Showing posts with label Triathlon. Show all posts
Showing posts with label Triathlon. Show all posts

Sunday, 18 December 2016

Positive medicine - getting stronger, getting fitter

Surf workouts
I'm away to unwind on a surf week to Taghazout, Morocco over New Years, with its killer whales and big breakers (I'll be starting on the nursery waves) and wondering how best to get in shape for it.  Boozy with lots of laughs & games w/nieces is the likely prep I'll do (since it's Christmas just before) but be good to know what I should be doing!  Over all these years of exercising (hillwalking, runs, swims, rides, football, climbs, racquetsports, capoeira, kayaking, surftrips, snowboarding, hockey, and very occasional gym/CrossFit sessions) I've never devoted much time to finding out what constitutes effective training, I've just worked on the basis of volume and a competitive streak.  The answer is unlikely to come up in our medical lectures: sports preparation falls a bit too much on the 'wellbeing' side for our 'heal-the-sick' focused course.

So how generally to optimise strength/fitness?  What do I know already?  I've learned along the way to fuel before & after exercise, and my dad, once ripped back in the 70s, suggested to us as boys that pushing to the limits was good, and on strength building 3 sets of 8 was the way to go then to up the weight when it became too easy.  My triathlon buddies seem to blend interval and slow-paced runs into their endurance training.  My electrophysiologist buddy Marie suggested pushing to failure on the last set.  Let's see what a bit of research has to say about getting stronger and getting fitter...


General principles of strength and fitness building
Accepted advantages of exercise: energy, mood, sporting ability, improved sleep, stress tolerance, attractiveness, libido & sexual prowess (whoop!), alertness, weight management, improved immunity, chronic disease avoidance.  Strength & bulk-wise: some say this confers a perception of authoritativeness, and you might imagine some occasional practical application (lifting fallen trees from crushed cars is a rarity, though...)

Tips on exercise motivation: ideally be doing an activity that you intrinsically love, vary the monotony of training formats, capitalise on supportive friends&family, make a plan, reward yourself, find a role model, develop your background knowledge, set goals, measure your performance against those goals, train socially.  Sounds reasonable enough.

Nutrition - quantity:
The body uses the same energy molecular currency 'ATP' everywhere. This is the end product of breakdown of carbohydrates, proteins, fats.  Adequate protein levels are necessary for tissue repair and muscle building, and fats are important for vitamin absorption and hormone production.

During intense training periods, increased intake is recommended:
1.3-1.8g protein/Kg/day (that'd be 104-144g for me, = 4 tins tuna or 4 chicken breasts or 20 eggs!) (Phillips & Van Loon, 2011)
30-60 kcal/Kg, that'd be 2400-4800kcal for me, of which 30kcal/Kg should be carbs.  (Tarnopolsky, 2008)
Lots of water, even better if this replaces electrolytes too post-exercise, particularly sodium.

Nutrition - timing (I've used weak sources here, but I've found consistent guidance)
3-4 days before endurance event: carb-load with 12g/Kg/day of low-GI foods (e.g. seeds, wholegrains) prior to an event to maximise glycogen stores
3 hours before race: eat a small meal (400kcal) to allow insulin to normalise
In the last 3 hours pre-event: keep drinking about a pint of water an hour
Immediately before exercise: top-up a few mins before with a carb snack with a little protein
During exercise: Isotonic carb drinks/snacks during exercise (i.e. take an energy bar to the beach).  If exercise lasts >2 hours, incorporate some protein into the fuel during the exercise to avoid muscle catabolism.
Recovery: carb (1.5g/Kg in first 30 mins after exercise) w/ protein snack (~40g) post-exercise
There's no evidence that splitting the diet into more than 3 meals a day makes a difference - many researchers have looked into this (Helms et al., 2014)


Getting stronger - and building muscle
Strength and power:
Simply, strength = ability to lift things (force).  Power = ability to lift them fast (force x velocity).
Weight training also offers a choice between strength increase and hypertrophy (muscle size) - it is possible to prioritise the look rather than the functional ability.  Functional goals first seem more my kind of principle...

Frequency of exercise:
Reps: 1-5 strength; 5-8 muscle hypertrophy & strength equally, 8-10 hypertrophy; 12+ endurance  (meathead wisdom, supported by Mangine et al., 2015)
Sets: 2-3 for strength, this is 45% more effective than just 1 set.  (Krieger, 2009)
Rest: 5mins for strength; 30-60secs for hypertrophy (one study suggests 3mins); 20-60secs for endurance (de Salles et al., 2009)
Sessions: 3x per week is optimal for beginners to avoid mental fatigue, leaving at least 48h between the same exercise, and at least 1 full day off a week (therefore maximum 6x training per week)
Vary your training across the week: using one day in the week to focus on each of strength, power and hypertrophy is best - thanks Rob for the intro to Daily Undulating Periodisation (Rhea et al., 2002)

Features of the exercise (more meathead wisdom):
  • Compound exercises are most time-efficient (rather than isolating a specific muscle and working it, which means much more time in the gym would be required)
  • Free weights use more muscles than resistance machines - you use the stabilisation muscles too
  • Injury avoidance - proper form when lifting reduces injury risks, and barbells are best to avoid injuring yourself
  • Training to failure (i.e. until you can't do any more reps): this is exhausting, and may affect the rest of a workout leading to less overall work done, aka 'central fatigue'.  That said, the intensity may increase strength gains for the target muscle.  So - use it with consideration!
  • Specific exercises: squat and benchpress at least twice per week 
  • Endurance training decreases strength training performance - so cut the long runs if you're looking simply to strengthen up

Getting fitter and faster
What is fitness? (US Surgeon General, 1996, Ch3 p.72)
(1) Cardiovascular capacity (heart contractility, left ventricle dilation, stroke volume)
(2) Skeletal muscle adaptations (increase in number of mitochondria in muscle, more oxidative enzymes within mitochondria, better capillarisation, faster diffusion of oxygen and fuel into muscle, increase of fatigue-resistant slow-twitch muscle fibres)
(3) Metabolic adaptations (better disposal of metabolic waste, increased use of fat as fuel)

General tips on building fitness
|A| A regular training stimulus is required for adaptation to occur and be maintained
  • adaptation: (1) after a power sprint session - 2 days; (2) after a VO2 max oxygen debt, e.g. hills session - 2 weeks; (3) after a long endurance session - 6 weeks.
  • detraining: this is significant within 2-4 weeks.  Fitness can be maintained despite a 70% reduction in training frequency/duration, as long as the intensity of that training is maintained, but if not then all functional gains are lost after 2-8 months (US Surgeon General, 1996, Ch3 p.72)
|B| Structure your fitness training around the race calendar - so you peak at specific competitive events.
  • generally start with higher volume & low intensity, and adapt to lower volume & high intensity as competition approaches
  • 'periodise' into four week blocks, and make a focus out of each of the four-week blocks, e.g. strength, speed, power, technique, endurance or post-race active rest (Bazyler et al., 2015)
  • focus on skill acquisition in periods of lower training volume & intensity
  • taper off before competition (for 1-4 weeks, depending on how rapidly you detrain)
|C| Vary your fitness training approach.
  • vary the intensity of training.  One coach recommends that 10% of your training should be faster than your race pace, i.e. if your 5km run pace is 6m15 miles, do 80% at 8min miles, 10% at 7min miles, 8% at 6min miles and 2% at 5min miles.  This 80:20 split of higher to lower intensity training is accepted wisdom for runners and other endurance athletes (Seiler & Tonnessen, 2009)
  • incorporate muscle-work: when strength training is the focus, use the gym.  High-force, low-velocity training at 80% of your 1 repetition maximum for 5 or 6 repetitions on relevant muscle groups yields the best results (even tho' lots of people don't like the gym!) (Bazyler et al., 2015)
  • have a calmer week every fourth week or so - helps you recover and stay fresh & keen
  • high intensity interval training (HIIT) incorporates short periods (e.g. 30s-5m) of maximal effort followed by a rest, preferably of active recovery.  There's no clear optimal level of the work:rest interval, but 1:2, 1:1, 2:1 are frequently mentioned, confers endurance benefits up to 2x per week (Seiler & Tonnessen, 2009)
For those looking to burn fat: a moderate exercise intensity is best


So what about the surfing?
What's needed:
- strength and endurance: bursts to catch the waves, endurance to paddle all day, balance and power to pop-up on uneven waves

Use a surfing-specific training manual to make the plan:
- Nutrition: pre-load with lots of high GI carbs, carb/protein snacks, energy drink, carb/protein recovery drinks
- Warmup: follow the 7 surfing-specific dynamic routines
- Swim (in the pool): interval training combining high intensity burst swimming (30-60s) with endurance work.
- Strength @ home: HIIT the pull ups, push-ups, lunges, squats
- Gym (1): full body/balance - deadlifts, overhead presses, single-leg squats/medicine ball tosses,
- Gym (2): core - medicine ball / stability ball
- Gym (3): shoulders&back - cable chops, bent rows, cable pulldowns etc.
- Stretching: best done post-exercise


And what next...
So food's in the bag, exercise is in the mind (!), now for tagines, freshly caught fish, and NYE beach party...

Local transport here we come

Review credit - thanks to Rob Armstrong, including his important caveat that although general principles apply, everyone is genetically different, one size does not fit all, so you have to try things out to see what works for you.

Sunday, 2 October 2016

Positive medicine - stretching and warming up

Post-run stretching at Hackney Marshes parkrun
I've run 5-15km a week for the last 25 years (somewhere approaching 7000km) and continue to do so on the medical course.  It's a part of life now - I neither love it (apart from those times when I'm super fit) nor loathe it (aside from the repetitiousness!).  Up and down Donegal mountains on the Glover Highlander, searching new streets when growing into Maidstone or settling into Bavaria, Lancashire, Sheffield, Battersea and Derby; sweating buckets against all advice in Ghana in the midday sun (ouch!), and joining running clubs in Kent, Clapham, Nairobi, Derby and Mansfield, it's been consistent at least.  I've heard a load of received wisdom about stretching over the years, precious little of which I ever imagine has been researched by the people who have told me.  And as a medic, perhaps I should now be a little better informed...

The research consensus on stretching and warming up seems to be (1) DO warm up before exercise but (2) DO NOT stretch before exercise, but instead stretch (particularly the hips) at other times.  And - stretches, like so many things, are activity specific.  May be a surprise - so below details how stretches increase range of movement, performance, and affect injuries.  Here's the evidence...


Stretching

What is the physiological effect of stretching (i.e. what's happening in your muscles)?

Acutely:
  1. Analgesia - increasing your tolerance of stretch, allowing you to tolerate a greater range of movement (ROM) than you had previously  LINK (2012) ; LINK (2006), p.5
  2. Stress relaxation of muscle - reducing the passive tension in a muscle.  This tends to last < 1 hour LINK (2006), p.6
  3. Elastic extension - as muscle sections (sarcomeres) slide over one another (and to a lesser extent, tendons and other connective tissues stretch) - muscle is the least stiff section so extends the most LINK (2009).  
  4. Plastic deformation - short sarcomeres may be torn; connective tissue at the musculo-tendinous junction may be torn, abnormal crosslinks may be torn.  At the end of the muscle's ROM, tendinous collagen may also be torn.  May occur, can be pathological, therefore stop when it hurts. LINK (2005), p.51, 65
Chronically (adaptively):
  1. Stretching stimulates protein synthesis in muscle - more sarcomeres are synthesised and added to the end of the myofibril LINK (2005), p.53
  2. Ruptured collagen fibres are repaired by synthesis of further collagen which reunites the fibres, adding 'links into the chain' LINK (2005), p.55 

Effect of stretching on Range of Movement (ROM) LINK (2012) ;  LINK (2014) ;
  • Static stretching increases ROM maximally if load is applied between 10 and 30 seconds LINK (2012)
  • 2-4 repetitions give maximal stretch (subsequent repetitions do not increase range) LINK (2012)
  • ROM increase is greatest if the muscle is contracted prior to stretch
  • Foam rolling appears to have a far greater influence on ROM than stretching LINK (2014), slide 28
  • Acutely, the ROM increase lasts less than an hour, whether the subject is exercising or not LINK (2009)

Effect of stretching on injuries
  • Stretching does not reduce the occurrence of injury LINK (2012) ;  LINK (2014), slide 8
  • Static and dynamic stretching have equivalent effects; active dynamic stretching is fine (full range), ballistic stretching (full range, bouncing intensely at the ends) increases risk of damage.
  • Stability-mobility paradox: highest injury rates are in people at the top and bottom 20% of the flexibility distribution curve. LINK (2014), slide 19

Effect of stretching on power
  • Pre-performance static stretching reduces power by 4-30%, LINK (2006), p.8 (this was at a duration of 120 secs+ per muscle group), lower stretching of 30s+ shows little compromise- therefore stretching before exercise is not a good idea for performance.  LINK (2009)
  • Post-performance (or inter-performance) appears to elicit long term performance benefits LINK (2009)
  • However, increased flexibility in general does not increase running economy, so these benefits of stretching may be activity-specific LINK (2014), slide 19

Optimal level of stretch

  • Greater flexibility in the hips is adaptive for running (faster runners have this) LINK (2014)
  • Less flexibility than standard in the lower leg joints (i.e. knees and ankles) is adaptive for running LINK (2014)
  • However, years at sitting at desks and wearing shoes may exaggerate our inflexibility, and hence it's a probably a good idea to stretch out when you're running, particularly as you age. 


Warm-up

What is the physiological effect of a warm-up?
  • temperature effects on the muscles, e.g. increased nerve conduction rate, increased anaerobic energy provision LINK (2003)
  • neuromuscular effects, e.g. increased intramuscular Ca2+ LINK (2014)
  • psychological effects, e.g. increased exercise enjoyment and motivation LINK (2014)

Performance effects of warm-up
  • Stiffness is reduced by warmup LINK (2014), slide 21
  • Reduces injuries: the maximum force of energy absorbed before failure is increased if muscle groups are warmed up before training LINK (2014)


Summary guidance on warm-ups and stretching
  1. You should warm-up with low intensity exercise before high-intensity exercise
  2. You should stretch muscle groups for 2-4 x 10-30s after or between exercise sessions - this helps with muscle synthesis and is likely to yield performance benefits
  3. You should not seek super-flexibility; a moderate range of flexibility is optimal for most activities.  For peak performance running (if that's your only sport), flexible hips and slightly stiffer-than-average ankles is probably the best combination
Runner's World offers us an (incompletely evidenced!) guide to stretches


About Me

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Medical student, keen on travel, piano, and the outdoors. Past work in psychological research and healthcare IT consulting.