Exercise Physiology | BJC Health Connected Care

One Fat Rheumatologist 7

By Dr Irwin Lim, Rheumatologist

Psst!

I’m going to show you mine even if you don’t want to tell me yours.

It ain’t pretty but the measurement is what it is, the one that counts – Body Composition Testing.

My 1st post for 2012 was about my New Year Health Resolution. I’ve just added another KPI. This rheumatologist needs to convert fat to muscle.

As I write this, after a light dinner of Thai Beef Salad, I really feel like that ice cream sitting in the freezer.

I’m now focussing on the 37.9% fat. Off to have a cup of tea instead.

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

Arthritis requires an integrated approach. We call this, Connected Care. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 01-11-2012
Posted in: Diet & Nutrition, Exercise Physiology, Our journey to better health

Knee Osteoarthritis: a not-so-new IDEA 0

By Dr Irwin Lim, Rheumatologist

Knee osteoarthritis is really very common. Particularly, as our population becomes more overweight and sedentary.

Patients will often ask about non-pharmacologic treatment (non-”drug” treatments), looking instead for a “natural” alternative.

Often, the elephant in the room is ignored.

Weight. Too much of it. Excess weight is the most obvious modifiable risk factor in knee osteoarthritis.

At the recent American College of Rheumatology Meeting (ACR 2011) in Chicago, results of the Intensive Diet and Exercise for Arthritis (IDEA) trial were presented. The IDEA trial was designed to test the hypothesis that intensive weight loss, either with or without exercise, would reduce pain and improve function in patients with knee osteoarthritis when compared with those patients who exercised but did not undergo dietary restriction.

454 overweight and obese patients, all older than 55 years, with symptoms related to their knee osteoarthritis were divided into 3 groups:

Intensive Dietary restriction only
Intensive Dietary restriction plus exercise
Exercise only

The goal for the dietary restriction patients was a 10% reduction of baseline body weight. The exercise intervention consisted of low to moderate intensity walking as well as resistance training 3 times a week for 1 hour each time.

After 18 months, mean weight loss for the group on dietary restriction only was 8.9kg. When exercise was combined with dietary restriction, the mean weight loss was 10.6kg.

The exercise only group had much less mean weight loss, only 2kg.

Similarly, pain levels and walking speed (the measure used to assess mobility) improved most in the combination group with dietary restriction and exercise. On these measures, the exercise only group did also show benefit but again, this exercise only group did not do as well when compared to groups with dietary restriction.

The IDEA trial basically shows that weight loss, when combined with low to moderate intensity exercise, can lead to about 50% reductions in pain and to improved function.

The elephant in the room needs to be addressed.

It’s something I expect doctors and allied health professionals have known for some time, but as a group, we tend to be poor in addressing this very important issue. We need to highlight how important weight loss is for our overweight patients with knee osteoarthritis.

In fact, we are doing these patients a disservice if we don’t.

BJC Health’s Connected Care approach emphasises the need for weight loss with knee osteoarthritis. It’s good to see more and more evidence supporting this approach.

Are you addressing the elephant?

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 11-20-2011
Posted in: Arthritis: degenerative & mechanical, Connected Care, Diet & Nutrition, Exercise Physiology, Knee & Hip

Diabetes? Please exercise. 0

By Suzy Oglesby, Exercise Physiologist

For most people, being diagnosed with diabetes is a life-changing moment. As an Exercise Physiologist I see many patients who have been diagnosed with Type 2 Diabetes merely days before I see them, and hence an important part of my role is educating them about their new health burden.

I see this time in their lives as being similar to hitting a fork in the road. They have been hit by a change which forces them to make an important choice. The difficulty is that both roads look the same from the start, and it is only when you begin travelling down the road that you can truly see what each road holds.

Lets take the easy road first. You begin the journey right where you left off before you got told you had diabetes. Your diet and exercise habits don’t change because you feel the same now as you did the day before you knew you had diabetes. You convince yourself – you don’t feel unwell so you couldn’t be that bad. As you continue down the road you begin to notice that the road itself becomes tough.

Uncontrolled diabetes is very closely linked to more sinister health conditions such as cardiovascular disease, eye problems and stroke. Type 2 diabetes was identified as the 6^th leading cause of death in a position statement released by the American Heart Association in 2009. The tougher it gets, the more you realize you need to turn around and take the other road. The problem is that by this stage it is often too hard to make your way back, let alone find your way!

Now lets discover the other road – the one that inspires you to exercise, change your eating habits and undergo the lifestyle overhaul. Initially it seems like a big change. From experience, regular exercise is a foreign concept to most people in this situation. In fact approximately 74% of people with Type 2 Diabetes perform no regular exercise or have inadequate levels of exercise to impact on their health condition (Diabetes in Australia: A Snapshot, 2004-05, Australian Bureau of Statistics). It is a hard road to embark on as you now have to “find time” to exercise, and let’s face it – initially it hurts! However over time through persistence your body becomes stronger and adapts to a regular exercise regime. You now begin to “make time” for exercise because it has reached the stage where you feel good about exercising and can see the benefits of your hard work. Enter the fairy tale ending where you live happily ever after.

Hitting this fork in the road is a stressful time, and something that you do not have to conquer alone. Having a good support network of health professionals can help to shine light on both roads, revealing what lies ahead and guiding us towards better health. We often get told that life wasn’t meant to be easy, and sometimes what seems like the hard road initially is the one that makes us stronger and opens up better opportunities in the long run.

Suzy Oglesby is an exercise physiologist and a bone density technician at BJC Health.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Stop Press: Stopping recurrent fractures after suffering a fracture from weak bones (osteoporosis) is a priority. We have launched our Refracture Prevention Program at our Parramatta clinic to stop bones breaking.

Posted on: 08-2-2011
Posted in: Exercise Physiology

My Exercise Classes are Fun 0

Image: Ambro / FreeDigitalPhotos.net

By Sarah Comensoli, Exercise Physiologist

No matter where I have worked over the years, I have found that the winter months are when the majority of clients find it hardest to stick to their exercise regime.

Motivation is low.

With shorter days and chilly mornings and evenings upon us, it can often feel much easier to just give the gym a skip and stay at home with a good cup of tea. I myself battle with this also!

Group based training is a great way to keep motivated during these months. Classes are not only a great individual workout but offer each individual the chance to work hard in a supervised and positive environment.

A number of clients have mentioned how motivating it is to be training in a group, a situation where they can be encouraged and often inspired by others around them. Clients often share a few laughs as they attempt a new exercise for the first time. I am still surprised how often friendships have formed whilst sweating it out!

I strive to keep my classes as varied as possible, in terms of the nature and duration of the activities performed such as bike races, boxing challenges and throwing tasks. Often we will have mini-challenges when class participants get a chance to compete against each other.

No one is sitting or standing still!

But above all else, I strive to create an environment where everyone feels welcome and encouraged. And although my clients tend to leave with sweaty faces and rosy cheeks, they (most of the time!) are also wearing a smile.

Sarah Comensoli is an exercise physiologist at BJC Health.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Posted on: 07-14-2011
Posted in: Exercise Physiology, Our journey to better health

Why Body Composition testing is better than your weighing scales 3

By Suzy Oglesby, Exercise Physiologist

At some point in our lives most of us experience a “health kick” where we get the urge to curb our eating habits and pound the pavement in the pursuit of physical perfection. It may be summer time motivating us to sculpt our beach body, or simply not quite fitting into our favourite jeans that gives us the subtle nudge that we need to drop a few kilograms.

Whilst we may initially ‘feel’ the benefits of our health kick, there is only so long we can keep going without physically seeing results.

Unfortunately for most of us our progress monitor is the trusty bathroom scale, and while our clothes seem to be loosening the scales are telling us a different tale.

At this point many people will accept defeat and resume their former ways. What we don’t know is that our health kick is actually working by changing the composition of our body i.e. our fat and muscle mass.

Muscle and fat have different densities and hence replacing the same mass of fat with muscle will not change our weight but will reduce our measurements. So while the scales didn’t necessarily lie to us they didn’t give us the bigger picture either that would have boosted our motivation to continue.

Enter the DXA body composition scan!

A DXA scan not only gives an accurate measure of body weight but also gives us valuable information about the composition of our body such as our body fat percentage, our lean tissue and bone weight. While some of the more expensive scales will give a reading of body fat percentage, their accuracy is significantly affected by our ever changing hydration levels. In addition their methods involve calculations rather than absolute measurements of the different tissues that make up our body.

Traditionally underwater weighing was seen as the most accurate method of determining body fat. However in recent years the DXA body composition scan has become the gold standard.

DXA scans are unique in that they employ a 3 tissue (muscle, fat and bone) system of body composition assessment, unlike most other methods which use a 2 tissue model (muscle and fat). While the DXA scan does involve radiation, the levels are extremely low – in fact you will get more radiation from a flight across the country than you will from the scan.

So the next time you hear the fitness fairy knocking on your door, book in at BJC Health for a DXA body composition scan and stay on track this time!

Suzy Oglesby is an exercise physiologist and a bone density technician at BJC Health.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.