer steps and land with more force on their heels. In the January 2010 issue of the journal Nature, Harvard scientists reported that urban schoolchildren in Kenya who wore shoes ran differently than unshod rural youngsters. Most of the urban children struck the ground with their heels, causing impact peaks, or shock waves, to travel up their legs. The barefoot runners landed lightly near the front of their feet.

A compelling finding, sure, but practically useless. Unless you were raised in the bush, you grew up wearing shoes, and as repeated biomechanical studies show, our bodies cling stubbornly to what they know. When researchers from the University of Wisconsin La Crosse outfitted recreational runners with barefoot-style running shoes, about half of the runners continued to strike the ground with their heels, just as they had in their old shoes. But if you hit with your heels and no longer have cushioning to dissipate the force, you amplify the pounding instead of reducing it. “It’s tough to relearn to run,” the scientists cautioned in their report.

Meanwhile, landing near the front of your foot, as adept barefoot runners do, can be beneficial but is no guarantee against injury. Biomechanics research shows that forefoot striking sends shock waves up your leg, too, but in a different pattern than when you heel-strike. These forces move mostly through the leg’s soft tissues instead of the bone, meaning less risk of a stress fracture—but more chance of an Achilles injury. In other words, your body takes a pounding from running, barefoot or not.

Your Move: The truth is, going barefoot can be good for your body. It all depends on your susceptibility to specific injuries and how you make the transition. If you’re ready to give it a try, experts agree you should start slowly. “Go for a ­typical run,” says Stuart Warden, an assistant professor at Indiana University’s School of Health and Rehabilitation Sciences. “Then take off your shoes for the last quarter of a mile.” Gradually increase the barefoot distance by a quarter-mile at the end of each run. And, above all, concentrate on form: land lightly, don’t overstride, and try not to hit the ground with your heel.

The biggest mistake barefoot newbies make is overstriding. Adopt quicker movements that cover less distance. If you’re on the fence about whether barefoot is right for you, use the following as your guide.

Will Barefoot Running Help My Injury?

  • Sore Knees: Barefoot running is worth a try; it can lessen knee pain.
  • Achilles-tendon problems: Barefoot running is probably not worth trying. Striking your forefoot increases stress on the Achilles.
  • Heel pain or plantar fasciitis: Do not swith to barefoot running. Without perfect form, you’ll be pounding that sore heel without any padding.
  • Sprained ankle: Barefoot running could be beneficial after the ankle heals. Going shoeless can improve the body’s pro-prioception, or spatial awareness, reducing risk of another sprain.

Myth #3: You Need to Focus on Your Core

Myth: You Need to Focus on Your Core
Truth: Core strength is probably overrated, and you risk injury by focusing too specifically on it

First off, many athletes erroneously cling to the notion that six-pack abs are a sure sign of a strong core. More to the point, it’s unclear whether core-specific training benefits athletic performance at all. In one study, a group of collegiate rowers who ­added an arduous eight-week regimen of core exercises to their regular rowing ­workouts wound up with stronger, tauter cores. But they didn’t become better rowers: their performance levels remained the same. Similarly, researchers at Indiana State University ­measured core strength among a group of Division I varsity football players and then had them complete sets of standard exercise drills like shuttle runs. The researchers found almost no correlation between a super­charged core and athletic performance.

What’s more, the crunch, that ubiquitous exercise that promises a solid midsection, is often harmful, because many gym rats are pumping them out with terrible form. When researchers simulated crunches using spines from pig cadavers, the spinal disks usually ruptured after a couple thousand reps. “Crunches are totally unnecessary,” says Thomas Nesser, a professor of physical education at Indiana State University.

Your Move: Core strength is important, but most people get what they need simply by practicing their sport. Common routines like squats, deadlifts, and kettlebell drills add plenty of core strength. And new studies show that running—long thought to provide little or no core benefit—does work your midsection. “Train for your sport and core strength will develop,” advises Nesser.


Myt#4:  Guzzling water prevents crampsTruth: Water and electrolytes have little to do with muscles seizing upMyth:Guzzling water prevents cramps
Truth: Water and electrolytes have little to do with muscles seizing up

Myth #4: Guzzling Water Prevents Cramps

Myth: Guzzling water prevents cramps
Truth: Water and electrolytes have little to do with muscles seizing up

For years we’ve heard that exercise-­induced cramping is caused by dehydration and the associated loss of sodium and ­potassium. We’ve been urged to load up on bananas or chug salty sports drinks before and during workouts. But in 2011, South African researchers studied hundreds of Ironman triathletes, a group frequently felled by muscle cramps. To check for signs of clinical dehydration, researchers took blood samples just prior to the event’s start, for measuring levels of sodium and other electrolytes, then drew blood again at the finish line. Forty-three of the Ironmen cramped during the race, but the afflicted were no more dehydrated than the other competitors were, and they had comparable electrolyte levels. The principal difference between the two groups was speed: the tested group finished faster.

A team of scientists at North Dakota State University in Fargo reached similar conclusions. In a 2010 study, the researchers asked a group of fit young men to fill up with ­water, then induced cramping by zapping them with a series of low-level electric pulses. They did the same after the men rode stationary bikes in a heat chamber, with some of them losing up to 3 percent of their body weight to sweat. Since it took the same number of electrical shocks to induce cramping again, the spasms “were likely not caused by dehydration,” says professor Kevin Miller, who led the study. Instead, he believes that muscle cramps are due to exertion, fatigue, and a cascade of accompanying biochemical processes.

Get over it: Miller can’t tell you how to eliminate cramps altogether—there isn’t enough research—but stretching seems to be the best option to relieve acute cramping once it’s set in. That and pickle juice. In one of Miller’s recent studies, cramp-stricken ­cyclists who drank 2.5 ounces of it recovered 45 percent faster than those who drank nothing. Miller speculates that something in the acidic juice disrupts the nervous-system ­melee in the exhausted muscle.


Myth #5: Popping Ibuprofen Prevents Soreness

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Ibuprofen may make sports pain worse. (Inga Hendrickson)

Myth: Popping ibuprofen prevents soreness
Truth: It does more harm than good

At the 2006 Western States 100, an ultra-endurance marathon in Squaw Valley, California, seven of ten racers polled said they had swallowed ibuprofen before or during the race, while almost 60 percent of racers polled at the 2008 Brazil Ironman said they popped painkillers. “It’s become part of their ritual of getting ready,” says ­Stuart Warden, director of the Center for Translational Musculoskeletal Research at Indiana University and an expert on rehabilitation of sports-related injuries.

After the Western States race, however, competitors who’d used ibuprofen were just as sore as those who hadn’t. Surprisingly, they also displayed more blood markers of inflammation than other competitors, even though ibuprofen is an anti-inflammatory. Recent work from others has suggested that frequent use of painkillers can blunt the ability of muscles to adapt to exercise. In a 2010 study of distance-running mice, researchers determined that “ibuprofen administration during endurance training cancels running-distance-dependent adaptations in skeletal muscle.” In other words, the rodents’ muscles stopped building strength in response to the training. In an editorial in the British Journal of Sports Medicine in 2009, Warden went so far as to say that “ritual use” of ibuprofen “represents misuse.”

Your Move: Don’t take ibuprofen unless you have a legitimate injury. Muscle pain is part of the body’s training response, and nothing has been shown to effectively ward it off.


Myth #6: Dehydration Hurts Performance

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Overhydrating? It’s hurting your performance. (Inga Hendrickson)

Myth: Dehydration hurts performance
Truth: Overhydrating is more likely to sabotage your personal record.

In the 1990s, endurance athletes were advised to stay ahead of their thirst and drink as much as they could stand during training and races. A decade later, almost everyone had been schooled with the knowledge that hydrating to excess can cause hyponatremia—essentially, intoxication caused by consuming too much water, a ­potentially fatal condition in which cells swell with the excess fluid.

However, whether dehydration is ­equally troublesome and a hindrance to peak performance remained up in the air. But ­according to a 2011 review of time-trial studies of dehy­dration, losing up to 4 percent of body weight during exercise does not alter performance. Results from endurance events seem to bear that out: during the 2009 Mont-Saint-Michel Marathon in France, researchers measured the weight loss of 643 competitors and compared it with their finish times. The runners who lost the most water weight were also the fastest. Most of those who finished in less than three hours lost at least 3 percent of their body weight to sweat.

Your Move: “Drink when you feel thirsty,” says James Winger, M.D., assistant professor at Loyola University’s Stritch School of Medicine in Chicago, who conducted a survey of distance runners last year and found that misconceptions about hydration were rampant, even among endurance athletes. “Thirst is an exquisitely finely tuned indicator of your body’s actual hydration status,” Dr. Winger says. “Listen to it.”


Myth #7: Ice Baths Speed Recovery

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Post-race icing: proof that the placebo effect is alive and well. (Inga Hendrickson)

Myth: Ice baths speed recovery
Truth: They’re not worth the chill

Many elite athletes, from marathoners to gridiron stars to starting pitchers, practically swear by icing up as a way to promote healing. But this nearly universal post-race/game/workout ritual now looks like nothing more than proof that the placebo effect is alive and well. In a 2007 study in the Journal of Sports Sciences, men who completed a punishing 90-minute shuttle run and then eased themselves into a 50-degree bathtub for ten minutes told researchers afterward that they were sure they were less sore than they would have been without the bath. Yet their levels of creatine kinase, a hallmark of muscle damage, remained the same as in runners who hadn’t soaked. Also in 2007, in one of the few randomized controlled tests examining the popular practice, 40 volunteers did seated leg extensions until near exhaustion. Afterward, half sat in lukewarm water while the other half sat in an ice bath. Next day, those who’d ice-bathed were just as sore as the control group. In fact, the ice bathers reported more pain than the others during a test in which they were asked to rise out of a chair using their tired leg for support. The authors concluded that the “protocol of ice-water immersion was ineffectual.”

Get over it: If you like freezing your butt off, soak away, but the benefits are strictly psychological. Any physiological effects won’t last longer than the ice itself.


Myth #8: Long and Slow Burns More Calories

Myth: Long and slow burns more calories
Truth: You need to pump up the intensity

For years it’s been assumed that you eliminate more lipids in the magical fat-burning zone—exercising between 68 and 79 percent of your maximum heart rate—than when you ­really exert yourself. Why? Because, the ­theory went, low-intensity exercise allows the body to fuel itself from the midsection rather than from readily available food calories.

But a report by David Nieman, a professor in the Human Performance Laboratory at Appalachian State University in North Carolina, showed that strenuous exercise burns more calories per minute than easy sessions. Which isn’t surprising: higher intensity equals more calories. But that study also determined that intense exercise increases your metabolism for up to 14 hours afterward. In other studies, light-duty exercise produced no such caloric afterburn. “We’ve become a nation of exercise wimps,” Nieman says. “Too many people don’t bother or are afraid of exercising hard. But intensity is probably the only way to lose weight with exercise.”

Your Move: Start sprinkling high-speed intervals into your slow runs. Do hill repeats on your bike. Try to maintain a heart rate at or above 80 percent of your max for about 45 minutes several times a week.


Myth #9: Fructose Is a Performance Killer

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Athletes should embrace fructose. (Inga Hendrickson)

Myth: Fructose is a performance killer
Truth: Fructose can be a performance superfuel

The warnings are stern: avoid fructose, ­especially in the form of high-fructose corn syrup, because it’s contributing to an obesity epidemic. And the evidence is strong that people who are sedentary should avoid it. But for active individuals, it’s a different story. “All athletes who compete or train for a period longer than 45 to 60 minutes will improve their performance by ­ingesting a ­solution containing carbohydrates,” or sugar, says Luc van Loon, a professor in the Department of Human Movement Sciences at Maastricht University Medical Centre in the Netherlands. And you’ll get more performance bang if that ­sugar is, in part, fructose. When cyclists in a British study drank a beverage containing both fructose and glucose (a simple sugar that typically appears on ­labels as maltodextrin), they rode almost 8 percent faster during a time trial than riders who drank fluids with glucose alone. “Fructose and glucose are ­taken up in the intestine by different transport proteins,” van Loon says. “This allows for a more rapid uptake of carbo­hydrates from the gut.” Which means you have more calories available to you more quickly if you drink or eat carbo­hydrates containing fructose.

Most high-fructose corn syrup contains approximately equal portions of glucose and fructose and is perfectly acceptable for athletes. The concerns about high-fructose corn syrup have more to do with the highly processed foods they often show up in ­rather than the intrinsic characteristics of the ­sugar. The drawback for endurance athletes is that the ideal ratio of glucose to fructose is 2:1 (not the 1:1 of corn syrups). “There are very few drinks on the market that provide that perfect mix,” says Asker Jeukendrup, a professor of exercise metabolism at the University of Birmingham in England, who led the study of cyclists.

Your Move: Read labels. Some drinks, such as PowerBar’s Ironman Performance beverages, tout their 2:1 glucose-fructose mix. For do-it-yourselfers, sports nutritionist Nancy Clark’s homemade sports drink, from the fourth edition of her Sports Nutrition Guidebook, is an ideal performance boost. Gather ­together these ingredients:

  • 1/4 cup sugar
  • 1/4 teaspoon salt
  • 1/4 cup orange juice
  • 2 tablespoons lemon juice

Then, in a quart pitcher, dissolve the sugar and salt in ¼ cup hot water. Add the orange and lemon juice and 3 1/2 cups cold water.


Myth #10: Supplements Help Performance

Myth: Supplements help performance
Truth: There’s no such thing as a magic pill. (At least a legal one.)

Antioxidants, Including Vitamins A, C, and E

Conventional Wisdom: They destroy free radicals, molecules created during exercise that are thought to contribute to cell damage.
Science Says: According to recent studies, some free radicals appear to trigger chemical reactions that actually help strengthen muscles after exercise and improve health. So taking antioxidants in excess may curb the benefits of exercise.

Quercetin

Conventional Wisdom: A flavonoid found naturally in apples, red wine grapes, and other fruits and vegetables, it’s thought to improve endurance capacity and fight fatigue.
Science Says: Athletes get little or no benefit from it. An upcoming review of seven studies concluded that quercetin may be useful for out-of-shape people who start exercising but does next to nothing for the already fit.

Creatine

Conventional Wisdom: It’s the most ­popular supplement in the country, and power athletes insist it helps build muscle strength and bulk.
Science Says: It does—to a point. College football ­players who used creatine bench-pressed more weight, and Australian soccer players sprinted faster. But if you’re an endurance athlete, creatine draws extra water into cells, leading to diarrhea and even cramping.

DHEA

Conventional Wisdom: DHEA raises testosterone ­levels and helps build muscle and increase power.
Science Says: Yes and no. DHEA is a naturally ­occurring hormone that affects the body’s ability to produce testosterone. But a 2006 study in the New England Journal of Medicine found that daily doses in men with normal levels did not increase muscle strength.


Up for Debate

Massage Boosts Recovery

In a 2010 study, Canadian researchers had 12 healthy young men squeeze a hand grip until their arm muscles were spent, then had a certified sports-massage therapist give half of them a rubdown. The other half received no such pampering. Surprisingly, the ­massages did not increase blood flow to the men’s muscles—one of the primary reasons athletes seek bodywork after a strenuous workout. Additionally, researchers concluded that a massage “actually impairs removal of lactic acid from exercised ­muscle.”
Missing Link: Studies are needed that examine whether post-exercise massage might have other benefits. Most athletes swear they feel better after being kneaded, but so far there’s no evidence at the cellular level to justify the indulgence.

Surgery is best for an ACL tear

A landmark study on torn ACLs published in 2010 in the New England Journal of Medicine led to heated disagreement about the effectiveness of going under the knife. Researchers randomly assigned either surgery or physical therapy to a group of 121 active adults who’d suffered an ACL tear. After two years, the groups’ knees were similar in terms of function and pain, showing that there was little advantage to the surgery.
Missing link: Finding a better way to repair wracked knees. While plenty of athletes have come back from an ACL tear at an extremely high level—surgery and physical therapy can usually restore basic knee stability—many never reach peak performance again. In current ACL surgery, injured tissue is often replaced. But some surgeons are experimenting with reconstructing the ligament with new forms of tissue grafts, which could produce better long-term outcomes.

Cortisone Shots Speed Healing

Although they can provide immediate pain relief for soft-tissue injuries such as tennis ­elbow and Achilles tendinopathy, the shots can slow healing over the long term, according to a number of new studies. A comprehensive review of the available research published last year found that people who’d received cortisone shots had a much lower rate of full recovery than those who’d done nothing at all. Plus, they had a 63 percent higher risk of relapse.
Missing link: Trying to figure out exactly what’s going on inside overtaxed tendons and ligaments. In fact, scientists don’t fully understand the mechanics of injuries like tennis elbow and Achilles problems, so they don’t know how best to treat them—except to say that cortisone shots don’t appear to do the trick.

Top 5 benefits of yoga therapy for cancer care

By Laura Kupperman

Ample scientific literature supports the benefits of yoga for cancer care, pointing toward improvements in quality of life, well-being, sleep, strength, and energy. Studies also show diminished anxiety, depression, stress, PTSD symptoms, heart rate, and more. (If you’re interested in the research, this is a great place to start, and yogatherapy.health lists relevant studies, too.)

What I’d like to share with you here, though, are the benefits I’ve witnessed, and experienced, personally. Since 2005, I’ve offered yoga to hundreds of women and men diagnosed with cancer, as well as trained other teachers how to do so safely. Over and over, I’ve been awed and humbled by the positive effects of integrating yoga therapy into cancer care. And as a 15+ year cancer survivor myself, I’ve also been on the receiving end of everything I’m sharing with you.

Here then, are my top five benefits of incorporating yoga therapy into cancer care.

  1. Befriending and supporting your post-diagnosis body. The physical side of cancer treatment may include surgery, radiation, chemotherapy, transplant, hormone therapy, and immunotherapy. Even under the best of circumstances, your body likely will have been poked, prodded, and cut, resulting in asymmetries, imbalances, weakness, and tightness. Yoga therapy can help you gently explore your body’s “new normal” so you can safely begin to address these side-effects.
  2. Breathing deeply. Breath is a central pillar of yoga therapy, and the breath is never more important than when you’ve received a life-changing diagnosis. When you breathe deeply you massage your internal organs, improve lymphatic flow, and help calm your nervous system, among other benefits.
  3. Standing up straight. This one sounds basic, but think about it: If you’ve ever had a bad cold, all you want to do is curl up in the fetal position and lie on the couch. Multiply that by 20 with a cancer diagnosis and by 100 if you’ve had surgery in your chest, and you may end up walking around like Quasimodo. Adopting a slumped, heart-protective posture is totally normal under the circumstances, but your organs and glands function best when they’re not mushed together. Chemotherapy and other treatments exact quite a toll on many body parts, and we need to support their health by giving the
    m the space to work. There’s a reason the “Wonder Woman Power Pose” (shown to increase confidence and pain tolerance) involves standing up straight, and yoga therapy can you help experience this power for yourself.
  4. Paying attention to the present moment. If you’ve been diagnosed with cancer you may be spending a lot of time in your head. Pondering treatment options and incessantly thinking about “what if” can both create stress and rob you of the present moments that are still yours to enjoy. Yoga therapy can teach you how to mindfully engage with what is actually happening in the present moment, and take a vacation from mind chatter. 
  5. Making peace with whatever is, or isn’t. Yogic philosophy is rooted in helping practitioners find peace of mind. One of the best definitions of yoga I’ve heard is “the ability to make peace with whatever is or isn’t happening in your life.” Let’s face it—cancer sucks. Nobody asks to be dealt that hand of cards. But it’s also true that there are ways of experiencing an illness that can increase suffering, and other paths that can help decrease suffering. Yoga therapy is a terrific path for learning how to decrease suffering.

Many students I’ve worked with over the years began their yoga practices after completing chemotherapy or other treatment, and the one comment I repeatedly hear is, “Why didn’t I start this sooner?!” So regardless of whether you’ve tried yoga before, my encouragement to you is DON’T WAIT. If you want individualized support from a caring professional who has the tools to help you start feeling better now, it’s time to check out yoga therapy.

Laura Kupperman, MA, C-IAYT, is a yoga therapist specializing in yoga for people with cancer. She also trains others to work with cancer survivors, presents at medical conferences on the benefits of yoga for cancer wellness, and serves as a business coach for other wellness professionals.

Renee Moilanen: The weight of the world on our kid’s shoulders

By RENEE MOILANEN | renee.moilanen@gmail.com |

As much as I support the idea of children walking to school, I cringe every time my third-grade son hefts his gargantuan bookbag onto his shoulders and trudges hunchbacked toward campus.

Loaded up with his required laptop, lunchbox and textbooks, my son’s bookbag weighs 14 pounds. That’s nearly 25 percent of his body weight, a hefty addition on his half-mile trek to school, which is – I swear I’m not exaggerating – uphill both ways. If I had to haul an extra 30 pounds on my back to get to work, I’m pretty sure I’d malinger more often.

The poor boy has started to develop the posture of a desk-bound office worker. And every now and then, he gripes about back pain. I can’t tell if it’s the usual moans and groans of a coddled 9-year-old or the beginnings of a real problem.

The pediatrician did nothing to alleviate my concerns. Nothing more than 10 pounds, she said. If that means buying a second set of textbooks to keep at home or subjecting him to embarrassment with a rolling backpack, so be it. He’ll thank me later.

Heavy backpacks, it turns out, are a real health issue. In 2017, roughly 7,800 children were treated in emergency rooms for injuries related to backpacks, according to the Consumer Product Safety Commission. And the American Academy of Pediatrics recommends limiting backpacks to no more than 10 percent of a child’s weight. Heavier loads can give kids low-back strain, shoulder pain and poor posture, a preview of middle-age they don’t need.

A few years ago, the California legislature adopted a resolution urging school districts to develop guidelines for easing the backpack load. The resolution is full of suggestions, everything from electronic textbooks and more lightweight handouts to hanging scales in classrooms to monitor backpack weight.

But if local school districts are working on the issue, they haven’t gotten the word out to my overloaded boy. I’m starting to question whether studying for a social studies test outweighs the spinal stress of hauling that textbook home. An extra-credit science project? Not if that means schlepping five pounds of clay volcano to school.

At the parent-teacher conference, I couldn’t concentrate on the teacher’s comments about math aptitude and reading scores. I kept waiting for the chance to ask my one burning question: Does my son really need to bring the Chromebook home every day? Can’t he leave that three-pound monster at school? Because achieving technological competency is important, but so is an uncompressed spine, and surely we can have both.

Experts urge ergonomic backpacks with well-padded shoulders. Waist straps, which help distribute the weight more evenly. Even smaller bookbags, which seemed counterintuitive until I realized my son was using his extra-large bag to haul around broken keychains, interesting rocks and 37 pencil stubs. I’m now more diligent about clearing the junk.

But the problem may only worsen as my son approaches middle school, and then high school, where presumably the workload intensifies, textbooks thicken and after-school activities add new supplies to his already stuffed backpack.

So I’m steering my son toward lighter-weight activities. So what if he dreams of learning to play the tuba? A harmonica is fine. And he’ll thank me later.

Secrets from a 76-Year-Old Ironman Athlete

By Karla Walsh

27,886. That’s how many days Lis Heckmann lived on this Earth prior to the 2015 Ironman World Championship in Kona, Hawaii. The 76-year-old retiree from Lehigh Acres, Florida, was the oldest competitor tackling the 2.4-mile swim, 112-mile bike, and 26.2-mile run this year. Here’s what we learned from six-time Ironman, who BTW, has also tackled 20 half Ironman races (70.3 miles), 100 Olympic and sprint triathlons, 12 marathons, 20 half-marathons, and countless 5K and 10K races. [Editor’s note: WHEW!]

1. Build from your specialty. One of Heckmann’s top tips for beginners? “Aim to be proficient at one event prior to training for your first triathlon. This gives you an anchor to work on and allows you to work on two instead of three disciplines,” she says.

2. Never lose hope. Strike 1: “While carrying a box in a slippery, greasy parking garage in 1975, I slipped and broke my ankle into 16 pieces. Fifteen screws and 6 months later, I was able to exercise again and started swimming and biking as part of my doctor-advised rehab,” she says. But her career kept her too busy to become a hardcore fitness fiend until about 10 years later when Heckmann took up running. Strike 2: That bad break caused arthritis. “In 2000, I started doing triathlons after my orthopedic doctor told me that I needed to focus more on cross-training to take some of the pressure off of my ankle,” she says. Strike 3: Heckmann was hit by a car while on a 75-mile bike ride in 2009. Her leg was broken, but just like always, her resolve was not.

3. Find a support team. Tim, her husband of 25 years, is her number one fan. “My proudest moment is seeing my husband’s smile as I cross the finish line. He is the most supportive man in the world,” Heckmann says. “Even though he thinks I’m nuts, he’s spent hundreds of hours taking me to the beach for open water swims or shadowing me in the car when I do long bike rides.”

4. Don’t fear new gear. “I’ve tried nearly every brand of sneakers. Three months ago I discovered Hoka shoes and I now own three pairs. Running feels better than it has in years!” she says.

5. Practice, practice, practice. Almost like a full-time job, Heckmann prepares for her next race for about 30 hours each week. Her seven-day schedule:

  • Every morning: 30 minutes of stretching
  • Five days/week: Swim for 1 hour
  • Three days/week: Run 7 miles, strength train for 1 hour
  • One day/ week: Spin for 1 hour
  • Plus 8 to 10 hours of biking

6. Keep yourself entertained. During those long and slow training runs or bikes, Heckmann tunes in to “bouncy Latin music or audiobooks.” Follow her lead and pop in those headphones (when on a safe, traffic-free path) and cue up one of our go-to motivating playlists.

7. Time it right. Next big race, Heckmann plans to arrive earlier to recover from jet lag and give her body time to adjust and deal with any lingering exhaustion, illnesses, and more.

8. Choose an active hobby. Since retiring from her career in real estate, Heckmann focuses on preparing for triathlons and tending to her organic garden. Even something as low-intensity as weeding and digging can help reduce your risk for cardiovascular disease, obesity, osteoporosis, and more.

9. Reflect on your success. “My most memorable race was running down Alii Drive, the final sprint, during my first Kona Ironman in 2005. I could hear Mike Reilly over the loudspeakers saying, ‘You are an Ironman.’ It was extremely emotional knowing that an entire year of training was coming to fruition, and I would be joining a very exclusive club of triathletes that have run the same path,” Heckmann says.

10. Move forward after failure. Unfortunately, Heckmann had to drop out of Kona this year, after struggling with a cold and stomach issues during the swim and the first 40 miles of the bike leg, but being in good enough shape to even attempt the 140.6-mile triathlon seven decades in has us uber-inspired. “I don’t think that age is a limitation to me and never really gave any thought to being the oldest in any race. I just want to do my best,” she says. Now, she’s more determined than ever to race down that road again! Next up: Training for the 2016 Florida Ironman to qualify for 2017’s Kona Ironman. Remember: Never let one setback hold you back.

Photo: Andrew West

Destress Your Holidays: 4 Ways to Develop Holiday Presence

by Charlotte Bell.

The holidays are a mixed bag. On the one hand, they’re fun. We get to turn our focus to reconnecting with friends and family. On the other hand, adding lots of extra commitments into our calendar can create feelings of stress. It’s not always easy to fit more commitments into our schedules. Then there’s shopping, wrapping, mailing, etc.

All these things can add up to a feeling of being overwhelmed. Yoga—including asana, pranayama and meditation—can help. Here are some ways to use your yoga practice to relieve potential holiday stress. I call it developing holiday presence.

4 Ways to Develop Holiday Presence

  1. Adjust your attitude: While we may indeed be overwhelmed with responsibilities at the moment, we don’t have to add to the overwhelm by responding with negativity. We have a choice. We can approach our responsibilities with resentment or we can approach them with appreciation. Truth is, generosity is a positive force. Being generous with our time, energy and other resources is a source of joy. It’s helpful to remember this.
  2. Restore yourself: Make restorative yoga your best holiday friend. It’s important to take time for yourself during the holidays. Think of it as a way to develop generosity. That this generosity is toward yourself doesn’t make it any less valid. Supta Baddha Konasana (Supine Bound Angle Pose) is one of the few poses you can practice on a full stomach. Practice it any time, for 5 to 20 minutes.
  3. Breathe: It sounds a bit trite, especially since humans breathe about 23,000 times a day anyway. But taking time out to practice long, slow, deep breathing can refresh and calm a frazzled nervous system. When you feel yourself becoming agitated, breathe slowly and deeply. Slow, deep breathing calms your nervous system, and therefore the rest of you as well. Breathing is the superpower we all have at our disposal. Use it!
  4. Gain perspective: Remember that whatever stress you’re going through at the moment will be but a memory tomorrow, or maybe even an hour from now. Mindfulness teaches us that everything changes, all the time. That drama that consumed you a week or a month ago—where is it now? When you feel drama starting to take over, step back, breathe deeply and tune into the sensations in your body. Let the sensations be. Relax into them.

If you’re reading this blog, you probably already practice yoga. Put your skills to work, not just on your yoga mat, but in your daily life. Developing holiday presence will help smooth out stress and bring joy and gratitude to your holidays.

Should I Go to Restorative Yoga or Just Take a Nap?

BY https://greatist.com/p/ejjohnson

It was Friday night after a long week. I was exhausted, but I had recently signed up for a trial yoga membership in an effort to practice more “self-care,” so I looked up the schedule and found a late-night restorative yoga class that promised to leave me feeling “balanced, rested, and elevated.” Yes, please, I thought as I grabbed my mat and hurried through the cold to the warehouse-like studio.

Once inside, I was instructed to grab what felt like a large carry-on of props: two blocks, a firm pillow-like thing called a bolster, and two blankets. I dragged this load into the dark room, laid everything out, and was prepared to be restored. I couldn’t wait to feel balanced, rested, and elevated—look at me and my Friday night self-care!

As the class started, we moved through a few stretch-like positions slowly, then set up for our first restorative pose. I followed instructions and positioned the bolster-pillow-thing under my stomach while in child’s pose. The teacher instructed us to turn our head to the right and lay it on the bolster. Great. Done.

Then I waited. And waited. And waited. After what seemed like an eternity, we were instructed to turn our head to the left and… lay it on the bolster.

My mind erupted. Are you kidding me?

If I knew I was going to walk in the cold just to lie on a pillow and turn my head every 10 minutes, I would have just gone to bed early instead! After the 75-minute class ended, I stormed home and that’s exactly what I did (… and slept like a baby).

At the time, I didn’t put together that my childlike slumber could have been a positive side effect of the class, but I was curious as to why anyone would pay money for what seemed like a 75-minute group-snooze. So I decided to do some research and talk to people who are fans of the practice.

Restorative yoga was first developed to help people heal from injury, illness, or burnout by holding certain poses for longer stretches of time (5-20 minutes) compared to a traditional yoga class. Some claim that it is the most advanced practice of yoga due to the difficulty of achieving conscious relaxation—it’s all about moving past the “Um, now what?” I was fixated on in that first class and learning to achieve a state of active relaxation.

OK, great. But couldn’t I just take an hour-long nap instead?

Elian Zach, yoga instructor and founder of the Woom Center in New York, believes that naps and yoga are both useful self-care tools, but they’re not interchangeable. “When restorative yoga is done right, it can facilitate a deeper rest than sleep. What happens is almost the equivalent to REM sleep, but when we sleep, we dream and can experience anxiety. It’s not necessarily always a quality time of rest.”

Eileen Goddard, a restorative yoga teacher at Yoga Vida in NYC, shed some light on all the added equipment. “In order to fully relax, we need to feel supported, both physically and mentally. We prop up in restorative yoga, particularly at the joints, to give the body this experience of full support.” Goddard adds that another important prop is the presence of the teacher, which offers another level of support.

And the studio atmosphere itself can make or break a good restorative yoga class. “The environment needs to exude a personality that is soothing and calming,” Zach says, adding that at the Woom Center, they have everything from a 3D sound system and overtone-emitting instruments to three unique aromatic combinations that alchemist Michelle Gagnon developed to help students unwind. (Which, whoa.)

This is all starting to sound a little better than a nap—but what are the real benefits of this type of self-care?

Yogis who practice restorative yoga regularly (at least once a week) report feeling more focused and experience better sleep post-class.

“The biggest benefit of practicing restorative yoga is the opportunity for your nervous system to switch over from the ‘fight or flight’ stress response to the ‘rest and digest’ relaxation response,” Goddard says. Other reported benefits include improved management of pain, anxiety, and depression as well as lower blood sugar and even weight loss.

study from the American Diabetes Association observed a focus group of obese women who practiced restorative yoga over a 48-week period and a group who engaged in a stretching program over the same time period. They found that those who practiced restorative yoga lost a significant amount of subcutaneous fat over the six-month program compared to those in the stretch group, and those same women continued to lose during the maintenance period once the program was over. The study credits this to the practice’s focus on relaxation and stress reduction, which led to a decrease in cortisol (the hormone we blame for abdominal fat).

Sign me up! Restorative yoga for life! I have self-care figured out now!

I won’t be removing Pilates and cycling classes from my schedule any time soon—you can’t just replace regular exercise with restorative yoga. Instead, even the study noted that restorative yoga is a “complementary, ancient practice” that should be used in addition to regular exercise.

So, intense workout, restorative yoga class, or just a nap? Why not all three. “There is room for high-intensity classes,” Zach says. “There is a time for sharing space with others and another to sit alone and veg in front of the TV. Sometimes that’s OK, but sometimes you want to find self-care in a bigger way. Restorative yoga isn’t lazy—it’s a proactive act of self-care.”

E.J. Johnson is a Brooklyn-based comedy writer and performance artist. If you like pictures of pink sparkly things, you can follow her @ej.sunshine on Instagram.

Exercise Wins: Fit Seniors Can Have Hearts That Look 30 Years Younger

By PATTI NEIGHMOND

We know we need to exercise for our health, but a lifelong exercise habit may also help us feel younger and stay stronger well into our senior years. In fact, people in their 70s who have been exercising regularly for decades seem to have put a brake on the aging process, maintaining the heart, lung and muscle fitness of healthy people at least 30 years younger.

Take 74-year-old Susan Magrath, a retired nurse practitioner who lives in Muncie, Ind. Magrath has been running almost daily for 45 years. She often runs outdoors and describes it as addictive. “It’s just such a release, just a wonderful release,” she says. “I ran today and there were little snowflakes coming down, and I was down by the river and it’s just wonderful. And I think it’s become more of a contemplative meditative process for me.”

Magrath may be living proof that lifelong exercise helps with cardiovascular and muscle health. She recently took part in a study at the Human Performance Laboratory at Ball State University, also in Muncie, headed by exercise physiologist Scott Trappe. Trappe is among the first to study the enticing new population of lifelong exercisers.

After the running and aerobic boom of the 1970s, large numbers of septuagenarians stuck with it and have been exercising regularly for the past 50 years. In this population, Trappe says, “We were interested in basically two questions: One, what was their cardiovascular health? And two, what was their skeletal muscle health?

What he saw surprised him. “We saw that people who exercise regularly year after year have better overall health than their sedentary counterparts. These 75-year-olds — men and women — have similar cardiovascular health to a 40- to 45-year-old.”

” ‘Exercise wins’ is the take-home message,” he says.

In the study, Trappe divided 70 healthy participants into three groups. Those in the lifelong exercise group were on average 75 years old and primarily kept their heart rates up through running and cycling. They had a history of participating in structured exercise four to six days a week for a total of about seven hours a week.

The second group included individuals who were also, on average, 75 years old but did not engage in structured exercise regimens, although they might have participated in occasional leisure walking or golf.

The third group consisted of young exercisers who were, on average, 25 years old and worked out with the same frequency and length of time as the lifelong exercisers.

All participants were assessed in the Human Performance Laboratory at Ball State University. Cardiovascular health was gauged by having participants cycle on an indoor bike to determine VO2 max, also known as maximal oxygen uptake, which is the measurement of the maximum amount of oxygen a person can use during intense exercise and is an indicator of aerobic endurance. During the cycling test, which became increasingly challenging, individuals exhaled into a mouthpiece that measured oxygen and carbon dioxide levels.

The aerobic profile of the participants’ muscles was measured by taking a sample via a biopsy about the size of a pea, says Trappe. Then in the lab, researchers examined the micro vessels, or capillaries, that allow blood to flow through the muscle itself.

They also looked at specific enzymes that provide fuel to the working muscle and help break down carbohydrates and fats.

Although the study was relatively small, the findings, which were published in the Journal of Applied Physiology in August, suggest a dramatic benefit of lifelong exercise for both muscle health and the cardiovascular system.

“Lifelong exercisers had a cardiovascular system that looked 30 years younger,” says Trappe. This is noteworthy because, for the average adult, the ability to process oxygen declines by about 10 percent per decade after age 30.

“It’s kind of a slow decay over time that’s probably not so noticeable in your 30s or 40s,” says Trappe, but eventually as years go on, becomes apparent. People can get out of breath more easily and may have difficulty pushing themselves physically.

The age-related reduction in VO2 max is directly associated with an increasing risk of multiple chronic diseases, mortality and loss of independence. Maintaining a strong heart and lung system has been shown to decrease these health risks.S

As for muscle health, the findings were even more significant, says Trappe. Trappe says researchers were surprised to find the 75-year-old muscles of lifelong exercisers were about the same as the muscles of the 25-year-olds. “If I showed you the muscle data that we have, you wouldn’t know it was from an older individual. You would think it’s from somebody that’s a young exerciser,” he says.

David Costill, 82, was not part of the study but is a former colleague of Trappe’s and professor emeritus of exercise science at Ball State University. As an exercise physiologist, he has always known about the benefits of exercise and has been committed since high school.

He says he has spent about “60 years actively exercising.” Costill ran marathons for about 20 years until his knees started to bother him, so he headed to the pool. “And I’ve been swimming for the last 35 years.”

When Costill looks at his friends, he says he finds he can do a lot more physically than they can. “If I’m out with a group of my peers, guys who are near 80, and we’re going someplace, it seems to me they’re all walking at half speed.”

Trappe says the findings are clear: 30 to 60 minutes of exercise a day may be the key to a healthy life. But you don’t have to run marathons or compete in cycling events. “If you want to do 30 to 45 minutes of walking a day, the amount of health benefit you are going to get is going to be significant and substantial,” he says. “Will it equal the person training for competitive performances? No. But it will outdo the couch potato.”

Unfortunately, couch potatoes are the norm. Federal guidelines recommend two hours and 30 minutes of moderate exercise a week, or one hour and 15 minutes of vigorous exercise per week. Yet 77 percent of Americans do not come close to getting that amount of exercise.

Dr. Clyde Yancy, spokesperson for the American Heart Association and chief of cardiology at Northwestern University Feinberg School of Medicine, says the findings suggest “a lifelong investment in health and fitness appears to be associated with a really sustainable benefit out until the outer limits of life.”

Since we are living longer, maintaining a good quality of life is more important than ever. While the study was small and the findings need to be confirmed, they present a “strong argument” for lifelong exercise that is inexpensive and accessible for everyone. “If you can swim, do yoga, cycle, or walk,” you can benefit,” Yancy says.

Health experts have figured out how much time you should sit each day

By Brigid Schulte

You may want to stand up while you read this — and a lot of other stuff.

Experts now say you should start standing up at work for at least two hours a day — and work your way toward four.

That’s a long-awaited answer for a growing number of workers who may have heard of the terrible health effects of prolonged sitting and been wondering whether they should buy standing desks or treadmill desks.

Today, the average office worker sits for about 10 hours, first all those hours in front of the computer, plowing through e-mails, making calls or writing proposals — and eating lunch. And then all those hours of sitting in front of the TV or surfing the Web at home.

Medical researchers have long warned that prolonged sitting is dangerous, associated with a significantly higher risk of heart disease, diabetes, obesity, cancer, and depression, as well as muscle and joint problems. Some have gone on to say that the office chair is worse for your health than smoking and kills more people than HIV. Even working out vigorously before or after work may not compensate for extending sitting.

But now, those researchers have come up with formal suggestions for how much time to sit and to stand that could dramatically change our work habits.

According to the expert statement released in the British Journal of Sports Medicine, Americans should begin to stand, move and take breaks for at least two out of eight hours at work. Then, Americans should gradually work up to spending at least half of your eight-hour work day in what researchers call these “light-intensity activities.”

“Our whole culture invites you to take a seat. We say, ‘Are you comfortable? Please take a seat?’ So we know we have a huge job in front of us,” said Gavin Bradley, director of Active Working, an international group aimed at reducing excessive sitting that, along with Public Health England, convened the expert panel. “Our first order of business is to get people to spend two hours of their work day NOT sitting. However you do it, the point is to just get off your rear end.”

Bradley said the first level of activity is simply standing.

“I’m standing right now while I’m talking on the phone,” he said. While the group endorses the use of sit/stand desks, Bradley said there are other activities that can get people to move for two hours during the work day. “Taking your calls standing. Walking around. Pacing. Holding standing meetings. Walking meetings. Walking over to a colleague’s desk instead of sending an e-mail. Using the stairs instead of the elevator. Taking a lunch break. Simple stuff.”

Bradley himself has changed the way he works completely since taking on this challenge to get people out of their seats: He starts his day standing on a comfort mat and has his sit-stand desk programmed to tell him, through a pop up notification on his computer, to change his posture every 20 to 30 minutes.

It’s all about mixing it up,” he said. “Metabolism slows down 90 percent after 30 minutes of sitting. The enzymes that move the bad fat from your arteries to your muscles, where it can get burned off, slow down. The muscles in your lower body are turned off. And after two hours, good cholesterol drops 20 percent. Just getting up for five minutes is going to get things going again. These things are so simple they’re almost stupid.”

Researchers have known about the link between inactivity and higher rates of sickness and mortality dating back to studies of bus drivers and office-based postal workers in the 1950s. And more recent observational studies comparing workers who sit for long periods against those who sit for fewer hours have found that sedentary workers have more than twice the risk of developing type 2 diabetes and cardiovascular disease, a 13 percent increased risk of cancer and 17 percent increased risk of dying.

At the same time, with the rise of office work, the use of cars and buses rather than walking or bicycles, and the rise of leisure pursuits like TV and computer games that favor the couch potato, the world has become more sedentary. The World Health Organization estimates that 95 percent of the world’s adult population is inactive, failing to meet minimum recommendations for health of 30 minutes of moderate to intense physical activity five times a week.

Authors of the new guidelines said they were a starting point only, and designed to give people some kind of research-based target, rather than rely on the claims made by the manufacturers of treadmill and sit-stand desks that are becoming all the rage. (More than 90 percent of workers in Scandinavia have access to them.)

“This is an initial guidance, which we do expect to have to evolve with time,” said James Buckley, one of the report authors and a professor at the Institute of Medicine at the University Centre Shrewsbury and University of Chester. “But to ensure the marketing and promotions people to race away with self-determined claims, we have felt it is better to have some guidance rather than no guidance that is some how linked with scientific evidence.”

James Levine, an obesity expert at the Mayo Clinic and author of the book, “Stand Up,” though not involved in the guidelines, said they were a good start. In his work, he found that the reason why some people seem to eat a lot, never work out, yet never put on weight, is because they’re standing, walking and moving more throughout the day, rather than sitting for hours on end.

The guidelines “show we need to fundamentally rethink the way we’re working,” Levine said. Some small studies, he said, have found not only health improved, but also productivity ticked up 15 percent when people stood and moved more during the day. “The way we have developed our workplaces and even our schools is actually profoundly unhealthy. It’s a real design failure.”

But it’s not just office design, the researchers say. It’s work culture. Shannon Wurthman is a case in point. When Wurthman, 29, moved with her husband to Urbana, Ill., she left her office job and became a freelance consultant for web development companies and social media organizations. She began working at home.

“In the office, there’s so much pressure to sit – the feeling is, if your butt’s not in your seat, you’re probably not doing your job,” she said. “But now that I’m working at home, I don’t get up and walk around to talk to people. I’m not walking to meetings. I’m not even walking to and from my car in the parking lot.”

She has the flexibility to take walks during the day. But she doesn’t. “I get so caught up in my work,” she said. Plus, her work in social media keeps her digitally connected at all hours. And, research has found, people who telework tend to put in longer hours than office workers.

But Levine and other researchers said change is on the horizon. Some companies are holding standing meetings. Jennifer Heimberg, a physicist at the National Academy of Sciences, goes on a run with her boss for her annual performance evaluation. “It can be easier to introduce difficult topics when you aren’t sitting across the desk from each other,” she said.

Ikea is marketing a cheaper sit-stand desk. And Apple’s new watch can be programmed to tell people when it’s time to move.

Jessica DeGroot, who heads the nonprofit ThirdPath Institute designed to help people better integrate their work and home lives, can also find herself caught up in work.

“But I know that I think better when I get up and walk outside,” she said.

So at a recent conference, she paired up attendees and had them “Walk and Talk” from 2:30 to 3 p.m.

“At the typical conference, people have been sitting all day, and by 2 or 3 o’clock, they’re drained,” she said. “Instead, when people came back from the walk, they were smiling and engaged. Strangers sat down next to each other just so they could keep on talking they were so jazzed. It was fun to watch.”