Sunday, January 22, 2017

Exercise Can Reduce Inflammation

Let's go for a 20 minute walk
I've written before that just running 5-10 minutes daily at really slow speeds is enough to reduce your risk of dying from all causes and cardiovascular disease.

You will be very happy to know that just one bout of moderate exercise can act like an anti-inflammatory. This findings by researchers have encouraging implications for obesity and chronic "inflammatory diseases" like arthritis, fibromyalgia and other autoimmune diseases.

The study found that one 20- minute session of moderate treadmill exercise  can stimulate the immune system, producing an anti-inflammatory cellular response.

The researchers had 47 subjects walking on a treadmill at an intensity level that was adjusted based on their fitness levels. Blood was collected before and immediately after the session showed changes in inflammatory protein TNF, which produced an anti inflammatory cellular response throughout the body. (TNF is a key regulator of local and systemic inflammation that also boosts immune responses).

We all have inflammation occurring normally in our bodies as part of the body's immune response. It is how our bodies heal itself after an injury, defend itself against viruses and bacteria and also repairing damaged tissue. When the inflammation is chronic, it can lead to serious health issues.

Exercise is often taboo to patients with chronic inflammatory arthritis or fibromyalgia as they think it going to make their condition worse. But this study may contribute to developing new strategies for using exercise to treat patients who suffer from chronic inflammation.

I know what some of you must be thinking after reading this. Hmmm, after my hard training, I can probably do a short 20 minute workout to reduce inflammation and recover.

Well, if you ran hard for the past 3 days etc, then you need a real day off (yes that means no swimming, no cycling etc). You need to rest.


Dimitrov S, Hulteng E and Hong S (2016). Inflammation And Exercise: Inhibition Of Monocytic Intracellular TNF Production By Acute Exercise Via β2-adrenergic activation. Brain, Behaviour and Immunity.

Friday, January 13, 2017

The Weekend Warrior Phenomenon

Picture by Naval Surface Warriors from Flickr
We see a fair amount of "weekend warriors" in our clinics. By definition, a weekend warrior is a person who holds a regular 9-5 job and has a family to take care of on a daily basis. They are usually too busy to exercise on a week day so they try to cramp all their exercises on the week end.

In other words, these weekend warriors are compressing their total physical activity into one or two prolonged runs, bike sessions or a single vigorous basketball or football game each week.

We see them in our clinics because they are more likely to face a higher risk of sports-related injuries than people who exercise more often. This may be due to the fact that their sessions are more vigorous and are higher intensities compared to those who exercise more regularly.

However, published evidence from a large study of 63,591 adults showed that exercising even just once or twice per week  appears to be enough to significantly reduce all-cause mortality risk.

The risk of death from all causes was nearly 30 percent lower among weekend warrior adults compared to inactive adults. Risk of cardiovascular (or heart) death was 40 percent lower for weekend warriors while the risk of cancer death was 18 percent lower.

Among those who exercised regularly compared with the inactive group, risk of death from all causes were 35 percent, 41 percent for cardiovascular death and 21 percent for cancer death respectively.

As you can read, the researchers concluded that such fitness regimes (that are restricted to one or two days a week) can be almost as effective as those who require you to work out on a much more regular basis.

If you look at the stats more carefully, you'll see that the weekend warriors were mostly male and nearly half exercised only once a week. Almost 90 percent reported that their exercise occurred during vigorous sports like competitive running and cycling or team sports like football.

So even if you do not have the time to exercise in the week day, that single session you do on the weekend is gonna be of benefit too.And if you do get injured (hopefully you don't), you can come and get treated in our clinics.


O'Donovan G, I-Min Lee, Hamer M et al (2017). Association Of "Weekend Warrior" Amd Other Leisure Time Physical Activity Patterns With Risks For All-cause, Cardiovascular Disease, And Cancer Mortality. JAMA Int Med. Published online 9 Jan 2017.
 DOI: 10.1001/jamainternmed.2016.8014.

*Thanks to Rachel Wong for helping me with the photo above.

Friday, January 6, 2017

Another Pair Of Running Sandals To Try- Luna Sandals

Some time last month, I was contacted by Fred from Run Minimal to try a pair Luna of running sandals. I gave my size to Fred and received the sandals in the mail today.

This is my second pair of running sandals as previously I had received a pair of Earth Runners Huraches running sandals to try as well.

First impressions were that they feel more comfy than the Earth Runners. The Luna Mono Mgt which I received felt softer for sure (compared to the leather made Earth Runners).

Well, I don't think I can ever run as far and as fast as the Tarahumara Indians even if I'm wearing sandals modelled after what they use. But I'm happy to try them.

Let me have a few runs in them before I tell you how they feel.

Here are a couple more pictures

Monday, January 2, 2017

A Brand New Start

It's a brand new month (and a new year of course), and another month of temptations from the way I look at it.

Hot on the heels of Christmas and the new year is Chinese New Year on 28/1/17- more Chinese New Year goodies and feasts heading your way.

With all the rain we've got recently (and more to come according to weather forecasts), this is the not great for exercising outdoors. Not when there also seems to be endless events filling your calendar with school re opening for the children and work etc.

I'll try to take all this as motivation to keep running (cycling, going to the gym etc, fill in your favourite exercise).

Need some "me" time in between. I'll go for a run. Want to eat some "bak kwa"? Go for a run. Need to kick start your exercise routine? You got it. Go for a run (or any exercise of your choice).

Don't fret if you miss a few runs this month, do go out and exercise when you can. Your body will definitely thank you for it.

Have a great 2017.

Friday, December 23, 2016

If Only You Know The Power Of Sleep ....

The power of sleep
While I was still working at the Singapore Sports Council or SSC (now known as the Singapore Institute of Sport or SSI) I used to travel a lot with the Singapore badminton players while they were competing or training overseas.

And no matter where the badminton players were training or competing, their normal routine would be training in the morning, break for lunch and there would always be a nap after lunch before training again. Even our national table tennis players took daily naps when they were not out buying eggs (okay I'm just kidding). No disrespect meant!

Why am I writing about sleep here? You and I know that a lack of sleep can lead to negative consequences. It can affect your mood, cognitive function and physical performance. Few studies though have looked at the opposite - the effects that sleep extension can have on performance.

The American National Sleep Foundation recommends 7-9 hours of sleep a night for adults for general health and well being. But a study on Stanford basketball players by researchers Cheri Mah and colleagues showed that with 5-7 weeks of sleep extension, i.e. going to bed earlier and waking later, subjects had improved basketball performance, reaction time and running speed.

The researchers concluded that "extended sleep beyond one's habitual nightly sleep likely contributes to improved athletic performance."

As it is, most of us will find it difficult (myself included) to find more time to sleep. Our smart phones, the iPad, Netflix etc are big distractions. Yes, I have to stay up writing this so you can read it. Well, I'm not racing anymore.

Many of you will focus on improving your performance by training harder and smarter, but those improvements become smaller and more difficult to obtain after a while. Your fellow competitors will likely swim/ bike/ run similar intervals in addition to hitting the weights room etc. It all comes to to all the fine details. Some of these small gains (like sleep extension) are found outside of aerobic and interval training.

It's probably easier to change your bedtime to get more sleep by gradually going to sleep earlier. Try to go 15 to 30 minutes earlier each night to find a good time for yourself.

Sleeping in never happens for my wife and I, our boys are up by 6 am or earlier most mornings. If you can sleep in good for you.

I remember attending a meeting prior to the 2004 Athens Olympics where the then Director of High Performance, SSC was questioning the then CEO of Singapore Badminton Association (SBA) why the Singapore badminton players needed naps when they could be working part time or studying in between training as what many of the elite athletes at the Australian Institute of Sports do.

Then CEO of SBA's reply was if it (naps) has the potential to impact performance in a positive manner, then we try to take care of it.

In the picture below you see me more excited than Ronald Susilo after he defeated Lin Dan in the 1st round at the 2004 Athens Olympics.

That's how we should help our athletes.


Mah CD, Mah KE et al (2011). The Effects Of Sleep Extension On The Athletic Performance Of Collegiate Basketball Players. Sleep. 34(7): 943-950. DOI: 10.5665/sleep.1132

I really like this picture I took from a Star Wars book - Goodnight Darth Vader which I bought for my son by Jeffrey Brown.

Sunday, December 18, 2016

Which Calf Is Bigger?

Notice any difference in the picture above? If you look closely, you'll notice that the left calf is slightly bigger than the right. Upon palpation my patient's left calf does feel more "meaty" compared to his right.

This is surprising as my patient says that his right leg is his dominant leg. Usually the dominant leg is bigger and stronger than the non dominant leg.

Now, this patient, who is an ultra marathoner came in to see me yesterday after a 35 km training run in the morning. He said that his right calf muscle often cramps after about 35 km.

Even after an easy run, his right calf and hamstrings often feel more tired and fatigued compared to his left. He also felt that it required more effort to bend his left knee compared to his right.

My patient also does not have any numbness, pins and needles down his right leg or other neurological signs. After checking his back as well, I explained to my patient that the reason for his muscle cramping in his right calf muscle is simply due to muscular fatigue.

Since his left calf is bigger, it will also be stronger than his right calf. This means that after running a certain distance his right calf will work harder than the left calf and will fatigue faster too.

I explained that muscle cramping is not due to sodium (or salt) loss, dehydration, electrolyte or fluid loss. I've explained this in a bit more detail before in another post, have a read here please if you're keen.

We then discussed how he could do some isolated (right) leg training to make his right calf stronger to avoid cramping eventually.

Here in his case, size does matter.


Schwellnus MP, Nichol J, Laubscher T and Noakes T. (2004). Serum Electrolytes Concentrations And Hydration Status Are Not Associated With Exercise Associated Muscle Cramping (EAMC) In Distance Runners. BJSM. 38: 488-492. DOI: 10.1136/bjsm.2003.007021.

Saturday, December 10, 2016

Last Floss Band Course ....

... for this year.

I was informed earlier by Jane today that this is the 6th Floss Band course I've done for the year. Wow, I haven't really been keeping count and didn't realise we've done so many thus far. This I must say though, the year has really flown by. It's 3 weeks to the end of the year!

Well, one thing remained constant. We had a full house again today. There were lots of physiotherapists (from SGH and Khoo Teck Puat Hospital) and many physiotherapy students too among those who signed up. I always enjoy having fellow physiotherapists around to share and bounce ideas.
Getting to know the participants
Asking Jensen to demo for a change
Bert having a go 
I'm the winner!
 Jacqui (Her Lift's gym) and her dislocated shoulder ....
Jane, Danny, Amy and Jerome came really early for lunch first and then got everything ready when I was still seeing patients. Really appreciate their help in setting up the place and also packing up when we were done. Please contact them at Sanctband Singapore for the next Floss Band course.

A big thank you to everyone who came too, hope everyone learnt something useful and can implement in your own area of work.

It was nice seeing Ang Hong again today too. She was my relief form teacher and taught me Biology when I was 15 years young when my form teacher went on medical leave for a few months. She was also one of the first few female triathletes I knew back then.

And yes, this is the last Floss Band course for this year, but there will be more next year. Stay tuned.

*Thanks to Jane Fong and Danny Ho for the pictures.