The relationship between the wrong shoes and knee pain while exercising

The knee joint is one of the most complex joints in the human body. While the joint is strong, it is formed around many bones, ligaments and tendons that give it its versatile nature. The knee not only takes the pressure of your whole body during general everyday activities, but during exercise this tensile force can increase to three times the force of your body weight. That’s a big load to take!

The fact most people are unaware of is that our feet play a vital role in the functioning patterns of the knee. There are three types of gait patterning with the feet – pronation (flat foot), neutral or supination (rolling out).

Without the right shoe for your foot type, this incorrect arch patterning can transfer into the knee, changing the patterning of the joint and can cause an increase in the ware and tear of the joint. It is also one of the most common causes of knee pain while exercising.

If you are experiencing an increase in knee pain, speak to one of our exercise physiologists and they can assess this for you, or alternatively visit your local podiatrist or shoe fitting specialist to be fitted into the right shoe for you!

Sleep Apnoea - The Fatigue Of Sleep

What is Sleep Apnoea?

Sleep apnoea is a sleep disorder characterised by repetitive pauses in breathing during sleep. Whilst sleeping, the muscles of the throat relax to the point of blocking the airways above the voice box. Breathing stops, for between a few seconds and up to one minute, until the brain registers the lack of breathing (or a drop in oxygen levels) and sends a small wake-up call. The sleeper rouses slightly, typically snorts and gasps, then drifts back to sleep almost immediately. In most cases, the person doesn’t even realise they are waking up. This pattern can repeat itself hundreds of times over every night, leaving the person dogged by sleepiness and fatigue.

The most common type of sleep apnoea is Obstructive Sleep Apnoea. There are different degrees of sleep apnoea, with the severity of this disorder depending on how often the breathing is interrupted. The following averages can be used as a guide:

• Normal - less than five interruptions an hour
• Borderline - 5 to 15 interruptions an hour
• Mild sleep apnoea - between 15 and 30 interruptions an hour
• Moderate sleep apnoea - between 30 and 50 interruptions an hour
• Severe sleep apnoea - over 50 interruptions an hour

What causes Sleep Apnoea?

Obesity is one of the most common causes of sleep apnoea. A loss of around 5 to 10 kilograms is often enough to dramatically reduce the severity of the disorder.

Other causes of sleep apnoea include:

• Alcohol, especially in the evening, which relaxes the throat muscles and hampers the brain’s reaction to sleep disordered breathing
• Certain illnesses such as hypo thyroidism or the presence of a very large goitre
• Large tonsils
• Medications, such as sleeping tablets and sedatives
• Nasal congestion

What are the warning signs of Sleep Apnoea?

• Loud, repetitive snoring – sleep apnoea sufferers follow a pattern of loud snoring followed by episodes of silence and then a loud snort or choking sound
• Excessive daytime sleepiness – this can occur whilst at work, watching TV or even driving the car
• Erratic mood shifts – people with sleep apnoea are more susceptible to depression and increased irritability
• Morning headaches
• Memory or learning problems
• Poor concentration
• Dry throat upon waking in the morning

How common is Sleep Apnoea?

It is estimated in Australia that 17% of middle-aged men and 6% or middle-aged women suffer from Obstructive Sleep Apnoea. Anyone can have sleep apnoea, however the more risk factors you have, as well as a family history of sleep apnoea, increases the risk of this disorder.

How is Sleep Apnoea diagnosed?

Your doctor will do a physical exam and check your mouth, nose and throat for large or extra tissue. Your doctor may order a sleep study which is performed in a hospital or sleep centre.
The most common sleep recording to diagnose sleep apnoea is called a polysomnogram or PSG. This test records:

• Brain and muscle activity
• Eye movement
• Breathing and heart rate
• Air movement into your lungs
• Oxygen in your blood

Can Sleep Apnoea be Treated?

Yes It Can!

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness. The following methods may be used:

• Continuous Positive Airway Pressure (CPAP) is the most common treatment for sleep apnoea. This involves wearing a mask while you sleep which blows air into your throat at a pressure level which is right for you. The increased pressure keeps the throat open while you sleep
• Oral Devices such as custom-made mouthpieces can be helpful in some people with mild sleep apnoea. The mouthpiece will adjust your lower jaw and your tongue to help keep the airway in your throat open while you are sleeping
• Surgery may be an option only if the above alternatives do not work. Such procedures are effective only in a small proportion of mild obstructive sleep apnoea sufferers

Preventing Sleep Apnoea

Prevention for sleep apnoea relies on changes to lifestyle. It is recommended to:

• Lose weight
• Reduce night time alcohol
• Quit smoking — smoking damages the smaller airways of your lungs which reduces your total lung capacity. Smoking can exacerbate your sleep apnoea

Do I need Help?

To help determine whether you need medical treatment, answer the following questions.

• Do you gasp, choke or stop breathing during sleeping?
• Do you snore loudly at night?
• Do you feel tired and un-refreshed during the day?
• Are you overweight?
• Do you have a neck girth over 42cm?
• Do you have high blood pressure?

If you answer ‘YES’ to two or more of the above questions, you may have sleep apnoea and you should see your GP.

10 Tips for Weight Maintenance

If you've worked hard to achieve your weight loss goals, you'll want to enjoy your healthy weight for life.

Here are our top ten tips for weight maintenance:

1. Monitor Your Weight

Check your weight each week (don't weigh yourself too often as it's natural for your weight to fluctuate daily). Invest in a reliable set of scales. It's normal for your weight to fluctuate by 1-2 kilograms, but if you notice your weight increasing on two or more consecutive weeks try one (or a combination) of the following three actions:

• Identify any deviations from your eating plan. You may need to record your intake or check your portions
• Increase the duration and / or frequency of your exercise sessions
• Be honest with yourself: are there any areas of your lifestyle, behaviour or environment that have changed?

You should set an upper and a lower limit on your weight maintenance range (a Dietitian can help you set appropriate limits). If you hit your upper or lower limit, seek professional help from a Dietitian or Doctor as soon as possible. And don't procrastinate for too long - it's much easier to reverse a 1-2kg weight gain than it is to reverse a 5-7kg weight gain!

2. Monitor Your Eating Patterns

Keep a food diary to ensure that you are eating the right amounts of food from each of the five food groups. It may sound tedious, but a food diary helps you to check that you are eating regularly. Try to maintain a consistent eating pattern, including weekends and holidays.

3. Exercise

To maintain your weight you need to exercise at a moderate intensity (a rate at which your heart rate is elevated but you can still carry out a conversation) for at least 250 minutes per week. Try walking for 50 minutes on five days of every week. For the fitter members of the audience, you can try vigorous cardiovascular exercise such as jogging for 20 minutes a day on three days of the week.

If you want to change the shape of your body or strengthen your muscles, try resistance training, or performing exercise against an opposing force such as water, free weights, weight machines, a theraband, a fit ball or even your own body weight. Resistance training increases the proportion of lean body tissue (muscle) in your body contributing to a higher metabolic rate, as well as improving your posture, flexibility and strength. If you are interested in starting a resistance training program, it's best to have a program designed by an Exercise Physiologist.

4. Continue to Set Goals

The goal of weight loss is change, whereas the goal of weight maintenance is no change. It can be hard to maintain your resolve when you don't see results for the effort you are putting in. To account for this, try setting other life goals that are better enjoyed at a lower weight (e.g. joining a community walking group or travelling).

5. Reward Yourself

When you were losing weight you were probably enjoying the associated rewards: compliments from friends, the excitement of fitting into smaller clothes and a dropping body weight. You'll have to devise a new set of rewards to keep you motivated during weight maintenance: treat yourself to a massage, buy a book or have a manicure or pedicure at the end of every month. You'll need to reward yourself for at least the first few years after weight loss.

6. Enlist Support

While you were losing weight it's likely that you received encouragement from family, friends and health professionals. Weight maintenance can be just as difficult as weight loss at times - and it can be a more isolated process. But it doesn't have to be that way. Tell the important people in your life that maintaining your healthy weight is important to you and that you'd like their support and encouragement for the long term.

7. Stay Vigilant

It's easy to become complacent when you achieve your weight loss goal. People sometimes fall into the trap of thinking, "I can have an extra scoop of chocolate ice cream - I've lost a lot of weight and I'm feeling really good." Just because you've lost weight it doesn't mean that extra calories don't add up anymore!

It's important to treat yourself from time to time, but it's also important to recognise when extra treats are creeping into your diet too often. By keeping a food diary (or just listing your treats on a notepad) you can identify how frequently you are indulging. You should consume no more than 2-3 treats per week and try to limit your treats to a 200 Calorie portion.

8. Be Organised

It's hard to manage your weight when the rest of your life is in chaos. Leave plenty of time to relax, sleep, shop for healthy foods, prepare healthy meals and exercise.

9. Maintain a Healthy Level of Self Esteem

Don't link how you feel about yourself to your weight. Be happy with your weight and proud of the weight loss that you have achieved.

10. Don't Use Food to Stabilise Your Moods

If you are feeling stressed or upset, find a non-food related way of calming yourself - go for a walk or call a friend.

Lastly, don't forget that weight maintenance can be just as challenging as weight loss (if not more so in the first two years). But it gets easier with time, and by following our advice you will be well on your way to success.
 

Hydration for Health and Performance

The human body can be broken down into two basic compartments – lean mass (i.e.. muscle, bone, tissue) and fat mass (i.e. essential fat in the brain, bone marrow, organs and storage fat).

• Lean mass is approximately 73% water
• A 1 to 2% dehydration level will not make you thirsty, but will negatively affect your physical and mental performance (i.e. poor stamina, poor concentration)
• The body can last up to six weeks without food, but it can last only one week without water

Water is essential to good health

• Water is a key component of blood, which carries nutrients and oxygen to all the cells of the body
• Water is a key medium for the body to remove waste products
• Water is used in many metabolic functions (i.e. energy production)
• Water is a vital component of tissue that helps protect the organs, joints, muscles etc
• Water is the lubricant for the brain and joints
• Water is vital in regulating body temperature
• Water helps to maintain skin health and appearance

How much water should you drink each day?

The answer depends on your body size and daily activity level. On average an adult will lose between 1 to 3 litres of water per day. Water is lost through urine and faeces, sweat and breathing.

This deficit is made up from moisture in the food that we eat and beverages we might drink. Some beverages like coffee or beer contain substances that cause a diuretic effect (i.e. caffeine, alcohol). These do not help to replace lost water. Therefore as a general rule of thumb it is a good idea to drink at least 2 litres of water each day in addition to other beverages.

This may seem like a lot at first, but over a few weeks your body alters its hormone levels and drinking the water will become easy. If you are exercising regularly you may need to drink more water to match your losses (i.e. increased sweating).

Dehydration

Dehydration occurs when the water content of the body is too low. This is easily fixed by increasing fluid intake. Symptoms of dehydration include headaches, lethargy, mood changes and slow responses, dry nasal passages, dry or cracked lips, dark-coloured urine, weakness, tiredness, confusion and hallucinations.

If you regularly don’t drink enough water there can be an increased risk of kidney stones and in women urinary tract infections. There is also limited evidence to suggest an increased risk of some cancers including bladder and colon.

Ways to incorporate water into your daily schedule

• Buy a bottle of water where you know the volume. That way it is easy to calculate how much water you have consumed throughout the day
• Buy a water bottle that comes with a sports cap so you can take it with you to any activity
• Half fill a water bottle and freeze it overnight. When you take it with you the next day, you can top it up and have cold water for several hours
• Have a 2 litre jug of water in the refrigerator and finish it by the end of each day
• When dining out, ask for a jug of water for the table
• Replace some of the coffee and tea you might normally drink during the day with a glass of water. Aim for no more than 4 caffeine containing drinks per day
• Form the habit of having water with lunch and dinner
• Add a slice of lemon or orange to water to give it a hint of flavour
• Using sports water is fine, but be careful, some of them are quite high in calories and they can be an expensive way of replacing your lost fluid
• Discuss your program with a doctor if you have high risk factors, or a known problem with your heart

Healthy & Happy New Year

Christmas is over...
  
...So where to from here?

Now that the silly season for 2011 has passed, we are faced with a new year ahead. At this point of the year it is a good idea to re-evaluate where we are at with our life plans. The New Year also gives us an opportunity to set New Year’s Resolutions. Ask yourself what do I want to achieve in 2012? This can be your ultimate target for the year and it forms the basis for setting smaller goals.

Re-setting goals

Think of your resolutions as new goals for the year. Set short-term goals to accompany your longer term goals.  A good way to approach this is to include goals that encompass a variety of aspects of your life:

• Extrinsic e.g. Eating habits, food choices, exercise, shopping, reading food labels, health outcomes, etc
• Intrinsic e.g. Comfort eating, stress management, self-esteem, negative thought patterns, assertiveness, etc

This ensures a thorough approach. Write down your goals and put them somewhere noticeable (eg. office / study / fridge / back of toilet door / etc) so that you are continuously aware of your target.

Remember to re-evaluate your goals along the way so that they are still relevant for your current situation. This also helps with motivation.

Some guidelines for setting goals include:

Keep it real - Make your plans realistic and achievable. Consider your lifestyle and how realistic your resolutions are.

Be specific - Set specific goals so that you know exactly what you are aiming to achieve and so you are able to measure your progress.

Plan - Think ahead and be prepared. This definitely applies to food and exercise - know what events or activities are coming up and re-arrange your original plan accordingly. Take a few minutes prior to the occasion to organise when you will have your meals and what you will have.

Planning is also important for anticipating potential obstacles that you may encounter along the way, and determining possible solutions early. This process is useful for minimising their impact or avoiding them all together.

Anticipate setbacks - Ok. So let’s say the Christmas / New Year break didn’t go exactly to plan. Don’t worry – it’s not the end of the world! We have a new year ahead of us remember! The important thing is to remain focused. Return to your normal routine with meals and exercise as quickly as possible and keep in mind that one meal or one day is not going to make a significant difference in the overall scheme of things.

Dealing with setbacks is part of the behaviour change process.  Don't get downhearted if you experience them; see them as an opportunity to learn about yourself instead. Avoid “all or nothing” thinking and learn to accept your mistakes and then move on.

Reward yourself - Develop a system of non-food related rewards for behaviours that support your goals. Don't wait until the very end - set milestones and reward yourself as you go.

Overall, take it easy, keep it real, and remember your goals and resolutions are an ongoing process, not an overnight transformation.

We hope you had an enjoyable Christmas and Happy New Year from the staff at WWMC!