Spotlight on Exercise, Part 3: Creating An Exercise Habit

Spotlight on Exercise, Part 3: Creating an exercise habit

Please do take a look at Part 1, The health benefits of exercise & Part 2, The potential risks of over-exercising of this series before reading the following. It will help to give some more perspective and context.

Moving our body throughout the day, regularly getting out of breath and incorporating some strength and resistance training into our week are all fantastic ways to maintain health and prevent future disease. However, increasing this to multiple hours of strenuous exercise on a regular basis does not necessarily magnify these benefits. More is not always better.

If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Here are some ideas and tips that may help you to find your ‘happy medium’ of exercise intensity and frequency.

Whilst I don’t purport to have all the answers (who does?! I am not a fitness professional and am still on my own fitness journey), these are some of the things that help Richard’s and my own clients:

  • Have at least one complete rest day every week, but also give yourself the permission to take a longer break if you feel you need too.
  • Try not to be too rigid with your training programme, and work on both emotional and mental flexibility with your plan. Remember the importance of the whole tripod of exercise, diet and rest. You need all three to be equally balanced.
  • Become aware of the messages your body uses to let you know if you are pushing yourself a little too much. Listen to them and adapt what you are doing accordingly. What works best for you will be constantly changing and evolving over time.
  • If you are suffering with stress or anxiety and feel overwhelmed by exercise instead of relieved, some periods of hyper-relaxation can be really helpful. Try guided meditations, breathing exercises, yoga, or other mindfulness-based activities. Even having a long, hot bath or just sitting in nature for 10 minutes can be so beneficial.
  • Make time for energy-boosting situations; spend time with friends and family, watch a comedy, go to the cinema. Remember that being healthy certainly isn’t all about training and nutrition plans.
  • Think outside of the box. Movement doesn’t have to mean formal exercise – walking the dogs, doing chores around the house, even going shopping (!), gardening, walking a few stops instead of sitting on the bus or tube can all contribute.
  • If you sit at a desk all day, consider switching from a normal desk chair to more active sitting (there are all sorts of options available online), or a standing desk. Things like moving your bin away from arms reach, always making your coffee on another floor and moving your printer to the opposite side of the room will prompt you to stand up more frequently throughout the day – small movements which really add up over the course of a year.
  • Give yourself enough time to adequately recuperate after illness or injury – your body needs rest to heal and build muscle.
  • Sleep is essential – the amount required varies from person to person, but in general, you need to get enough sleep to feel generally alert and wakeful for the duration of the day
  • Mix up your training to avoid over-stressing particular muscles and joints, but also to stop it getting boring or too repetitive
  • Be aware that other life stressors can add to the stress of physical training. Don’t be afraid to ease off training a bit during those periods. Sometimes the best thing you can do for yourself is just to have a week or two off.
  • Eat to fuel your body properly – and that doesn’t just mean getting enough calories, carbohydrates or protein, but also making sure that you are getting all the essential micronutrients (vitamins, minerals and essential fatty acids) too.
  • Consider working with a fitness professional to help you plan an appropriately staged and periodised training programme, if you are a high performance athlete or enjoy training for a significant number of hours per week. Try using the FITT principles to guide your training plan; Frequency, Intensity, Time and Type.
  • Likewise, consider working alongside a functional physiotherapist to help prevent injury as well as treat it – particularly if you are more of a ‘weekend warrior’.

. . . . . . .

Handy resources:

For more information on recommendations for exercise, do take a look at the NHS choices website:

nhs.uk/physical-activity-guidelines-for-adults

For some simple, 10-minute workouts you can do at home:

nhs.uk/Livewell/loseweight

Advice on exercising in pregnancy:

nhs.uk/conditions/pregnancy-and-baby


Spotlight on Exercise, Part 2: The potential risks of over-exercising

Spotlight on Exercise, Part 2: The potential risks of over-exercising

If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Please do take a look at Part 1, The health benefits of exercise.

It is common for practitioners to skirt around the tricky topic of over-exercising. But in clinic, this is something I often see.

We do need to move, of course, for all the health-giving reasons I highlighted in Part 1 (The health benefits of exercise), and I completely understand that everyone’s abilities and hobbies differ. But pushing ourselves excessively (and that is definitely the key word here) with endless hours of classes, training sessions, long runs, gym time and so on may not necessarily be the best idea for overall health. I sometimes see clients who are so exhausted and stressed and just need to focus on getting some good quality sleep and rest in order to establish a better overall life balance. It can be hard to encourage them to consider meditation or yoga instead of their daily HITT class.

Whilst no single definition of ‘over-exercising’ exists, I tend to think of it as the point at which your body is starting to struggle with the amount of training stress you are asking it to handle, i.e., where the downsides are starting to outweigh the positives.

This tipping point will vary widely between people and their life circumstances. Someone who is happy, stress-free, fit and healthy can potentially handle a higher training load than someone who is under enormous personal pressure, less fit than they used to be and suffering from a chronic disease. Therefore, there cannot be an absolute level at which you can definitively say “this is over-exercise” and “this is not”. It will all depend on the individual.

Having said that, there are a couple of questions that I might ask my clients, to help them to identify for themselves if they might be over-doing it. Whilst this is not a validated test, it may help to prompt a discussion about ways that we could potentially modify (not necessarily stop) an exercise programme if desired:


1. How do you feel emotionally during and after your workout?

– Do you feel excitement and joy during and immediately after your session, followed by a sense of contentment and ease a little while later?
– Or do you feel more panic, anger or anxiety during and immediately after your session, followed by a sense of overwhelm, exhaustion and despair?

2. Do you look forwards to training or dread it?

3. Do you find yourself getting lots of infections or back-to-back injuries?

4. Are you always tired, particularly upon waking?


If you find that your answers to these questions are weighted more towards the negative, then this may be an indication your balance is tipping in the wrong direction and perhaps it’s time to ease off a little.

Effective training can be thought of as a tripod made up of exercise, diet and rest. If all three are not equally addressed, the tripod will tumble and so will your training goals’ – Richard Hannam

When it comes to exercise, I therefore think of it as a bit of a goldilocks phenomenon; not too little, not too much, but just the right amount for you at each point in time is the best bet for optimising health.

The reasons why people over-exercise are, of course, varied. For some, it is simply what is necessary to enable them to compete at a high level. But, perhaps more commonly in my clinic, it is as a result of trying to manage either weight or body image, or a belief that it is somehow necessary to really go hard with the training to be healthy – a conviction that seems to be increasingly fueled by social media and fitness gurus.

Although it is certainly true that a combination of exercise and diet together is the best way to maintain a healthy weight in the long run, we may be more likely to maintain good habits if we are exercising for enjoyment and pleasure, rather than simply as compensation for calories. Remember – exercise should never be considered penance for eating. We need to eat, and we need to move. Neither needs be contingent on the other!

Here are a few potential consequences of over-exercise on health and/or sports performance

  • Dampened immune function, and potentially increased risk of common infections (such as coughs and colds) (Smith, 2003).
  • Gut inflammation and potential increase in intestinal permeability after prolonged periods of intensive exercise (Costa et al., 2017).
  • Irregular menstrual cycles
  • Female infertility (Olive, 2010), particularly if underweight (Rich-Edwards et al., 2002).*
  • Excessive weight loss
  • Excessive fatigue (Meussen et al., 2013)
  • Increased stress, reduced sleep
  • Increased risk of injury, especially if you are more of a ‘weekend warrior’ (Psoinos et al., 2012)
  • Over-training syndrome; where you are continuing to train vigorously, but your performance starts to deteriorate over the long term (Meussen et al., 2013).

*However, in women with a BMI > 25 who undertake vigorous exercise of for <60 minutes per day, there is actually a reduced risk of infertility (Hakimi and Cameron, 2016). So, as with so much of health and nutrition, individual context clearly matters.

. . . . . . .

For more information:

The UK register of Exercise Professionals is a good place to start your search for a new fitness instructor to help and support you: exerciseregister.org/members/members-directory-listing

. . . . . . .

 

Next: Part 3, Creating an exercise habit

References & Bibliography:

Barrack, M., Ackerman, K. and Gibbs, J. (2013). Update on the female athlete triad. Current Reviews in Musculoskeletal Medicine, 6(2), pp.195-204.

Costa, R., Snipe, R., Kitic, C. and Gibson, P. (2017). Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Alimentary Pharmacology & Therapeutics.

Griffiths, M., Szabo, A. and Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), pp.e30-e30.

Hakimi, O. and Cameron, L. (2016). Effect of Exercise on Ovulation: A Systematic Review. Sports Medicine.

Lakier Smith, L. (2003). Overtraining, Excessive Exercise, and Altered Immunity. Sports Medicine, 33(5), pp.347-364.

Lee, I., Sesso, H., Oguma, Y. and Paffenbarger, R. (2004). The “Weekend Warrior” and Risk of Mortality. American Journal of Epidemiology, 160(7), pp.636-641.

NICE (2013). Physical activity: brief advice for adults in primary care | Guidance and guidelines | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ph44/chapter/1-Recommendations [Accessed 9 Jun. 2017].

O’Donovan, G., Lee, I., Hamer, M. and Stamatakis, E. (2017). Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Internal Medicine, 177(3), p.335.

O’Keefe, J., Lavie, C. and Guazzi, M. (2015). Part 1: Potential Dangers of Extreme Endurance Exercise: How Much Is Too Much? Part 2: Screening of School-Age Athletes. Progress in Cardiovascular Diseases, 57(4), pp.396-405.

O’Keefe, J., Patil, H., Lavie, C., Magalski, A., Vogel, R. and McCullough, P. (2012). Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise. Mayo Clinic Proceedings, 87(6), pp.587-595.

Olive, D. (2010). Exercise and fertility: an update. Current Opinion in Obstetrics and Gynecology, 22(4), pp.259-263.

Psoinos, C., Emhoff, T., Sweeney, W., Tseng, J. and Santry, H. (2012). The dangers of being a “weekend warrior”. Journal of Trauma and Acute Care Surgery, 73(2), pp.469-473.

Rich-Edwards, J., Spiegelman, D., Garland, M., Hertzmark, E., Hunter, D., Colditz, G. and et al. (2002). Physical Activity, Body Mass Index, and Ovulatory Disorder Infertility. Epidemiology, 13(2), pp.184-190.

Roberts, D., Ouellet, J., McBeth, P., Kirkpatrick, A., Dixon, E. and Ball, C. (2014). The “weekend warrior”: Fact or fiction for major trauma?. Canadian Journal of Surgery, 57(3), pp.E62-E68.

Stranahan, A., Lee, K. and Mattson, M. (2008). Central Mechanisms of HPA Axis Regulation by Voluntary Exercise. NeuroMolecular Medicine, 10(2), pp.118-127.

Walsh, N. and Oliver, S. (2015). Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Immunology and Cell Biology, 94(2), pp.132-139

 


Spotlight on Exercise, Part 1: The health benefits of exercise

Spotlight on Exercise, Part 1: The health benefits of exercise

What part should exercise play?

It’s hard to argue with the fact that regular movement is good for our health. As well as playing an important role in helping to prevent heart disease, type 2 diabetes, stroke, some cancers and musculoskeletal problems, exercise can also boost our mood and cognitive function (NICE, 2014) (Kramer and Erickson, 2007). Plus for many people, it can also be a source of great enjoyment, a bit of headspace, a way to unwind and de-stress or an excuse to catch up with mates.

I do also know that this isn’t the case for everyone and many dread doing exercise. Personally, I have to force myself to do it and many of my clients feel the same way. So seeking out ways to enjoy it are key. For me this is being outdoors, with my dogs or with friends rather than being in a gym or class, but each to their own.

I am not a fitness professional. However, I do understand the importance of movement for a healthy mind and body. This 3-part series has been written in collaboration with Richard Hannam, an experienced health and wellbeing physiologist and personal trainer, who has kindly shared his wealth of expertise and knowledge throughout this feature. If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Whether you love it or hate it, exercise is important, but it is easy to get confused about what we are aiming for and why we are doing it. Social media can make it seem a very off putting and daunting task (only for those with perfect bodies!) and fitness websites can sometimes make it seem that unless you are training everyday, top-to-toe clad in tight fitting Lycra, then it’s not for you. And don’t get me started on how tight and uncomfortable most exercise clothing is, seemingly made for those who are slim and fit and not for those with “normal” bodies. Almost everyone I know and work with wants realistic and enjoyable ways to exercise that isn’t going to cost them a fortune and make them feel bad about themselves.

So I thought I would start by sharing what the UK general recommendations for exercise are, and hopefully show that it isn’t as difficult to achieve / scary / unrealistic as we might think. And, happily, there is no need to join an expensive gym, spend hours lifting weights, or bedeck yourself with fancy fitness gear to achieve these suggestions.

The current UK movement recommendations for healthy adults are as follows (NICE, 2013)

  • Try to be active in some way daily – anything is better than nothing. Even if that’s just 5 minutes a day to start with.
  • Over a week, this could add up to at least 150 minutes of moderate activity (you can choose how you divide those minutes up)
  • Or, comparable benefits can be achieved through at least 75 minutes of vigorous activity spread across the week
  • Or a combination of the two.
  • Try to incorporate some resistance (muscle strength) and balance training twice a week – this is important for bone health and health preservation (such as pilates, yoga and body weight exercises).
  • Everyday movement (walking up stairs, walking to the shops, doing the housework, pottering around etc.) is just as important as formalised ‘exercise’.
  • Many workplaces are now starting to offer the option of standing desks to help minimise the amount of time you spend sitting, or if this isn’t an option, I have found that putting a Sissel SitFit on my desk chair has made a big difference to back aches and pains, and I also find that I just move about a lot more whilst I am working away – I honestly love it (and it’s a bit less cumbersome than an exercise ball).

How to get the right intensity

Working to a ‘perceived intensity’ helps you tailor the activity you are doing to your current level of fitness. Richard uses this simple guide with his clients, called the ‘sing’ test:

Moderate intensity:
Faster breathing, increased heart rate and feeling warmer. In other words, you could still talk, but you couldn’t sing whilst you are moving.

Vigorous intensity:
Hard breathing, rapid heart rate and shortness of breath. In other words, you can neither talk nor sing whilst you are moving.

This is how it could look in real life:

Monday:  Rest day – just pottering about at home or work
Tuesday:  Walk to work and home again (60 minutes moderate cardio)
Wednesday:  Pilates class (strength & balance training)
Thursday:  Spinning, dance or circuits class (45 minutes vigorous cardio)
Friday:  Quick body weight workout at home (strength & balance training)
Saturday:  Bike ride and play in park with kids (60 minutes moderate cardio)
Sunday:  Gardening or general housework (30 minutes moderate cardio)

Exercise doesn’t always need to mean pounding the treadmill hard, or sweating it out in class. Sometimes it can just mean gentle movement therapy. Find a green space and walk around it, do some gentle stretches, swim in the sea, play with your children, potter about the garden. It is all valuable and valid movement”

Handy resources:

For more information on recommendations for exercise, do take a look at the NHS choices website:

nhs.uk/physical-activity-guidelines-for-adults

For some simple, 10-minute workouts you can do at home:

nhs.uk/Livewell/loseweight

Advice on exercising in pregnancy:

nhs.uk/conditions/pregnancy-and-baby

. . . . . . .

References:

Kramer, A. and Erickson, K. (2007). Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends in Cognitive Sciences, 11(8), pp.342-348.

NICE (2014). Physical activity: exercise referral schemes | Guidance and guidelines | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ph54/chapter/what-is-this-guideline-about#benefits-of-physical-activity [Accessed 9 Jun. 2017].


Life as a Nutritional Therapist, Amelia Freer

Life as a Nutritional Therapist

life as a nutritional therapist

Life as a Nutritional Therapist, Amelia Freer

life as a nutritional therapist

One of the wonderful things about my profile as a nutritional therapist is that I get lots of budding nutritional therapists asking for advice. And of course I believe that there is plenty of room for more well-trained and enthusiastic nutritionists to help support a population which is suffering from an increasing number of diet-related diseases.

I receive many requests asking where to study, how to get started or those with an interest who are considering a new professional path. Regrettably I am unable to answer each individual request, so I have tried to answer all of the queries and share all that I think is necessary to consider and give you a little more insight into the reality of the vocation and lifestyle of nutritional professionals.

1: Get properly qualified

An online, or weekend course does not properly qualify you for this profession. Nutritional Therapy is a challenging profession that requires a huge amount of time and dedication. Working with an individual’s health, advising and supporting them appropriately needs to be managed responsibly. This is very different to running a glamorous blog! This is an industry that is now starting to achieve better recognition and hence regulation. Ensure that your course is recognised by The British Association for Applied Nutrition and Nutritional Therapy (BANT) (BANT.org.uk) which is the professional body for Registered Nutritional Therapists. Its primary function is to assist its members in attaining the highest standards of integrity, knowledge, competence and professional practice, in order to protect the client’s interests, nutritional therapy and the Registered Nutritional Therapist. BANT offers a wide range of benefits to students and full members and has its finger on the pulse for any changes or new developments within this dynamic profession.

I studied at The Institute for Optimum Nutrition (ion.ac.uk) and absolutely loved it. I have continued my education with The Institute for Optimum Nutrition (functionalmedicine.org). I am not familiar with the other courses available having not done them and suggest you really research each one that is recognised by BANT in order to choose which one feels right for you and your professional goals.

2: Your qualification is just the beginning

The moment you complete your studies is the moment you really start learning as a nutritionist. You have the foundations to practice safely, but you will still need to learn on the job, make mistakes and gain in wisdom, experience and confidence. What works with one client won’t work with another. Gradually you will build up a set of skills, phrases and knowledge which will become your own personal toolbox.

3: Work with the mind as well as the body

You may have a million and one scientific facts up your sleeve about the dangers of eating sugar, but you also need the skills and ability to help support someone who is bingeing on ice cream every evening because they are depressed. The mind and the body are inextricably linked, and food is almost always attached to a great deal of emotion. Understand where your role lies here – it is not your job to ‘fix’ people – you are only part of the process. And be aware when and where is the right time to seek help from colleagues who may be more able to support your client (psychologists, counsellors, GP etc.) to resolve these issues. I have built my own “toolbox” of appropriate practitioners to refer my clients to so that they can get the help they need.

4: It’s not all about looks!

I would say that the majority of clients that seek out a nutritional therapist are not just looking to lose a few pounds. They often have complicated medical histories, multiple symptoms, exhaustion, allergies, take a cocktail of medicines or behavioural problems around food, and need careful and safe support to help them move towards a healthier place. If in doubt, ask for advice from a mentor or specialist, and don’t be afraid to work closely with the other health professionals involved in your clients care. The wider impact of your actions and advice always need to be carefully considered. The best thing about helping these types of clients however, is the hugely positive impact that nutritional changes can have – and the weight loss is just a lovely side effect!

5: Keep developing

Science keeps on moving forwards, and you need to keep up to date with the most relevant changes. Attending regular professional development seminars, workshops or lectures is vital to keep your knowledge current. There are lots of networks and associations for nutritional professionals that provide information about lectures, seminars and events. You can’t stop learning once you have your qualification, even if it has felt like a mammoth mountain to climb!

6: You will often be changing your mind

Following on from the last point, you may find that as your knowledge progresses over time, your views and opinions also change. For example, I used to advise my clients to snack regularly. Now I encourage them to just have three proper meals everyday. Don’t be afraid to hold your hands up every now and again and say ‘Hey, I want to change my mind!’. Be open minded to new developments. You could not have known what was not yet discovered. Don’t adopt a “my way or the highway” approach. Everyone is individual.

7: Be aware that you might need to ‘unlearn’ a few things

Of course, by this I don’t mean go and throw all your textbooks away, but what you need to know is far, far more detailed than what your client needs to know about nutrition. In fact, most clients are not really interested in the science or the facts – they want practical action steps. Bombarding them with all of your passionate knowledge can be overwhelmingly confusing and not attending to their needs. Learning how to make things simple, even when they’re complicated and hard, is a vital skill for a great nutritional therapist. Think about it like an iceberg – just give them the curated tip of your knowledge.

8: Balance

This is a hard one, because so many nutritional therapists are passionate about what they do, and so many clients become rather reliant on their nutritional therapists. But you need to create boundaries you are happy with right from the beginning. I assure you that you will have happier clients as a result! I leave work behind at 6pm and do not answer work emails at the weekends. I explain all of this at the beginning of my partnership with a client, so everyone is clear from the start. Have a think about what you’d like your boundaries to be and don’t be afraid to state them clearly to any new client.

9: Money…

This is a tricky one to tackle, but I think it is important. Nutritional therapy is not a lucrative business, and many friends and colleagues I know have really struggled to make ends meet. The successful and glamorous side of the field is very rare, and although there are opportunities (such as book deals, sponsorship, meal delivery services etc.) to make a good profit, it is hard from seeing clients alone. It is definitely more a vocation, something you do because you love doing it, than a profession to make a fortune in! However, it is still an important profession and it’s reputation must be protected and so you need to be professional and run your business efficiently, charging appropriately for your time. Free advice and free consultations puts the client in an awkward position.

10: Sometimes you’ll need to defend yourself

Often I have met people socially who (for some unknown reason), feel obliged to tell me that they think my job is ridiculous. That nutrition is just calories in vs. calories out and people just need to stop being lazy. Where are their manners?! I used to get cross with this, but now I don’t rise to it. Their ignorance is a shame, but it doesn’t need to upset me. The best tip here is just to let it go – for every rude dinner party bully, there are a hundred other people who are on board with your message.

Although, as with every job, nutritional therapy has its challenges, it is also a wonderful, exhilarating and very rewarding job. There is no greater feeling than helping someone win an inner battle they’ve been fighting and become a healthier, happier person. The field is rapidly expanding and becoming a more dynamic and exciting place to work and learn. And so enjoy the journey and ride the wave of knowledge as it sweeps and expands throughout the health care of the future.

Wishing you the very best of luck for your future career!

 

amelia freer

FdSc, Dip ION