Unmentionables

We probably also at this time go to the lavatory. Even here there is a right and a wrong way.

Now you are probably going to say that I am going too far. After all, we have all been peeing and other things quite successfully all our lives. We learned these things before we could walk! The woman, and maybe also the man, will sit down. Be sure to sit down using your legs alone. Do not support yourself with your hands and try to sit slowly, feeling your leg muscles work. Don’t just flop down!

However, even if the man only stands there he can draw in his lower stomach muscles and release them several times and alternately close the cheeks of his bottom muscles several times (In later years this can help the flow of water). For the woman this is far more important. There are three groups of muscles which are often neglected. They are the rectal muscles, the vaginal muscles (particularly in need of exercise after a birth and an important sexual asset) and the urethral muscles. They should all be exercised several times when one is in a sitting position by concentrating on each group and tensing them several times and relaxing again

It is important at this point to do a minor exercise: hen we are passing water, it is very good to practise stopping the flow several times. Many of you will say this is ridiculous but there are other, older people, who sincerely wished they had done this more often. It is essential to keep control also of such muscles!

Teething

While the woman showers, let us imagine that the man cleans his teeth.

Even teeth cleaning is a form of exercise. Take your time, it’s not enough to change the early morning taste to that of some expensive toothpaste. Keep your tummy in and be aware of the muscles in your arms working. With time you will begin to identify each muscle as it works.

Then comes the massaging of your mouth with the rinsing water. This helps to keep the flexibility and vitality in your cheeks. Do it strongly, moving the water energetically around inside your mouth.

If you have a back problem, do not stand in a stooped position over the wash basin for any length of time. Bend your knees a little to get closer or support yourself with one hand on the basin (be sure it can stand your weight!)

Water ballet

In the shower the woman is now doing her private ballet.

If you have ever done aerobics or even watched them you will see that many of the flowing movements done in such exercises are a variation of the movements we do in the shower both washing and drying ourselves. Of course the breathing part of aerobics is missing but the movements remain the same and regular deep breathing is still essential.

We must be sure to stretch the arms out when we wash each one keeping the arms as straight as possible. As we wash our feet we must bow down by putting our bottom out at the back and keeping each foot a small step in front of the other. Now, in standing up, try to straighten the legs as far as you can before raising your body.

If you suffer any degree of back pain do not bend down like this. Rather rest your bottom against the wall and bend the leg up so you can reach each foot.

The floor of most showers are really booby traps — seeming to be specially constructed to cause many injuries. Be sure you have a non slip floor or secure floor mat.

As we wash our backs we can pull in our tummies and move the shoulders consciously and rhythmically.

As we stand in the shower and wet our faces and hair we can do the shoulder shrug! Raise your shoulders high and then drop them slowly down three or four times in a relaxed way. Do not drop them too suddenly as this can jerk your neck.

Now we begin to dry ourselves. This can really become a form of dance like the Chinese do with their flag-scarves or the disciples of Isadore Duncan in their natural Greek dancing.

You may feel that now again I exaggerate and, particularly if you tend toward a lower blood pressure, you may feel that the last thing in the world you want to think about is any form of dancing at a time when the day, with all its problems, is beginning. But this is the whole point of this programme. You may not feel like dancing and you may not feel like exercising – but you have to get dried after your shower! So we start by drying our hair (if you have washed it with the shower) elbows high and a brisk backward and forward movement from the elbows out.

Then we take the towel with one hand at each end and slowly dry our backs by extending each arm fully as we move the towel across our bodies.

To dry the front of our bodies, we move the towel in a similar way as with our backs, starting with our thighs and working up. Only when we come to the chest do we change to single handed up and down motions again, here keeping our tummy pressed in.

The lower legs and feet are dried in the same way as they were washed.

Once again, if you have back pains rather sit down on a bench or stool to dry the feet and lower legs.

Continuous Calisthenics

Survey results repeatedly indicate that calisthenics is one of the top two or three participant activities performed. Calisthenics, exercises such as the crunch and push-ups, are designed to build flexibility, strength, or muscular endurance in specific muscle groups. Even though most calisthenics are aerobic, they are often done intermittently. That is, calisthenic exercises are done a few at a time followed by a rest period. This type of calisthenics can build flexibility, strength, and muscular endurance, but does little for cardiovascular fitness or fat control.

Continuous calisthenics, or calisthenics that are done without stopping or with walking, jogging, rope jumping, or some other aerobic activity performed during the rest period, can develop virtually all health- related aspects of physical fitness. Fitness pioneer Dr. Thomas Cureton (1965) long advocated the use of continuous calisthenics, or what he referred to as “continuous rhythmical endurance exercise.” Almost everyone can plan a continuous calisthenic program by selecting exercises for each fitness part that will elevate the heart rate to the optimal level and sustain this intensity an adequate length of time. As is the case with CRT, it is essential that resting between exercises be kept to a minimum. Continuous calisthenics can be done individually, but is also excellent for group use.

Cross-Country Skiing

In Europe, cross-country skiing is one of the most popular aerobic activities. Of course, this sport requires snow and a certain amount of specialized equipment. For those who can cross-country ski on a regular basis, studies show that it is one of the most effective types of cardiovascular fitness exercise.

Dance Aerobics

One of the fastest growing aerobic activities is dance aerobics. The activity was first popularized by Jackie Sorensen in the 1970s as “aerobic dance.” Since then, the activity has been promoted as rhythmic aerobics, jazzercize, and dancercize to note but a few of the popular names. Dance aerobics is quite similar to continuous calisthenics though it does include dance steps as well as calisthenic exercises done to music. Initially, dance aerobics was done principally by women, but recently it has become popular with men. Current activity polls show that it is one of the most popular types of exercise in North America.

In most cases, dance aerobics consists of a pre- planned or choreographed series of dance steps and exercises done to music. Jogging, skipping, hopping, and other cardiovascular activities are also included in many routines. A routine is preceded by a warm-up and followed by a cool-down. Depending on the program, the warm-up and cool-down may be separate exercises done before the actual dance session, or may be part of the routine itself. A single routine may last from three to fifteen minutes. If routines are short, they may be done one after another with brief rest periods in between.

A regular dance aerobic program is safe for most people if the following guidelines are adhered to.

1. Wear proper shoes and exercise on a surface that “gives,” rather than on a very hard floor (i.e., concrete).
2. Do static stretching before and after dance aerobics. Avoid high kicks and other exercises that cause extensive ballistic stretching until you have developed good levels of flexibility (see Concept 8).
3. Make sure that the routine you select, whether done with a live instructor or video instructor, is suited to your current level of fitness. If the routine becomes too vigorous, walk or jog in place instead of trying to keep up. Discontinuing arm movements can also make the exercise easier. If necessary, stop and rest.
4. Consider exercising with others of similar fitness so that routines can be chosen to meet the needs of all group members.
5. Like jogging and other forms of aerobic exercise, it is recommended that you not perform the activity seven days a week. Taking off at least one or two days a week will lessen the risk of injury.
6. When an injury does occur, start slowly upon your return to exercise. Compulsive aerobic dancers may create problems for themselves by trying to dance too soon after an injury. Low impact dance aerobics may be a good way to resume exercise after an injury.
7. Avoid contraindicated exercises that are a part of some prechoreographed routines (See Concept 16).
8. Avoid landing on or supporting the weight on the balls of the feet. This can result in lower leg problems such as shin splints or calf pain.
9. Avoid competing or trying to perform kicks or other dance steps that are beyond your fitness capabilities.. Injuries can result if you overextend yourself to prove you can do what others do.
10. You may want to create your own routines to make sure they meet your own personal needs.

An easy dance aerobic routine is presented in Lab 7C to introduce you to this activity. If you choose dance aerobics as part of your exercise program, you can select more difficult routines. In general, dance aerobics is most enjoyable when done to music. However, when you are learning you may want to perform the routine to a drumbeat, a metronome, or a verbal count. Sometimes dance aerobic routines are learned to a count and then done to music.

One problem with dance aerobics is that it is a preplanned exercise program, therefore, it requires all participants to do the same activity regardless of their fitness or activity levels. A vigorous routine could cause unfit people to overextend themselves, whereas an easy routine may not result in fitness gains for those who are already quite fit. Also, some dance aerobic routines have been known to include contraindicated exercises.

Taken as a whole, the review posits that a range of exercise regimens may have a therapeutic role in relation to a number of psychological disorders. At the same time, the research evidence to date does not provide unqualified support for the efficacy of exercise, and enthusiasm must be tempered with an acknowledgment of the dangers associated with exercise. Certainly, the literature does not indicate that exercise should be treated as a panacea or snake-oil for psychological malaise of whatever kind. Instead, it does suggest that different forms of physical exercise may be palliative in relation to particular conditions.

Whether that exercise be non-aerobic, aerobic or anaerobic, of short, medium or long term duration, competitive or non-competitive, team or individual, single or multi-session, is not always clear but there are suggestions that different psychological conditions respond differentially to alternative exercise regimens and recent attempts to develop taxonomies of physical activity and mental health may offer a realistic starting point in attempting to draw together some of the diverse recommendations.

As to explanations of why more definitive conclusions cannot be reached at this stage, then three factors stand out.

Firstly, the research base remains thin and primary data are not extensive. To overcome this problem there is a need for large scale, multidimensional experimental programmes, associated with multivariate analyses of covariance to clarify the complexities of the relationships between physical exercise and psychological health.

Secondly, it is not yet clear how psychological and physiological processes and functions interact in the determination of outcomes. The grey areas of confusion are most apparent in the psycho- physiological responses such as stress reactivity. Indeed, it could be that Cartesian notions of mind-body dualism continue to drive a wedge between the physiological and the psychological. Greater collaboration between the two disciplines would undoubtedly help.

Thirdly, and in a related vein, the primary mechanisms that underlie the relation between exercise and psychological wellbeing remain poorly understood. It would also be fair to say that a great deal of the literature remains descriptive or atheoretical. That is, it is able to describe how exercise and psychological wellbeing interact but it has shied away from asking or exploring why the relationship is as it is. Here psychophysiologists have led the field in attempting to provide explanations, including consideration of the influence of catecholamines, body temperature and endorphins. Psychosocially, issues relating to lifestyle, boredom and time-out have also been implicated but how, when and where each factor may be involved is once more a matter for debate. In all likelihood, given the complexities of the relation between exercise and wellbeing outlined above, it is unlikely that any single theory, model or hypothesis will suffice. Instead, multiple perspectives must be used.

Finally, it is also important to recognise the difficulties associated with adherence to exercise regimens. No matter how beneficial such schemes may be, if there is no willingness to exercise voluntarily then the practical utility of exercise is diminished dramatically. Hence recommendations must be put in the context of adherence research. For example, it has been maintained that only 10% of the population is committed to physical activity; 20% will start but not adhere to exercise; 40% will promise to start an exercise programme; 20% need to be convinced to participate in exercise and 10% are not interested in any form of organised or recommended activity. Such research highlights the deep rooted resistance to taking exercise among large sections of the population, sections that lead essentially sedentary lives, with inactivity rates of 25% and 15% recently recorded for American and British populations respectively, and with the likelihood of even higher rates among those with psychological problems.

In exploring the population’s apparent resistance to physical activity, a recent review has considered some of the theoretical models utilised in designing exercise interventions. As with the arguments advanced earlier in relation to explanations for exercise induced mental health benefits, they conclude that no individual model can sufficiently explain exercise behaviour or how best to intervene. However, in proposing future directions, it is interesting to note that the authors draw on largely psychological components as offering promise for encouraging greater participation. Specific factors outlined include enhancing self efficacy, increasing enjoyment of the activity, enhancing social support and promoting the perceived benefits of exercise. While it is not within the scope of this chapter to explore public policy initiatives for exercise promotion further, we hope that a comprehensive review of the literature pertaining to exercise and mental health would assist in any future developments.

All these arguments aside, general practitioners remain the ideal mechanism by which to promote exercise regimens. At the same time, recent surveys suggest that despite a generally favourable reception from general practitioners themselves, their role is not without problems, particularly in relation to the referral system, their lack of knowledge of exercise recommendations, and difficulty in evaluating community health promotion schemes. Simultaneously, exercise by prescription schemes are gaining in popularity; a newspaper article reported on one fundholding
general practitioner in Warrington, Cheshire, who has invested practice funds in opening up a medical centre gym for his patients.

This level of enthusiasm for exercise promotion makes it all the more important that researchers, physicians and exercise practitioners continue to work together to develop sound guidelines. This will be of practical benefit to the patient and will also advance our understanding of the interplay between exercise and wellbeing, allowing us to develop a firm foundation from which to make recommendations in the years to come. General recommendations are now commonly accepted as to the somatic benefits which accrue from exercise; the relation between exercise, fitness and general cognitive functioning is now also receiving closer scrutiny.’ Alongside this research activity, now is the time to develop more specific guidelines relating to psychological benefits of exercise taking due cognisance of psychoooiaial variables—for example, sex, age, previous mental health, environment—and recognising that the picture which will be revealed will not be as unidimensional as previous work may have implied.

Several measures have been suggested to reduce the negative effects of circadian rhythm desynchronisation, although treatment of shift workers, competitive athletes, and simple international travellers is quite different. The measures include preadaptation, meal timing and composition, phototherapy, and chronobiotic drugs.

1. Preadaptation

Theoretically, the negative effects of jet lag can be reduced by changing bedtime for several days before a transcontinental journey, remembering that sleep changes should correspond to the direction of travel (eastward or westward). Adaptation should be disturbed by behaviour that anchors the circadian rhythms to the previous phase for example, taking prolonged naps at the new destination. To lock the circadian rhythms to home time, at least 4 hours sleep taken within the window of normal sleep in the home time zone are needed. However, in practice, preadaptation is superfluous when people are travelling west, arriving late, and only a few hours phase advance can be recommended before travelling east. Moreover, because of the difficulty of manipulating other synchronising factors (light, social constraints), preadjusting the sleep-wake cycles is largely ineffective.

2. Timing and composition of meals

Certain food constituents seem to have effects on rhythm adjustment. A high carbohydrate low protein meal, facilitating brain uptake of tryptophan and its conversion to serotonin, may induce drowsiness and sleep. On the other hand, a high protein low carbohydrate meal, which enhances tyrosine uptake and convertsion to noradrenaline, increases levels of arousal. Moreover, programmed use of theophylline and caffeine can speed rhythm readaptation and help to raise arousal levels in the morning. However, although studies on military personnel consuming such diets reported reduced sleep disturbance and less subjective feelings of fatigue in the days immediately after a transmeridian flight compared with controls, a clear link between diet and jet lag has not been formally established.

3. Phototherapy

When an individuals circadian phase is known, it is possible to act on the central clock mechanism, advancing or delaying the clock itself. Exposure to bright light, with specified intensity, duration, and timing, may advance or delay the phase of some human circadian rhythms. Most available studies have used jet lag simulations, so the subjects are not exposed to the full complement of time cues normally encountered by transmeridian travellers; this has been reviewed by Boulos et al.

Two studies have investigated the effects of light treatment on sleep patterns after flights. In the former, 19 subjects returning to the United States from Oriental or South Pacific localities (advance shifts of 6.5 to 10 hours) were instructed to expose themselves to either bright white light (2000 lux) or dim red light (<100 lux) for 2 or 3 hours on awakening in the morning for 3 days.” No differences were found between the group means for any sleep measure, but exposure to bright light early in the morning appeared to facilitate the consolidation of sleep into a single night-time episode.

In the latter, four subjects were polysomnographically recorded before and after a flight from Tokyo to San Francisco (8 hour advance).” In San Francisco, the subjects were requested to go bed at 2300 hours and wake up by 1000 hours and were exposed for 3 consecutive days to either bright ( > 3000 lux) or dim ( <500 lux) light for 3 hours starting at 1100 hours (0300 hours Tokyo time). The bright light treatment seemed to be effective in accelerating circadian re-entrainment.

However, the sparse number of field studies and the small sample population considered do not yet allow a clear judgment on the beneficial effect of bright light treatment for jet lag.61 In fact, the Consensus Report for Light Treatment for Sleep Disorders concluded that “much remains to be learned before procedures can be developed that are at once effective, reliable, and practical. For this to happen, optimal combinations of several light exposure parameters must be first defined and tailored to specific flight situations”.

4. Chronobiotic drugs

Chronobiotic drugs are drugs that specifically affect some aspects of biological time structure, but they must be administered at the right time of the day. In the past few years, several putative chronobiotic drugs have been evaluated—for example, barbiturates,62 short-acting benzodiazepines, serotonin-depleting agents,” and corticosteroids, with unsatisfactory or inconclusive results.

The pineal hormone melatonin (N-acetyl-5-methoxytryptamine) is a very interesting chronomodulating substance. It is normally secreted at night and in animals serves to transmit information about the light-dark cycle to the body.” However, melatonin acts in a highly pleiotropic fashion, also eliciting secondary humoral immunological responses for example, via interleukin-4 and other cytokines or acting as a powerful radical scavenger. The first reported administration of melatonin” induced a mild sedative effect, which was initially considered to be a pharmacological side effect. In fact, the hypnotic effect of melatonin is considered to be an integral part of its physiological action.

In an early study with polysomnography, intravenous infusion of melatonin before bedtime was associated with significantly increased sedation, reduced psychomotor activity, and shortened sleep-onset latency. A recent study on healthy volunteers provided further evidence that nocturnal melatonin secretion may be involved in sleep onset and that exogenous melatonin may be useful in treating insomnia. Low oral doses of melatonin, just enough to increase serum melatonin concentrations to levels normally occurring at night, produce hypnotic effects when given in the evening. Moreover, in humans, melatonin is likely to be an effective hypnotic agent to combat sleep disruption associated with increased temperature due to low circulating melatonin concentrations, and it may also improve sleep disruption caused by drugs that interfere with melatonin production—for example, blockers and benzodiazepines. Melatonin has been utilised for treatment of jet lag induced rhythm disturbances.

In an early study reporting its use in transmeridian travellers, Arendt et al. administered melatonin to 17 subjects over a period of 14 days after a westward flight from London to San Francisco. Compared with placebo, Melatonin significantly reduced the negative feelings of jet lag and increased subjective alertness. Moreover, treated subjects also reported significantly reduced sleep onset latency and improved sleep quality, and endogenous melatonin and cortisol rhythms resynchronised more rapidly than in those consuming a placebo.

In another study, 20 volunteers with experience in transcontinentsal flights were pretreated with melatonin (5 mg, orally) for three days before the flight, during the flight, and for 3 days after arrival at their destination. The subjects pretreated with melatonin, compared with those taking placebo, reported significantly reduced feelings of jet lag and less time to establish a normal sleep pattern reaching a “normal energy level” earlier than the controls and reporting lower levels of tiredness during the day. Nickelsen et al. administered 5 mg of melatonin or placebo at bedtime with no treatment before the flight in a cross over design.

An accelerated adaptation of cortisol and a consistent, though non-significant improvement of subjective jet lag with melatonin both westward and eastward were found. A controlled double blind trial with melatonin was performed in healthy volunteers flying between North America and France selected for their sensitivity to eastward jet lag. The protocol was simple, as one daily capsule of melatonin was administered on the day of return and the three consecutive evenings thereafter. A significant difference in self rating for global treatment efficacy, morning fatigue, and evening sleepiness was found in the melatonin compared with placebo group.

Ana study investigated the efficacy of oral melatonin in alleviating jet lag in flight crew after a series of international flights and the opt time for consumption; it was shown that benefits are especially likely to occur when melatonin is consumed after arrival. Subjects taking melatonin for 5 days at home after the return flight showed a more rapid recovery of energy and alertness than those to. melatonin from 1 day before departure. It has been reported the amount and the direction of the phase shift depends on time of melatonin ingestion: evening administration advances body clock and morning administration delays it.

Long term suppression of serum testosterone associated with exercise may result from decreased production rates, decreased protein binding or increased clearance. Of theses, the most likely mechanism is decreased testosterone production arising from either intrinsic failure of the testis to maintain adequate steroid biosynthesis perhaps due to testicular microtrauma and temperature increase’ or from central dysfunction in the HPG axis. The latteris supported by reports of decreases in LH pulse amplitude” and frequency’ as well as changes in pituitary responses to hypothalamic stimulation by exogenous GnRH in male athletes. In addition, factors may interact with the HPG axis including dietary intake”‘” and raised concentrations of stress related hormones.

Skeletal effects of lowered testosterone concentrations in male athletes

In female athletes menstrual disturbances have been found in association with lower bone density particularly at trabecular sites.Furthermore, stress fractures seem to be more common in women with amenorrhoea or oligomenorrhoea with a relative risk that is between two to four times greater than that of their eumenorrhoeic counterparts. There are few studies investigating the relation of testosterone levels to bone density and stress fracture risk in young male athletes. A recent case report described the clinical features of a 29-year-old male distance runner who presented with a pelvic stress fracture, greatly decreased bone density and symptomatic hypogonadotropic hypogonadism.” Using this case as an index, the authors hypothesised that exercise- induced hypogonadotropic hypogonadism could be identified in male athletes by the presence of one or more specific risk factors which included the presence of sexual dysfunction, a history of fracture, and the initiation of endurance exercise before age 18 Years.

They compared concentrations of free testosterone and luteinising hormone in 15 male runners with one or more of the above risk factors and 13 runners with none of the risk factors. Only one of the runners in the first group was identified as having primary hypogonadism and there was no significant difference between groups for hormone concentrations. Bone density, however, was not measured in these runners and correlated with testosterone concentrations. From a clinical perspective, it is important to clarify that although some male athletes do present With reduced testosterone concentrations, these concentrations are generally still within the normal range for adult men. Therefore, detrimental effects on bone density may not be as dramatic as those described for women with athletic amenorrhoea in whom oestradiol concentrations are well below normal.

Several studies have reported lower bone density in male runners than in non-runners or those running shorter distances. Male distance runners, averaging 92 km/week, were found to have 9.7% lower bone density at the lumbar spine compared with a group of non-runners. No differences in bone density were found at the radial or tibial shafts. Although hormonal status was not measured, the authors speculated that lowered testosterone concentrations may have played a part in explaining their results. Another study also reported negative correlations between running distance and lumbar spine, proximal femur and total body bone density in male runners. However, it was unable to show correlations between running distance and either serum total testosterone concentration or the free testosterone index (ratio between total testosterone and SHBG). The authors therefore suggested that the observed osteopenia associated with increased running distance—was independent of male sex hormones.

MacDougall et al. compared 22 sedentary men with 53 male runners divided into five groups on the basis of their weekly running distance. They showed that bone density of the trunk tended to be lower in those who ran more than 64 km (40 miles) per week while tibial bone density was greater in those who ran 24 to 32 km (15 to 20 miles) per week and tended to be lower in those who ran further than this. Nevertheless, total testosterone concentrations were within the normal range for the runners and did not differ from the controls.

Male triathletes were found to have similar bone density at the spine as a group of sedentary men, whereas male rowers had significantly higher spinal bone density. Although total serum testosterone concentrations of all groups fell within the normal range, triathletes had significantly lower concentrations than the controls. The authors claimed that the lower testosterone in the triathletes may have negated any positive skeletal effects arising from their higher levels of exercise. However, this cannot be stated conclusively without comparing the bone density of groups of triathletes with high and low testosterone concentrations. It is possible that some other factor common to triathlete training is affecting bone density independently of testosterone concentrations.

The results of these limited studies have failed to establish a relation between lowered circulating testosterone levels and osteopenia in male athletes. However, there are several methodological issues which should be considered. Only one study included assessment of SHBG in addition to total serum testosterone to give an indication of the amount of free testosterone. As SHBG is the biologically active portion, levels of this fraction may be more relevant to skeletal health. Furthermore, none measured dihydrotestosterone, an active metabolite of testosterone which has a greater anabolic effect. Most studies used single sampling procedures at differing times of the day which may not necessarily provide a true representation of the hormonal concentrations. Radioimmunoassays were used to measure testosterone and while these indicate the immunological activity of the hormone they do not necessarily reflect the biological activity. This depends not only on hormonal concentrations but also on receptor availability and sensitivity within the subject. It is possible that some male athletes have reduced biological activity of testosterone despite normal circulating concentrations and this may lead to bone loss.