Core training

Training the "core" is an important consideration for most people wanting to improve fitness, recover after pregnancy and to generally be better equipped to deal with the stresses that life throws at us. As a result most gyms have Swiss Balls available for use and many also have "Wobble Boards" and Hard Foam Rollers to balance on. Until now it has been difficult to know when to workout on unstable surfaces like wobble boards and Swiss balls and when to simply stand on the hard stable gym floor.

The current issue of ACSM's Health and Fitness Journal (January/February 2008 Volume 12 Number 1) has an excellent analysis of when unstable surfaces help and when they hinder. Coming at the subject of core training from a medical and a scientific angle helps enormously. The chart to the right is an analysis of what exactly is in "The Core".

The analysis starts with:

• what exactly is "The Core"
• what exactly are you trying to achieve with "Core Training".

As it turns out the core muscles comprise much more than just the visible 6-pack muscles - the rectus abdominis. The core goes beyond just the abdominal muscles and the lower back which many have regarded as core muscles. The list of muscles gets rather long. Here is the ACSM view of core muscles after full consideration of human anatomy:

1. transversus abdominis
2. internal oblique abdominis
3. quadratus lumborum
4. external oblique abdominis
5. erector spinae
6. rectus abdominis
7. latissimus dorsi
8. rectus femoris
9. sartorius
10. iliacus
11. psoas (major and minor)
12. gluteus maximus
13. semimembranosus
14. semitendinosous
15. biceps femoris (long head)
16. multifidus
17. rotatores
18. intertransversalis
19. interspinalis

This is quite a list to which one could add a few more muscles. All of these muscles are working to some extent in all core related exercises. It turns out that "isolation" is just about impossible.

The big point from this ACSM article is the important perception about the results from training core muscles. Core exercise can emphasises one or more of :

• Endurance from core muscles
• Strength from core muscles
• Power from core muscles.

Looking at core exercise in terms of are you trying to improve endurance, strength or power means that the exercises used need to be different. If you want all three to improve then you'll need to train for endurance then strength and then power. Take a couple of weeks of exercise for your body to recover and then go around the exercise loop again but this time starting from a higher level.

Core Endure is important for everyone whether you are an older person recovering from a serious medical issue or a highly paid professional sports star. Unstable surfaces such as Swiss Balls, Bosu's and Wobble Boards all help in the development of core endurance. The technical term for an unstable surface such as a Swiss Ball is a "labile surface" Look at this article which has some nice pictures of abs exercises on a bench, on a Swiss ball and on a wobble board. However it also turns out that exactly where you place the Swiss ball makes a big difference to how hard the exercise is. Read this piece of research. It turns out that having the Swiss ball near your shoulders makes core exercise easier and having the ball at the low back makes it harder. This is important to know is you are just starting to move your core exercises onto a Swiss ball. Easier to start and then gradually increase the challenge.

Core Strength becomes important after the core muscles have sufficient endurance. To develop core strength you need to move your exercise to get off the Swiss ball, wobble board, etc and move to a stable surface i.e. the floor. However the important thing to know about this phase of core development is that one sided (unilateral) exercises become critical for strength development. Use dumbbells for one sided exercises with one or both feet firmly planted on the floor. An example would be a one-sided hip extension while holding a dumbbell (reasonably heavy) in one hand. This article reports research showing that you need a stable surface for strength development.

Core Power is the ability to generate a lot of force rapidly i.e. you can move heavy objects fast. For core power both feet have to be firmly planted and you are rotating while pushing a load well within your capabilities i.e. for core power the weight or resistance is less than you are capable of but you are moving the weight fast. For instance you might be pushing a cable row handle forward (or back) as fast as you can against a reasonable resistance.


There are many books on Core Performance. I really like the one opposite by Mark Verstegen which covers exercise from many angles.






There are also books which just describe Swiss ball exercises - of which there are a great number. The book by Goldenberg and Twist is aimed at a sports audience but is a good read for many people but it does not make any distinction between endurance, strength and power.

Sleep Apnea

Sleep Apnea is becoming an epidemic - maybe at a rate of 24% in men and 9% in women.It looks as if the rise in Sleep Anea is tracking the spread of obesity. According to an article in the Lancet, severe Sleep Apnea is correlated with a three-fold increase in the risk of a heart attack (or similar cardiac incident).

The rise of Sleep Apnea as an important health issue motivated the ACSM (American College of Sports Medicine) to devote the whole of its October-December 2007 Certified News to the topic of Sleep Apnea. The issue was headlined as "Obstructive Sleep Apnea: An Elephant in the Closet of Importance to the Exercise Professional."

So what can be done ? The answer :

• lose weight - maybe as little as 12 pounds and 10% of body weight should make a big difference
• use a sleep aid such as a CPAP.

Is there a problem ? Well yes, because Sleep Apnea makes exercise more difficult:

• heart rate does not increase the way it should in a healthy body
• blood pressure goes up more than it should during exercise.
• wearing a CPAP every night is no bed of roses and hence long-term, every night use of a CPAP is unlikely. The peaceful image of a CPAP in use at the head of this blog is just a tad idealized. Read this forum to get an idea of what it's really like.
  

Can a Personal Trainer help ?
Is there an exercise prescription for Sleep Apnea ?
At the moment the ACSM does not have any specific exercise recommendations for Sleep Apnea but the issue of Certified News referred to above is the start of defining such a prescription.

One major problem standing in the way of a simple exercise prescription is the possibility, even likelihood, that anyone with severe obstructive sleep apnea is going to have other health issues such as obesity, Type 2 Diabetes, hypertension and a variety of heart issues such as congestive heart failure, cardiac arhythmias and perhaps a stroke risk.

The bottom line is to try for 45 to 60 minutes of low intensity exercise every day (or at least 5 days) a week. Low intensity is defined by the ACSM for this purpose as being 40%to 60% of maximum heart rate. This is longer than ACSM recommendations for hypertension, Type 2 diabetes and CV diseases but at a lower intensity.

The ACSM emphasizes that exercise for anyone with severe sleep apnea should be concluded gradually with an extended cool down period of at least 15 minutes. One additional ACSM recommendation is to closely monitor blood pressure and in particular to measure blood pressure 5 to 15 minutes after the end of exercise cool down. This is to check that blood pressure has returned to baseline value. If it has not then either the exercise intensity was too high or the cool down was too short.

Fitness Trends from the ACSM worldwide survey

The November/December 2007 Health & Fitness Journal published by ACSM [American Council on Sports Medicine] recently arrived in the mailbox and as usual it had a few gems. One such is the results from the annual survey of fitness trends. The top 5 and the changes between last year and this year:

1. Fully certified and accredited health/fitness professionals. (previously #3). In Georgia,USA there is draft legislation to license Personal Trainers. If a Personal Trainer is well qualified this is a good thing. However the major gym chains are all against it and probably are able to spend enough on lobbying to stop it becoming law.
2. Fighting childhood and adolescent obesity. (previously #1). This slipping down a notch is a surprise as I can see more and more parents sending their children into the gym to workout with Personal Trainers.
3. Personal Training (up from #7). In an area like mine, north of Atlanta, most people have long, tough commutes. Working out has to be squeezed into an already punishing schedule. Having a Personal Trainer makes sure that maximum value is obtained from time spent in the gym.
   
4. Strength Training (previously #6). Weight loss or weight control is an issue for many and it is now well established that an integrated program of cardio (aerobic) training plus muscle strength training is the best combination of exercise.
5. Core Training (unchanged at #5). Just about everyone wants a flat tummy and nice looking abs. This is not an easy look to get because you have to really work at it. The trick is to work the whole core area because just concentrating on the Rectus Abdominous (the 6 pack ab muscle in the front) does not get results. What you have to do is work the whole core area which includes everything front, back at sides from the hips up to the line across the nipples. To do all of this you need to know a lot of exercises and be able to use them in sequence and combination.