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Recently on the social media platform LinkedIn I saw a post put up by someone who I believe was an orthopedic surgeon. He had on his post  an image of a patient’s spine after they had had spinal fusion surgery. This is where rods and screws - and usually bone grafts - are implanted around two or more bones of the spine to reinforce that structure. It’s a risky procedure, despite many brilliant advances in the technology, and requires quite a significant rehab phase. The cervical and lumbar sections of the spine are common surgical sites, as these parts of the back are more vulnerable to injury - the lumbar spine being the main load-bearing structure of the back, and the cervical spine being the most mobile and least supported structure of that spinal column. Outcomes for this surgery are usually pretty good. More often than not patients will see reductions in pain, if at the sake of mobility. However, spinal fusion can increase the risk of pain from future osteoarthritis in the spine. The lack of mobility at the fused site can increase the stress put on other parts of the spine, thus accelerating osteoarthritis. And the site of the surgery itself can also degenerate over time, increasing the risk of further structural degeneration. Spinal fusion should always be thought of as a last resort - when pain becomes intolerable, and other options have been exhausted. So, the image was attached to a comment by the surgeon. To paraphrase, he stated that kettlebell exercises and weightlifting were BAD for the spine, and he advised any and all people he encountered to ONLY ENGAGE IN AEROBIC EXERCISE. He noted that the image shown in his post was from an older man who was swinging kettlebells for health and fitness, who had gone on to have a serious injury, thus requiring a major spinal fusion. Again. Weightlifting bad. Cardio good. End of story.

Further reading: 

Fragala, M., et al. (2019) Resistance training for older adults: Position statement from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research 33(8):p 2019-2052, August. DOI: 10.1519/JSC.0000000000003230

Izquierdo, M., Merchant, R.A., Morley, J.E. et al. (2021) International exercise recommendations in older adults (ICFSR): Expert consensus guidelines. J Nutr Health Aging 25, 824–853. https://doi.org/10.1007/s12603-021-1665-8

Rodrigues, F., Domingos, C., Monteiro, D., & Morouço, P. (2022). A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. International Journal of Environmental Research and Public Health, 19(2), 874. https://doi.org/10.3390/ijerph19020874

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Episode 6 - The Clock is Ticking

Human psychology is a fascinating thing. The mind is the driver for all of our behaviour - it is our software driving our hardware. The mind gives us our sense of self, and allows us to utilise our intelligence. It projects our personality, and hides our self-perceived flaws. Our mind is sensitive to all manner of stimuli - physical, emotional, and environmental - and always refers to its memory bank stored within the many billions of neurons within the brain when executing behaviours, thoughts and feelings. It both helps and hinders us. It can be a driver of accomplishment, of ambition, or curiosity, but it can also sabotage us, it can be a prison that restricts us, that stunts us, that kills us. 

When I am dealing with a new client, with someone who is new to exercise, I can usually tell within the first minute of an assessment whether or not that person is fully committed to the idea of exercise. Not because I have any special paranormal gift, not because I am especially gifted in reading body language. It’s because of one simple question - for most people it’s probably the hardest of all questions to answer, but the manner of their answer determines a lot: How much time are you prepared to give to exercise? 

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Further reading:

Beresford, T.P. Psychological adaptive mechanisms: Ego defense recognition in practice and research. Oxford University Press USA. 2012. pp13-26. 

Prochaska, J.O. The transtheoretical model of health behaviour change. American Journal of Health Promotion. 1997; 12 (1): 38-48. https://doi.org/10.4278/0890-1171-12.1.38

Weber, M.F., et al. Cancer incidence and cancer death in relation to tobacco smoking in a population-based Australian cohort study. International Journal of Cancer. 2021 Sept 1; 149 (5): 1076-1088. DOI: 10.1002/ijc.33685

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When we think about the way that exercise trains energy systems, we classify strength training as a form of anaerobic training, that is, utilising an energy system that does not require oxygen. The anaerobic pathway uses glucose to convert to energy. This process produces molecules that the cells within our body use as what I like to call ‘fast energy’, and is fundamental to all eukaryotic cells. Those molecules are ATP - that’s adenosine triphosphate, the power source of all biological energy - pyruvate and NADH - that’s nicotinamide adenine dinucleotide plus hydrogen. I won’t get too caught up in the molecular processes, it’s all a bit of a mouthful, but if you’d like to know more about this process, cellular respiration, the Krebs or citric acid cycle, and more, I’ll include some links in the show notes. For now, just remember that glycolysis - the AN-aerobic part of our energy system - works without oxygen. The oxidative, or aerobic, energy system - or, as I like to call it, the ‘slow energy’ system - uses oxygen to help us metabolise carbohydrates and fats for energy. This is useful for lower energy demands over longer periods of time. Think about weightlifting versus marathon running. Weightlifting requires enormous amounts of ATP to execute the movement of large loads in very short time scales. Marathon running requires ATP but in (relatively) lower amounts, over a much longer period. Weightlifting is anaerobic, distance running is aerobic. Everything needs ATP, but it’s all a question of time…

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Ludyga, S., et al. Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: A meta-analysis. Psychophysiology. (24 August 2016). https://doi.org/10.1111/psyp.12736

Alabduladhem, T.O., Bordoni, B. Physiology, Krebs Cycle. National Library of Medicine. (Updated 23/11/2023.) https://www.ncbi.nlm.nih.gov/books/NBK556032/

Smeitink, J., van den Heuvel, L. & DiMauro, S. The genetics and pathology of oxidative phosphorylation. Nat Rev Genet 2, 342–352 (2001). https://doi.org/10.1038/35072063

Hood, D.A. Mechanisms of exercise-induced mitochondrial biogenesis in skeletal muscle. Applied Physiology, Nutrition, and Metabolism. (12 May 2009). https://doi.org/10.1139/H09-045

Poole, D.C., et al. The anaerobic threshold: 50+ years of controversy. The Journal of Physiology. Vol. 599, Issue 3. 2021. https://doi.org/10.1113/JP279963

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Before we get stuck into this, just a quick side note: you’ll hear me use the expressions ‘resistance training’ and ‘strength training’ throughout this episode. Although there are subtle differences between the two, the meaning is basically the same. I’ll probably expand on this idea a bit more in another episode, but for now, think of them as the same.

If we think about the ways we can train our body to improve fitness, health and function, it can pretty much be broken down into two main modes: resistance training, where we use load - or resistance - where we seek to increase muscular strength and size; and aerobic training - which most people refer to as ‘cardio’, in fact a better term would be ‘cardio-respiratory exercise’, where we use exercise to elevate heart and breathing rate to improve the body’s capacity to utilise oxygen as an energy source. Obviously, that’s a bit of a mouthful, so ‘cardio’ will do for now.

Strength training can be considered a form of anaerobic training, that is, where the body uses energy other than oxygen. This process uses a type of metabolism called glycolysis, and for now at least, all that we need to know is that this is the process where glucose is converted to energy. 

Fundamentally, what we are training when we exercise are energy systems - we are encouraging a certain kind of chemical reaction in our body. The more we train, the more efficient these processes become, and we increase our capacity to repeat these processes. This is adaptation.

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Further reading:

Chaput, J., et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: Summary of the evidence. (2020) https://doi.org/10.1186/s12966-020-01037-z

Nunes, P.R.P., et al. Effect of resistance training on muscular strength and indicators of abdominal adiposity, metabolic risk, and inflammation in postmenopausal women: Controlled and randomized clinical trial of efficacy of training volume. (2016) https://doi.org/10.1007/s11357-016-9901-6

Grgic, J., et al. Effect of resistance training frequency on gains in muscular strength: A systematic review and meta-analysis. (2018) https://doi.org/10.1007/s40279-018-0872-x

Gordon, B.R., et al. The effects of resistance training on anxiety: A meta-analysis and meta-regression analysis of randomized controlled trials. (2017) https://doi.org/10.1007/s40279-017-0769-0

Hilkens, L., et al. Social media, body image and resistance training: Creating the perfect 'me' with dietary supplements, anabolic steroids and SARM's. (2021) https://doi.org/10.1186/s40798-021-00371-1

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I remember when I was a kid back in the 1980s there was this magazine called Omni. It was a science magazine published in the US, but available on newsstands here in Australia. On almost every cover there’d be some reference to how people would live in the future. There’d usually be articles about longevity, cryopreservation, elixirs (or drugs) of youth, and futurism. I seem to recall that there was never any mention of future Type 2 diabetes, obesity epidemics or botox. There were often claims that researchers were only 10 years off from an immortality pill. That in the future there would be no death. That no one would die of cancer in the 21st century. That future society would be some kind of pre-forbidden fruit Garden of Eden, with humanity living in perfect harmony with each other and our planet. 

Fast forward to today and the obsession with youth - and maintaining it - continues. There are daily articles about how amazing exercise is at any age (who would have thought?), but also about the latest research for an exercise pill. Yep, that’s right, a single pill that is able to provoke the very same metabolic processes in our body that exercise does, all while sitting on the couch. The cosmetic surgery epidemic is now in full swing and accessible to all . We don’t think twice about injecting botulinum toxin into our skin, even when we are still in our 20s. We have certain cohorts of the population who are already considered to be of healthy weight insisting on prescriptions for semaglutides, just to get that more magnified look of thinness. Nor do we concern ourselves with potential side effects from disfiguring and invasive surgery to tighten, or ‘lift’ our facial skin. We continue to dabble with body modification surgery to our genitals, our trunks, our bottoms and our legs, all in the name of ‘maintaining’..? What? Youth? Beauty? Self-esteem?

Contact email address: [email protected]

Further reading:  

Jackson Fyfe linkedin: https://www.linkedin.com/in/jackson-fyfe-5a3a1410b/

The Weekly Exerciser: https://jacksonfyfe.kit.com/the-weekly-exerciser

Burden of Ageing Population data 

Australia: https://www.aph.gov.au/-/media/05_About_Parliament/54_Parliamentary_Depts/548_Parliamentary_Budget_Office/Reports/2018-19/02_2019_Australias_ageing_population/Australias_Ageing_Population_PDF.pdf?la=en&hash=97A05620F5D6DE87D021938A844A65BFC4B335A6#:~:text=Over%20the%20next%20decade%2C%20the,%2436%20billion%20by%202028%E2%80%9329.

USA: https://www.nia.nih.gov/about/aging-strategic-directions-research/goal-society-policy

https://www.census.gov/topics/population/older-aging.html

Europe: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Ageing_Europe_-_statistics_on_population_developments

Japan: https://www.imf.org/en/Publications/fandd/issues/2020/03/shrinkanomics-policy-lessons-from-japan-on-population-aging-schneid

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My name is Matt Cooper. I’m an accredited exercise physiologist, and this is Fitness and Function.

Before we get started, let me say that there are times when exercise is not recommended for certain populations. Any exercise program should be cleared by your doctor, and be planned and supervised by an exercise physiologist.

You might’ve heard the expression ‘exercise is medicine’. It’s used a lot by people like me - exercise physiologists - who work in the clinical space, where people who may have been diagnosed with particular pathologies use exercise to help improve health outcomes. People with type 2 diabetes, for example. Or people who are undergoing treatment for cancer. People who have significant loss of bone density. People who have had a brain injury. Pretty much any type of pathology or diagnosis can benefit from careful, individualized exercise.

Contact email: [email protected]

Further Reading:

Thijs Eijsvogels’ article tn JAMA:
https://jamanetwork.com/journals/jama/article-abstract/2468899

Excellent paper on exercise and cognition by Daniel Gallardo-Gomez et al.:      Optimal dose and type of exercise to improve cognitive function in older adults.

https://www.sciencedirect.com/science/article/pii/S1568163722000332?via%3Dihub

Terrific research on exercise and insulin sensitivity by Iaccarino, Franco & Morisco:

https://link.springer.com/article/10.1007/s12265-020-10057-w

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My name is Matt Cooper. I’m an accredited exercise physiologist, and this is Fitness and Function.

To start, I’d like to thank you for listening to this production. You’ve probably found this because of a search relating to exercise, health, fitness, training, or a myriad of other related searches. Welcome. I don’t advertise this podcast. I don’t have any sponsors. It’s made specifically for people like you, who have made the effort to take that first - or next - step in your health and fitness journey. 

The message is simple. Exercise is for everyone. We all deserve to be fit and healthy. It doesn’t matter where you are in your life, if you’ve been training for decades, if you’ve never raised a sweat on purpose, if you’ve been given a recent medical diagnosis, if you hate sports,  if you prefer Pilates or yoga to weighlifting and cardio, if you are 28 or 88 - remember: exercise is for everyone.

One of the hardest things a person can ever do, particularly if we are considering someone who has never exercised in their life, is to start an exercise program. Changing behaviour, even when we are faced with certain medical truths, is very difficult. We are, after all, creatures of habit. But with sufficient motivation, and with the right people guiding and encouraging you, it is possible. And change will come...

Contact email: [email protected]