Dr. Shukairy, MD

07/28/2022

Strength for Life.

The last component of exercise that I would like to highlight here in addition to cardiovascular exercise and mobility exercise is strength training. Strength is the most critical aspect of how we interact with the physical world. If you think about it, most things that we do in our daily lives involve some degree of strength. We pull weeds, pick up a bag of dog food, push a lawnmower over the grass, etc. All of these acts involve physical strength.

The data and research suggest that as we age our strength gradually declines. It declines even faster when we get sick and therefore are immobilized.

Strength is the third and perhaps the most important pillar of this exercise framework we've been discussing. It is often the most neglected. While people often talk about “exercising” as a necessary activity most commonly they are referring to cardiovascular exercise, or perhaps mobility training. Strength training is rarely emphasized enough.

This is even more critical for older folks. As we age beyond our 50s come up our strength declines precipitously. The only way to slow down that decline and maintain muscle mass is to engage in strength training on a regular basis.

07/12/2022

The critical importance of mobility

When it comes to exercise, an often neglected aspect is the importance of mobility. A person's mobility is directly linked to the range of motion of their joints and spine. As any of us may have experienced when we've been bedridden for a few days, we have a lot more aches and pains throughout our bodies, especially as we advance in our years. Similarly, when we do not use our joints the way that they were designed to be used whether that be our shoulders, elbows, hands, knees, hips, or ankles, then the mobility of that joint is going to restrict over time. Furthermore, as we age our joints become more arthritic, and as they become more arthritic, we also begin to lose some of the range of motion of our joints. This affects our spines as well. The spine is uniquely designed with a disc, that serves as a cushion between the bones and for set joints in the back of the spine that allow for translation, leading to the ability to flex and extend our spines, particularly in the lumbar and cervical areas.

As a result of these processes, whether it is arthritis and aging of the joints or the lack of the use of the normal range of motion of our joints, we begin to have restrictions on our mobility as we age. The restriction of mobility in and of itself can lead to significant disability. It can lead to the onset of pain with certain types of motion. It can lead to the onset of a deformity in the alignment of our spines, for example. And therefore, it's an important principle of exercise to try and restore as much as possible the range of motion of our joints.

Any of us who have been through a bout of physical therapy can also attest to the importance of mobility exercises in restoring function. A lot of times the therapist is particularly focused on restoring the motion of the knee for example after a knee replacement. Because most studies show that if the knee is not utilized properly after knee replacement surgery, the potential benefit of the surgery is lost in terms of restoring the range of motion.

As a result of all of this, I've described above, range of motion exercises in which we could include dynamic and static stretching exercises are essential parts of maintaining a healthy lifestyle and the ability to do whatever it is we're inspired to do. Whether for some of us that means engaging in Tai Chi, Pilates, and yoga. or simply stretching before or after a basketball game, range of motion exercises should be utilized as a way to improve one's mobility, especially as we advance in our years.

06/04/2022

EAT Part 2 - Cardiovascular training

In EAT part one, we explored the necessity of exercise as a part of improving one's health and enhancing the prospects for good health toward the end of one's life. Now let's take a closer look at cardiovascular training.

As I briefly discussed last time, cardiovascular training as I define it as anything that involves the elevation of one's heart rate, and cardiac output. This can vary greatly from person to person. Some people can walk a mile without a significant elevation in their heart rate; other people can barely walk a block without significant heart rate changes.

Exercise experts often break up cardiovascular training into different zones Zone one is defined as no significant elevation of the heart rate. This is similar to walking steadily at a leisurely pace. Zone two is defined as an elevation of the heart rate but in such a way that a person can still carry on a conversation meaning, the health of the heart rate elevation is about 60 to 70% of max heart rate.

This zone two concept is found to be quite important in terms of cardiovascular training and overall health and longevity. It appears that zone two training has significant benefits for mitochondrial health. As a result, the American Heart Association and other health entities have recommended what is called “aerobic training.” I would name it zone two training. It should be performed 30 minutes a day and a minimum of five days a week.

Let's talk about the other type of cardiovascular training that seems to have significant benefits and that's zone five.You can define zone 5 as a nearly maximum effort requiring a significant elevation of the heart rate. This is often approximated by a concept called VO 2 Max. Without getting into the science weeds here, VO 2 Max is an important measure of a person's ability to extract oxygen from the air coming into the lungs, and into the bloodstream and muscles where it is needed.

Zone five also appears to be significantly correlated with a person's longevity and health. The better a person's VO 2 Max, the more likely they are to have long and healthy lives. and much less likely to have chronic disease.

The good news is zone five training does not require that you be a superstar athlete. Zone five training simply means spending perhaps 30 minutes once or twice a week training yourself to exercise with a maximum effort for short bursts of activity, such as running really fast fo.r 30 to 60 seconds, followed by two to three minutes of rest come up and repeating the cycle several times for 30 minutes.

The importance of this type of training cannot be overemphasized. Many studies show that having poor vo 2 Max is nearly as bad as chronic smoking in terms of health and cardiovascular risk.

To summarize, we need to do zone two training several times a week, and zone five training should be incorporated at least once or twice a week to enhance overall health and improve our cardiometabolic capacities.

05/26/2022

We need to EAT!

No, I don't mean by this that we need to consume food. EAT is an acronym for exercise activity thermogenesis. It is one of the four components by which we expend energy, or burn calories throughout the day. We've talked recently about the importance of NEAT. Now let us discuss the importance of EAT.

In my opinion, the easiest way to define exercise is something that significantly elevates one's heart rate to approximately 60 to 80% of their maximum heart rate. A person's maximum heart may be individually different for each person, as their rate can vary due to age, gender, color, fitness level, etc. Some suggest estimating your baseline heart rate by subtracting 220 from one’s current age to find your baseline heart rate.

Why is exercise important?

Fundamentally, it is not simply about burning the calories that you burn during exercise. In fact, this is much less important than the general benefits of exercise. Exercise as a significant improvement or causes a substantial improvement in a person's cardiovascular fitness. Many studies have demonstrated that if a person engages in exercise regularly, his or her risk of heart disease coma, diabetes, sarcopenia, hypertension, and other chronic illnesses improves significantly.

Of course, there are several different types of exercise that one can engage in. The most common exercise people think of when they use the term exercise is cardiovascular exercise ie: running, jogging, swimming, bicycling, StairMaster, etc. These types of exercise do in fact, have the benefit of conferring cardiovascular fitness.

Another type of exercise that in my opinion is often neglected is resistance training exercises. This type of exercise involves using weights to progressively increase one strength. You can think of it as weight training or strength training as well.

Both of these exercise types ought to be incorporated into a person's general fitness schedule as they each confer unique benefits. People who only engage in cardiovascular exercise are missing out on the benefits of being strong. Having physical strength is very important in terms of reducing the risk of sarcopenia which is the loss of muscle tissue as we get older.

Alternatively, focusing solely on strength training does not confer all the benefits of exercise that can be induced by cardiovascular training.

In my next post, I'm going to detail some of the different types of cardiovascular training and their unique benefits.

05/14/2022

It pays to be NEAT (part 2)

When attempting weight loss there are two sides to the equation, as discussed above. One is to identify, manage and control the amount of caloric consumption in a given period of time, say 24 hours. On the other side of the ledger, is the amount of energy we expend. However, it is difficult to strongly alter the energy expenditure of the body because of many complex hormonal mechanisms that attempt to regulate how much energy we expend throughout the day. Even when we are sleeping we are expending some amount of energy.

This is where the concept of NEAT comes in. NEAT involves non-exercise activity. You can think of this as the natural movements that you do such as fidgeting while sitting, moving from side to side, walking… basically, things you do every day. The reason it's deemed non-exercise activity is because it is performed without a significant elevation of the heart rate. Say, for example, if your heart rate normally rests at 80 beats per minute, then non-exercise activity typically would not raise the heart rate above 90 or 100 beats per minute.

That is to say, you're able to do the activity without becoming short breath. Now, of course, it's important to keep in mind that the threshold of activity differs between different people. Some may get short of breath while walking short distances, meanwhile, others may be able to walk up hills without getting short of breath.

So how do you drive a calorie deficit? One way is to increase the amount of NEAT that you perform throughout the day. Now it can be very difficult to increase your NEAT intentionally. One easy way to do this is to track your steps. If you have a step tracker, on your phone, or another device on your wrist, this can give you some approximate level of the activity that you do throughout the day in terms of steps. Say for example that you notice after tracking there's a week that you walk approximately 4000 steps a day. One way to increase your NEAT is to set a goal for yourself to double that to 8000 steps a day. This would increase the amount of calorie burn that you're engaging in without driving you to exhaustion.

The nice thing about NEAT is that it doesn’t require any special equipment or a special location like a gym. All it needs is an investment of your time. Simply walking more every day will increase your calorie expenditure and go a long way towards helping you and your fat loss goals.

Therefore my advice for everyone is to start increasing your NEAT by tracking your steps if fat loss is an important goal of yours. Once you've established your baseline amount of steps, try doubling it the following week. Make sure the kind of NEAT activity that you choose, such as walking, for example, is not causing you to become short of breath, nor elevating your heart rate severely. If it does so. then you may need to see your doctor for a more thorough evaluation.

Now let's go out there and do some NEAT!

05/10/2022

It pays to be NEAT [part 1]

Weight loss and weight management are difficult issues for many people. Despite multiple attempts to lose weight, many patients do not succeed in achieving their weight loss goals. This could be for a number of reasons. Part of it could be from a lack of adequate medical and surgical treatment considerations. Most studies of weight loss have demonstrated limited benefits or affect of diet on long-term weight management. While it is important to try weight loss through dietary management, the success rate is not high based on multiple studies that have been done looking at this issue. On the other hand, medical management, especially with new medications available, such as Semaglutide/Wegovy and other newer ones that are coming on the market, demonstrates a much more efficacious weight loss that seems to be long lasting as long as the patient remains on the drug. Surgical considerations such as sleeve gastrectomies and bariatric bypass surgeries have also shown long-term clinical effectiveness.

Many patients don't want to undergo surgical treatment, nor do they want to remain on chronic medication for the rest of their lives. What can we do to help those patients achieve their weight loss goals?

The first step in my opinion is education. People must understand that in the final analysis, what drives weight gain or weight loss over the long term is calorie management. That is to say, if a patient consumes more calories than he or she expends throughout the day, the body's general tendency will be to store that extra energy as adipose tissue - if no other needs for the energy can be found. On the other hand, if the patient is consuming less than he or she is expending in calories - then the tendency of the body is to use existing adipose stores or fat stores in order to make up that energy difference. This is what leads to fat loss.

Of course, this is a simplified look at the question of obesity and weight management. But it's a useful framework for us to then discuss the importance of NEAT or Non-Exercise Activity Thermogenesis.

05/01/2022

The Dry Fast:
Muslims around the world continue to celebrate the month of Ramadan. Ramadan is distinctive in its requirement that Muslims fast from sunup to sundown. It requires the Muslim to withhold from both eating and drinking - anything whatsoever - all day from sun up to sundown.

This type of fast is different from the very popular diet strategy: intermittent fasting. Intermittent fasting typically does not exclude the ingestion of liquids (such as water, coffee, tea etc.). This got me thinking about some unique aspects about intermittent fasting that I wanted to share with all of you.

Intermittent fasting has become a very popular and successful tool for people to try and manage their weight loss goals. Entire books have been written about the concept of intermittent fasting. Many physicians and others have commented on this practice as well. Famously, Dr. Jason Fung, wrote The Obesity Code, during which he advocated for patients with type 2 diabetes and metabolic syndrome prolonged fasts of 24 hours, 36 hours, and sometimes even longer depending on the patient's condition.

The primary benefit that occurs from intermittent fasting to the fasting individual is the reduction in calories. That is to say, the reason intermittent fasting works so well for weight loss is that it restricts people's feeding window i.e. the time that they are able to eat food. During this period of time, they typically eat less than they would’ve eaten throughout the entire day. You can imagine that this becomes even more true when somebody undertakes a much longer fast such as greater than 24 hours. This results in a significant calorie reduction from a person's regular calorie intake, which drives the benefits of intermittent fasting including weight loss and reversal of metabolic syndrome, type 2 diabetes and other significant medical conditions.

There is a practical benefit to intermittent fasting as well. Namely, that the fasting individual does not have to undertake any special circumstances to adhere to this protocol. They simply avoid eating during their fasting window and therefore can achieve their calorie reduction goals. This may make it more achievable for some to actually stick to a calorie deficit; a primary driver of the improvement of metabolic syndrome and type 2 diabetes. Notably, there are no major studies that have been done including randomized controlled trials that show any unique benefit to intermittent fasting over a general calorie reduction diet in the reduction of type 2 diabetes and metabolic syndrome.

However, for Muslims, the dry fast is unique. The absence of water and liquid throughout the day leads to a state of mild dehydration. Which in turn reduces the Muslim's energy levels through the day. Of course they are replenished in the evening once sundown occurs and they can eat and drink.

In my experience, the dry fast is quite powerful in both its spiritual and psychological effects. When you cannot or do not eat or drink throughout the day, a profound state of need and recognition of your own physical weakness is recognized. Then when sundown hits it's like a mini celebration every day in the month of Ramadan.

I would caution my Muslim friends and colleagues however, that it is way to easy to overeat in the month of Ramadan. Sometimes with sundown, the amount of food that is ingested more than makes up for the amount of fasting that was done throughout the day and a person ends up eating more calories not less. This of course leads to weight gain and not weight loss. Therefore for the Muslims out there, I would encourage you very much to adhere to a reasonable strategy of food intake at sundown.
Focus on eating plenty of nonstarchy vegetables, good sources of protein, and whole foods.
Avoid highly caloric processed foods that will drive your calorie intake way up.
Keep yourself hydrated between the hours of sundown and sunup in the morning.

Happy Fasting!

03/28/2022

CV exercise and training are great but enough for people w chronic neck and back pain or spinal issues. the addition of mobility and strength or resistance t...

03/25/2022

When you're setting goals with your spine specialist, work S.M.A.R.T.

When you’re developing goals with your surgeon or spine specialist, work SMART, not hard.

03/21/2022

Important indicators of when back pain warrants urgent medical assessment:

While rare, certain back pain symptoms are a sign of a medical emergency that may become life threatening or result in disability without prompt attention.

03/11/2022

Most ppl define exercise in a way that focuses on cardiovascular, Aerobic activity, such as running, hiking, swimming etc. CV exercise is very important for ...

03/09/2022

Do you have questions about back pain, neck pain, or an upcoming surgery?

Feel free to comment or direct message and Dr. Shukairy can help answer some of your questions.

Dr. Mohammad Shukairy is a neurosurgeon affiliated with Community Hospital in Munster, IN and St Mary Medical Center in Hobart, IN.