My Training and Fatigue Management

I had an interest in exactly what I was doing and how I was dealing with the fatigue.  The fine line between listening to your body to get the recovery you need vs. talking yourself out of a workout that needs to be done because you feel fatigued may be more difficult than walking that line.  In this case, it’s best to take the time and come back at it when you’re feeling closer to 100%.  Take this time to get some general activity in – walk, etc…

As a cancer patient, I tell people that for now, I have cancer – but cancer does not have me.  As I struggle through my workouts, the intensity gives me a good feeling of accomplishment and reduced fatigue throughout the day.  This feeling also crosses over to my confidence level – specifically if I’m throwing kettle bells and barbells around.  However, I’m finding the subsequent days after training, my body may slow down, telling me I need more time to recuperate.  If I feel like napping, I nap.  If I want to lay down, I lay down.  I stay hydrated and get my meals in as often as my body will tolerate the nausea.

Here’s what I’m doing:

·         Six exercises broken down into core, max strength, functional and single joint

·         Reps:  5-10 (If I get to 10 and it’s easy I go up)

·         Sets:  2-4 (more sets on the multi-joint movements, less on the single joint)

·         Rest between sets:  As needed, usually 1-4 minutes depending on my nausea

An example workout:

·         (Preparation: dynamic prep, corrective exercises)

·         Kettle Bell Snatch           12kg  4sets/10,8,5,5  Rest: 2-3 min

·         Kettle Bell Push Press     10kg  3sets/5,5,5      Rest: 1-2 min

·         Barbell Bent Over Row   90lb   3sets/10,8,8    Rest: 2-3 min

·         Lat Pulldown                   80lb   2sets/8,8         Rest: 2 min

·         Dumbbell Press               25lb   2sets/8,8         Rest: 2 min

·         Barbell Shrug                  135lb  3sets/10,8,8   Rest 2 min

·         (Recovery: foam rolling, AIS & static stretching)

All of this has been cleared by my doctor with the understanding that I’ll listen to my body and make healing the primary goal.

I’m only making it into the gym 1-2 times a week due to my fatigue, but that number will be increasing as this format is designed for 3 day/week training.

I hope this helps those of you who need it.  Talk to your physician before beginning ANY training program.

Until next time – Don’t be afraid to pick up steel and most of all listen to your body!

Nate

Intense Exercise and Cancer-Related Fatigue

From the mouth of my oncologist, Dr. Vishnu:  “Cancer sucks” – and he’s right.  During the battle of fighting this disease I’ve been exposed to chemotherapy, infections and complications that have caused me to lose over 45 pounds of lean body mass and, I kept thinking…  I need to get that back.  The best way I know how is by moving steel at above than normal loads and velocities.  However, there is a problem.  I felt so fatigued!  I’m so tired all the time - mostly to the point that I really don’t feel like doing anything except lying down all day.  I knew I needed to get out of this mindset fast.  But, before I began, I wanted to find out more about the subject:

Does high intensity weight training help to reduce cancer-related fatigue during chemotherapy?

These two articles are of interest of the dozens that I perused.

In this article, (Wyrick et. al., 2009) found that up to 70-100% of cancer patients suffer from cancer-related fatigue.  The concern for the patients was common:  Will exercise reinforce the fatigue or help diminish it during chemotherapy?  According to this study, by incorporating both an aerobic and strength training program, evidence revealed a reduced fatigue rating with an improved quality of life.  Out of the 27 studies reviewed in this literature, only 2 involved actual resistance training – so I wanted to dive a bit deeper.  (Adamsen et. al., 2009) incorporated a large base of subjects (over 200), of which I found the most comprehensive training regimen that included low and high intensity strength training, preparation and recovery methods that included yoga and message.  I was a little disappointed to see that the strength training exercises dealt primarily with machines (including a crunch machine – not a fan) such as the leg press, chest press and knee extension.  These exercises have little to no functional value to everyday living.  But the evidence is persuasive – reduced fatigue and improved quality of life for those that are currently going through chemotherapy by incorporating intense exercise.  Here are my findings:

·         Exercise works on reducing cancer-related fatigue during chemotherapy

·         Modes/types of exercise work

·         Intensity of exercise needs more research

·         Duration of exercise needs more research

·         Recovery of training is absolute

This gave me the informational green light I was hoping to find.  Many of the protocols and program details are under debate, but enough evidence was given to prove that intense exercise helps to relieve cancer-related fatigue.  What’s most excellent you ask?  This:  I’ll conduct my own research and use what is familiar to me.

·         Kettlebell Snatches

·         Kettlebell Clean & Press

·         Kettlebell Push Press

·         Barbell Cleans

·         Barbell Squats

·         Barbell Deadlifts

General Programming:

These exercises are formatted into a three day workout program during a one week cycle combined with other more single joint exercises (Hey, I want my arms to look big again…).  I make it to the gym 2-3 times per week based on my recovery and how my body is adapting to the stress.  I perform 3 Sets of 5-10 reps.  If I can hit 10 reps, the resistance goes up.  Recovery between sets is based on how I feel.  There are times I feel a bit sick to my stomach and need a few minutes.  Other sets, I can drop the weight and pick it right back up in a minute or two.

Nutrition:

I eat 5-6 small meals a day always including protein and carbohydrates.  Each workout is followed by a whey protein smoothie mixed with orange juice and fresh fruit.

Recovery:

This includes a comprehensive stretching program after each training day that deals with any movement imbalances or motor control issues I’ve developed due to losing so much weight.  Most commonly these include an elevated scapula due to stressful breathing patterns in response to pain and posterior pelvic tilt of my iliofemoral joints (hip) due to extremely tight biceps femoris (hamstrings).

In Closing:

I have been training this way now for 3 weeks and have packed on at least 4 pounds of lean body mass while feeling that I have better control of the side-effects the chemotherapy I am currently taking tends to dish out.  In short, fatigue does not have a strong grip on me as it used to.  I feel stronger, more confident and can endure more during the day which allows me to enjoy other aspects of my life longer and more frequently.

Unexpected Training Change

On Thursday July 28^th, I experienced a proliferated ulcer and had to be sent directly to the hospital for emergency surgery as my abdominal cavity was filled with air, fluid, etc… I’ve been hit quite a few times in my abdomen, but this was seriously the worst pain I’ve ever endured. Once at the hospital, my wife joined me as the surgeons planned their strategy. They performed the standard CT scans and other assessments to get as much information as they could.

However, it turned out to be more.

During the surgery, the surgeons noticed that I had multiple tumors on my liver, which apparently was identified previously during the CT scan as something “abnormal with my liver”. These tumors were biopsied and diagnosed as “carcinoid” tumors which could very easily be life threatening.

I really didn’t understand the diagnosis until Friday morning after the surgery when my wife explained it to me. She was in tears and I could tell she was on the verge of breaking down. Immediately upon finding out, I let this news take 30 seconds of my life. During that time I allowed myself to feel panicked, angry, confused and accusatory. After that, still feeling the effects of the anesthesia from the night before, I informed the nurse and my wife that I wanted to take a walk.

I counted 235 steps.

I laid back down exhausted and told my wife that I took 235 steps and this is where it will begin. From that time on, I will focus on fighting this and progressing the only way I know how: With willpower, fortitude, optimism and intelligence.

I was released one week later with every intention of creating my own rehabilitation program for the next 2 weeks as I heal from the surgery.

Here is my incision 8 days out of surgery.

My rehabilitation plans follow a 2 week foundation based on the healing of the incision - With a frequency of daily training with short duration bouts.

· Stage of healing: Repair Phase

· Indicators of limitations: Pain during ROM, dysfunctional ROM due to injury/surgery

· Indicators of success: time/reps/sets, RPE, Sex appeal (hey, I want to look damn GOOD for my wife)

MILESTONES

1. Maintain current mobility

o Hip

o T-Spine

o Contralateral movement

I have lost some mobility, so my goal is to maintain what I currently have until I can load my body with increased resistance and/or more challenging exercises to improve joint mobility. Research has shown that improving mobility can lead to improved stability and overall function.

2. Increase stability

o Lumbosacral (transverse abdominus & multifidi engagement)

o Scapulothoracic

o Glenohumeral

Stability is best suited by increasing or maintaining joint mobility. My focus here is address weaknesses in my lumbo-pelvic complex as well as engaging my ST/GH stabilizers. By training the transverse abdominus and multifidi using body weight and limb movement, one can avoid potential shutdown of the glutes which has been linked to low back pain. I’m already “hunching” over slightly from my surgery, so this is a concern for me as I heal. Check out Hodges & Richardson research as well as McGill on trunk/spine stability protocols.

3. Increase strength

o Glutes

See above. Strong glutes = increased ROM/mobility, optimal function during squatting, stepping, etc… and will spare my erector spinae and quadrates lumborum from firing overtime – Plus work with my deep trunk stabilizers to create an optimal pattern of movement during squatting, stepping, etc… that has been altered since the surgery.

4. Increase endurance

o Shoulder complex

Encourage appropriate scapular function and force couples while improving rhomboid, serratus anterior, trapezius and rotator cuff endurance.

5. Maintain breathing patterns

o T-Spine

o Dead Bug

Just as Mr. Miyagi stated in Karate Kid: “No breathe, no life!” I will be focusing on elevating the rib cage during forceful breathing; engaging my diaphragm and other thoracic elevators and depressors while maintaining contra-lateral movement patterns.

Here is my training program for the next 2 weeks based on the information above:

Preparation:

· Treadmill/Walking 3 minutes (if I feel like it)

· Low intensity dynamic stretches: knee hugs, pull backs, leg pendulum swings, over unders

Body:

1. Dead Bug

2. Floor Bridge

3. T-Spine Floor Rotation

4. Iso Push Up with hip flexion & extension

5. Elevated Push up

I utilize the exercises in circuit fashion, performing 10-15 reps based on RPE with 2-3 rotations. It usually takes me about 5-8 minutes to complete a couple rotations. Check out the video below:

Recovery:

As much as I’d like to hit some soft tissue, I’m not quite able to support my body weight on a foam roller or any device, apply forces necessary with the stick (on a 10 lb lifting limit) and I just don’t have a bedside manual therapist (any volunteers?). So I’m focusing on low intensity, old school static stretching.

· Hamstring static stretch

· Hip flexor static stretch

· Pectoralis Major static stretch

So that’s my approach - From 235 steps to my first training regimen. I have every intention of using this to getting my ass back to the gym and moving steel again.

In closing, the doctors believe that I have had the tumors for anywhere from 5-15 years - That they are slow and possibly “well-behaved”. However, I have scheduled examinations and tests throughout the next two weeks to help give the doctors the information necessary to create a plan.

With these plans, my wife and I have not been idle. We’ve been using our time researching nutrition therapies, planning exercise progressions (such as the one above) and making time for reflection and meditation – something I incorporated often in my life years ago, but somehow neglected over the past half decade.

Regardless of diagnosis or direction, I feel optimistic and thankful. Particularly for my friends, family, students and colleagues who have taken time to call, email, text or stop in for a visit. To everyone: THANK YOU.

Improved Cardiovascular System via Resistance Training

What does the word “cardio” mean to you? When you reflect on this word, what images form in your mind? Walking, running, cycling or even swimming perhaps may be the most common. What about equipment? I bet the treadmill, elliptical or stationary bike forms in your mind’s eye. The truth is, there are more ways than one to train our cardiovascular system based on how our body adapts to stress. Before we get into that, check out my workout.

Dynamic Prep:

· knee hugs, pull backs, lunge with rotation, leg pendulum swings, over-unders

Movement Development (2 sets x10 reps):

· toe touch progressions

Core Development (2 sets x10 reps):

· SL curl ups

· Planks with hip extension

Body (As demonstrated in the video: 8-10 reps of each):

· KB snatch

· Grapple Barbell Presses (Ground)

· Plyo Star Pushups

· Bosu KB Chops

Rock out 3 rotations with 60 seconds (or less) of recovery before starting the next interval.

Recovery:

· SMR – Piriformis, Rectus Fem.

· Static Stretch – Rectus Fem.

Check it out below.

When training for aerobic endurance, the physiological benefits include:

· Decreased resting heart rate

· Decreased resting systolic blood pressure

· Decreased pulmonary ventilation (breathing rate)

· Increased oxygen transport and usage (VO2)

· Increased capillary and mitochondrial density at the tissue level

These are all GREAT aerobic adaptations for improvement of the cardiopulmonary relationship. However, the cardiovascular system also adapts to anaerobic training and provides the following benefits:

· Increased ventricular contraction or stroke volume

· Ability of the cardiovascular system to perform under scenarios of high stress

· Increased anaerobic capacity (amount of ATP available in muscle)

· Neuromuscular coordination and movement economy

· Tolerance of increased blood lactate levels

· Increased oxygen deficit that must be made up (increased calorie expenditure)

· Increased motor unit recruitment (increased hypertrophy & strength)

How is this in a practical component? Look below...

OXYGEN DEFICIT

As you can see, aerobic and anaerobic training protocols BOTH have a positive effect on the cardiovascular system. In fact, Sloniger et al. determined that an oxygen deficit is created mostly due to increased activation of the muscles involved during anaerobic exercise – no surprise there, right? This deficit can allow the cardiovascular system to adapt in ways mentioned above along with expending many more calories over a period of time even when the exercise/training has stopped – great for those who want to lose a few pounds.

ATHLETIC DEVELOPMENT

Training for multi-dimensional bioenergetic development can also have a positive effect on explosive sport. This better correlates with specificity of the energy systems called into play. Being able to perform at the highest intensity throughout the entire game without “losing steam” is an example of good aerobic and anaerobic capacity. Let’s face it, developing an aerobic endurance foundation is crucial for all explosive athletes, however the focus needs to be on REPEATED anaerobic bouts of high intensity which replicates the energy systems called into play during game time. Through this type of training we give the cardiovascular system the ability to adapt to higher levels of blood lactate while improving the ability to buffer lactate during the brief downtimes, thus preparing the athlete for the next play.

HEALTH

Encouraging good health and disease prevention is also on this list. Let’s think about it… If we can give our cardiovascular system the ability to endure the longevity of our work (aerobic) as well as the ability to perform under higher levels of stress or load (anaerobic), then we are REALLY training for health. Here, Bouchla et al. displayed 20 rehabilitating chronic heart failure (CHF) patients who, half participated in only aerobic interval training and the other half participating in aerobic interval training AND resistance training. The interval training/resistance training group reflected a significant improvement in health, strength, hypertrophy, neuromuscular relationships and fiber type alterations.

All in all, look at the cardiovascular system as a multi-dimensional closed-circuit system which can adapt to aerobic and anaerobic stimuli. And next time you go to throw some steel around on the floor, remember: You ARE doing cardio!

See you next time.

Nate

Do you have your daily dose of soft tissue work?

I have been reviewing my skills and knowledge (as is the path of development) according to how I work with my clientele. I strive for an approach that is effective, efficient and simple. Over the past month or so, I've been wading through data, trying new techniques and finding what works best for me and my clients. More or less, I've been a bit reflective.

1. SOFT TISSUE
2. STABILITY, MOBILITY (STRENGTHENING & FLEXIBILITY)
3. SPECIFICITY

I like to call this "The Three S's"

SOFT TISSUE:

Manual therapists can help improve function, reduce swelling, improve recovery, increase tissue viability, prepare athletes for competition, propagate rehabilitation and affect psychological well-being. In fact, the research is suggesting that the combination of soft tissue work and neuromuscular stretching such as PNF has a larger impact on ROM than stretching alone. This article (2011) by Renan-Ordin et. al., suggests that manual therapy specifically targeting trigger points (which is a local contraction in a small number of muscle fibers in a larger muscle bundle/motor unit that when compressed will elicit a pain response) followed by stretching provided short term benefits for men and women experiencing plantar heel pain. Can we assume that these fascial relationships are probable and responsive throughout the rest of the body? I do. Trampas et. al. (2010) state similar results here in a study including 30 males with tight hamstrings who were divided into two groups. Group 1 received stretching only. Group 2 received manual therapy in addition to the stretching protocol. Guess which group increased ROM? That's right - Group 2.

Best bet:

• Physical Therapist, ATC, Chiropractor or other tactile based clinician
• Massage Therapist (Sports/Kinesiology focused or equivalent)

Here are some tools you can use if you are not a state licensed manual therapist:

• Medicine Ball
• Tennis Ball
• Foam Roller

Below is an example of "The Stick".

If you would like to learn more about how to perform rolling, check out Mark Verstegen at Core Performance here. A true professional - his instruction is pristine.

Tip: Just ensure you are not rolling over any edema (swelling or bruising), varicose veins or those with chronic pain disorders such as fibromyalgia.

At Efficiency in Motion and NPTI Seattle, we focus on leading with soft tissue work during the preparation of activity (workout, game, etc...) on areas that are extremely over-active - then move directly into the dynamic prep. Afterwards, we slow it down and spend more time on soft tissue before moving into active and passive based flexibility exercises. We find this helps to improve ROM, movement efficiency, kinesthetic response and recovery after a hard workout.

As for the other two aspects listed above, we'll dive into that later. For now, begin to incorporate soft tissue into your life and gain the psychological and physiological benefits that many of us have been tapping into for years.

Enjoy!

A Good Day in the Neighborhood

I've recently been working with a client who had a complete right side iliofemoral replacement. Common symptoms included neck pain, low back pain and a feeling of overall tightness throughout her body from her shoulders to her pelvis. The low back pain would begin early in the morning and last throughout the day.

Upon assessment I found the following:

• During a prone glute assessment that her right side glute was significantly weaker than the right (go figure), however both were very weak.
• A overhead squat test shown a significant asymmetrical weight shifting to the right side, reduced shoulder mobility due to tight lats - she was unable to fully lift the bar over her head, it was stuck out front (confirmed this with the supine lat assessment).
• Active leg raise shown bilateral mobility issues, but more so on the right with excessive lateral rotation of the iliofemoral joint during full knee extension. Upon further investigation, I suspected her piriformis for the increased degree of lateral rotation.
• Client was unable to perform a complete toe touch with a feeling of stiffness in her low back and hamstring area.
• A seated T-spine rotation assessment suggested a severe limitation in her ability to fully rotate to either side (20-25 degrees bilaterally).

Session 1-3

We focused on mobility. She was experiencing a large degree of "stiffness". As such, I wanted to help her feel less restricted. I introduced her to glute and T-spine exercises, focusing on full range of motion and the control of eccentric forces. We wrapped it up with a bit of soft tissue on the hamstrings and latissimus dorsi stretch.

Session 4-8

My focus was on increasing scapulothoracic stability (hitch hikers), continued T-Spine mobility and strength through functional movement (primarily lifting with the glutes and shoulders). However, by the seventh session she became overly fatigued as she was training on alternate days. I suggested a reduction of training intensity and re-assessed her glute strength and T-spine mobility. She was able to activate the right side glute for 36 seconds and her left for 52 seconds. T-spine mobility had improved, but not markedly. By the seventh and eighth day, I introduced more soft tissue and flexibility protocols and less strengthening. I focused on the piriformis, hamstrings, adductors and latissimus dorsi - off and on static/PNF protocols.

Session 9

She came in feeling better and stronger. She stated that she was able to withstand her back pain until well into the afternoon and that she felt less stiff in her pelvic region. I assessed her glute strength and found that she could activate her right side glute for over 1 minute, with her left side following suit - I was pumped! I incorporated a few exercises for her glutes and ST joint, stretched her hamstrings and piriformis (PNF) then sent her on her way.

Awesome!

Trapezius Anyone?

As I dive further into my study of the shoulder, its function never ceases to fascinate me. Coming across a study that reflected EMG activity of musculature during over head lifting with stable and unstable loads and surfaces, I found an interesting piece of information that suggests that the role of the trapezius is highly specific .

As their results suggest, increasing resistance using a barbell increases core activation. However, it does not reflect the same linear increase with the trapezius. Their results show little change in the root mean squares and external resistance of 79%, 86% and 89% of the stable surface, stable load lifts - meaning that regardless of load or surface, the trapezius will be firing with the same magnitude during over head lifting. The authors continue to state that the trapezius and it's role as a scapularthoracic (ST) and glenohumeral (GH) stabilizer is specific across all conditions. We also know that the trapezius plays a primary role in scapular elevation and upward rotation during the over head movement, but only after 90 degrees of humeral elevation, yet the forces this muscle has been shown to exert in the study is the same with lighter or heavier loads. In short, we need to condition the trapezius and encourage it's cocontraction with the serratus anterior, rhomboids and other ST stabilizers during rapid limb movement.

Look at it this way:

ST STABILIZERS > GH STABILIZERS > GH LIGAMENTS, CAPSULE & LABRUM

If there is any dysfunction/injury of the ST stabilizers, then the GH stabilizers have to work over time to stabilize the GH joint leading to an altered ball and socket relationship. This can progress to further joint dysfunction, placing increased stress on the ligamentous tissues and possibly pain.