To stimulate increases in strength and size it is minimally necessary to 1. work your muscles harder than they are accustomed to, which means 2. always attempting to lift a few more pounds or perform a few more repetitions on each exercise than you did before. These are the two most fundamental principles of building muscular strength and size – overload and progression. If these two things are not the primary focus of your training, nothing else you do is going to make any difference.

Weighted Dips

To stimulate the greatest possible increases in strength and size it is necessary to work as hard as possible. Do not make the common mistake of confusing doing more exercise for working harder. Working harder means putting more effort into each exercise, and if your level of effort is high enough you will neither need nor be capable of performing a large volume of work.

To work as hard as possible simply means;

1. doing as many repetitions as you are physically capable of
2. in reasonably good form
3. with an adequately heavy weight

Physical Versus Psychological Limits

Most people quit an exercise for various psychological reasons long before they’ve reached their true physical limits. Beginners and others unaccustomed to training at a very high level of intensity often mistake a moderate level of fatigue for muscle failure, quitting when the exercise starts to get hard rather than when more reps become impossible. Many simply quit when the exercise becomes too uncomfortable for them, lacking the necessary mental toughness to push through the discomfort of burning muscles, a rapidly pounding heart and being out of breath. Some quit when an exercise becomes harder because they fear they will injure themselves.

The gap between psychological and physical limits narrows and the tolerance for muscular burning and exertional discomfort improves for most people after they’ve been training for a while, but even advanced trainees may quit far short of a true all-out effort if they’ve never experienced it. Even many advanced trainees overestimate how intensely they actually train and underestimate the level of effort they are capable of. A good solution for this is to work out with a trainer or partner that knows how to motivate you to go all-out. The judicious application of high intensity training techniques like forced reps and negatives can also help you develop the ability to push yourself harder during training.

If you quit an exercise when it gets harder due to fear of injury, consider it is not the amount of weight or how hard you are working but the integrity of your form that determines your risk of injury. As long as you maintain reasonably good form and use a competent and attentive spotter or the appropriate safety equipment when necessary there is no reason to fear injury.

Also consider no matter how fatigued you become, you are always much stronger holding or lowering a weight than you are lifting it. As long as you don’t just let go, you will not drop a weight on yourself.

Good Form

The goal of an exercise is not to make a weight go up and down. Lifting and lowering a weight (or just lowering, if you’re doing negative-only reps) is just a means to accomplish the real goal, which is to work the targeted muscles intensely enough to stimulate strength and size increases. To accomplish this you need to maintain the proper body position and move along the correct path over the correct range of motion to maintain a high level of tension on the target muscles while avoiding positions which may result in other tissues being exposed to potentially harmful levels of force.

As an exercise becomes harder do not significantly alter your body position or path or range of movement or attempt to yank, jerk or otherwise quickly move the weight to make it easier to lift. If you do, the work is either shifted away from the target muscles towards other muscles or leverage is changed reducing tension, and you are no longer accomplishing the real goal, or you increase the risk of injury due to the sudden, uncontrolled increase in force resulting from rapid acceleration. It is neither necessary nor beneficial and potentially dangerous to attempt to continue beyond the point where can not lift the weight in correct form by cheating.

Maintain your focus on the real goal – high intensity muscular work – and don’t sacrifice form and risk injury for the sake of a few more less productive reps. How you lift the weight is far more important than how many times.

How Heavy?

The weight should be at least heavy enough to be moderately hard to lift right from the start. It should not be so heavy, however, that you are unable to perform at least a few repetitions in good form.

Assuming a moderate movement speed, within reason repetition range doesn’t appear to make as much of a difference in muscular strength and size increases as the effort put into an exercise. Some people will find they do better with or prefer slightly higher or lower reps, however most people will get good results with any reasonable range from as low as three to as high as twenty, as long as they are working as hard and progressively.

I recommend a middle range of 7 to 10 repetitions as a starting point for most trainees and most exercises. A higher rep range may be more appropriate for beginners when learning a new exercise, and lower rep ranges may be more appropriate if using very high intensity training methods like rest-pause or negative-only.

The High Intensity Mindset

High intensity training is as much a test of mental toughness as it is of physical strength, and your mindset going into the workout has a big impact on how hard you’ll be able to train. I have found the following to be effective in establishing the proper mindset for going all-out during your workouts.

Commitment

Although you may enjoy the mental and physical challenge of a hard workout, a workout is not an end in itself, but a means to accomplishing specific goals. Keeping your goals in mind will help you stay motivated. Think about how important those goals are to you and make a commitment to yourself to give your best effort, to not have any doubts after the workout as to whether you could have gotten another rep on an exercise or worked even just a little harder.

Focus

To put a 100% physical effort into an exercise you have to focus 100% of your mind on it. To prevent your mind from wandering or the things going on around you from distracting you during your workout, take a few minutes before you start to clear your head and get focused. Sit down, close your eyes and focus only your breathing until you are able to block everything else out and your mind is not wandering. Then take a few minutes to visualize yourself performing each of the exercises in your workout perfectly, easily beating your previous weight or reps on all of them. Finally, take a brief moment to think about your goals, your motivation for training.

Before each exercise, take a few seconds to close your eyes and regain your focus if you start to feel distracted.

Putting “Pain” in Perspective

Intense burning in the muscles, a rapid heart rate and labored breathing are normal sensations resulting from high intensity muscular work, and not real pain or an indication of physical harm. These sensations are not a cause for concern. What they do indicate is that you have reached the most productive part of the exercise.

When you begin to experience these sensations do not assume you are approaching your physical limits or the end of the exercise. Remind yourself the sensations are temporary and harmless, and the real exercise is just beginning. The burn in your muscles is your cue to work even harder, and the more they burn the harder you will work. Again, think about your goals and remind yourself they are worth working through the temporary and harmless discomfort.

This is important reading for anyone involved in exercise, either professionally or for their own health and fitness, and especially for those who train individuals with or have lower back pain, as it addresses many of the myths of the current core and stability training trends.

The Myth of Core Stability

Professor Eyal Lederman

CPDO Ltd.,
15 Harberton Road,
London N19 3JS,
UK,

E-mail: cpd@cpdo.net
Tel: 0044 207 263 8551

Abstract

The principle of core stability has gained wide acceptance in training for prevention of injury and as a treatment modality for rehabilitation of various musculoskeletal conditions in particular the lower back. There has been surprising little criticism of this approach up to date. This article will re-examine the original findings and the principles of core stability and how well they fare within the wider knowledge of motor control, prevention of injury and rehabilitation of neuromuscular and musculoskeletal systems following injury.

Key words: Core stability, transverse abdominis, chronic lower back and neuromuscular rehabilitation

Introduction

Core stability (CS) arrived in the latter part of the 1990’s. It was largely derived from studies that demonstrated a change in onset timing of the trunk muscles in back injury and chronic lower back pain (CLBP) patients [1, 2]. The research in trunk control has been an important contribution to the understanding of neuromuscular reorganisation in back pain and injury. As long as four decades ago it was shown that motor strategies change in injury and pain [3]. The CS studies confirmed that such changes take place in the trunk muscles of patients who suffer from back injury and pain.

However, these findings combined with general beliefs about the importance of abdominal muscles for a strong back and influences from Pilates have promoted several assumptions prevalent in CS training:

1. That certain muscles are more important for stabilisation of the spine, in particular transverses abdominis (TrA).
2. That weak abdominal muscles lead to back pain
3. That strengthening abdominal or trunk muscles can reduce back pain
4. That there is a unique group of “core” muscles working independently of other trunk muscles
5. That a strong core will prevent injury.
6. That there is a relationship between stability and back pain

As a consequence of these assumptions, a whole industry grew out of these studies with gyms and clinics worldwide teaching the “tummy tuck” and trunk bracing exercise to athletes for prevention of injury and to patients as a cure for lower back pain [4, 5]. At that point core stability became a cult and TrA its mantra.

In this article some of these basic assumption will be re-examined. In particular, it will examine:

1. The role of TrA as a stabiliser and relation to back pain: is TrA that important for stabilisation?
2. The TrA timing issue: what are the timing differences between asymptomatic individuals and patients with LBP? Can timing change by CS exercise?
3. Abdominal muscle strength: what is the normal strength needed for daily activity? Can CS exercise affect strength?
4. Single muscle activation: can single muscle be selected? Does it have any functional meaning during movement?

Assumptions about stability and the role of TrA muscle

In essence the passive human spine is an unstable structure and therefore further stabilisation is provided by co-contraction of trunk muscles. Erroneously, these muscles are often referred to in CS approach as the “core” muscles, assuming that there is a distinct group, with an anatomical and functional characteristics specifically designed to provide for the stability. One of the muscles in this group to have received much focus is TrA. It is widely believed that this muscle is the main anterior component of trunk stabilisation. It is now accepted that many different muscles of the trunk contribute to stability and that their stabilasing action may change according to varying tasks (see further discussion below).

The TrA has several functions in the upright posture. Indeed stability, but this function is in synergy with every other muscle that makes up the abdominals wall and beyond [6-8]. It acts in controlling pressure in the abdominal cavity for vocalization, respiration, defecation, vomiting etc. [9]. TrA forms the posterior wall inguinal canal and where its valve-like function prevents the viscera from popping out through the canal [10].

How essential is TrA for spinal stabilisation? One way to asses this is to look at situations where the muscle is damaged or put under abnormal mechanical stress. Would this predispose the individual to lower back pain?

According to Gray’s Anatomy (36th edition 1980, page 555) TrA is absent or fused to the internal oblique muscle as a normal variation in some individuals. It would be interesting to see how these individuals stabilise their trunk and whether they suffer more back pain.

Pregnancy is another state that raises some important questions about the role of TrA or any abdominal muscle in spinal stabilisation. During pregnancy the abdominal wall muscles undergo dramatic elongation, associated with force losses and inability to stabilise the pelvis against resistance [11, 12]. Indeed, in a study of pregnant women (n=318) they were shown to have lost the ability to perform sit-ups due to this extensive elongation and subsequent force losses [12]. Whereas all non-pregnant women could perform a sit-up, 16.6% of pregnant women could not perform a single sit-up. However, there was no correlation between the sit-up performance and backache, i.e. the strength of abdominal muscle was not related to backache. Despite this, CS exercises are often prescribed as a method for retraining the abdominal muscles and ultimately as a treatment for LBP during pregnancy. There is little evidence that localized musculoskeletal mechanical issues, including spinal stability play a role in the development of LBP during pregnancy. Often sited predisposing factors are, for example, body mass index, a history of hypermobility and amenorrhea [13], low socioeconomic class, existence of previous LBP [14], posterior/fundal location of the placenta and a significant correlation between fetal weight and LBP with pain radiation [14]. It is surprising that such dramatic postural, mechanical and functional changes to the trunk and lumbar spine seem to have an insignificant role in the development of back pain during pregnancy.

Another interesting period for us concerning stabilisation is immediately after delivery. Postpartum, it would take the abdominal muscle about 4-6 weeks to reverse the length changes and undergo re-shortening. Rectus abdominus takes about 4 weeks postpartum to re-shorten, and it takes about 8 weeks for pelvic stability to normalize [11]. It would be expected that during this period there would be minimal spinal support / stabilisation from the slack abdominal muscles and their fascia. Would this increase the likelihood for back pain?

In a recent study, the effects of a cognitive-behavioural approach were compared with standard physiotherapy on pelvic and lower back pain immediately after delivery [15]. An interesting aspect of this research was that out 869 pregnant women who were recruited for the study, 635 were excluded because of their spontaneous unaided recovery within a week of delivery. This would have been during a period, well before the abdominal muscles had time to return to their pre-pregnancy length, strength or control [11]. Yet, this was a period when back pain was dramatically reduced. How can it be that back and pelvic pain is improving during a period of profound abdominal muscle inefficiency? Why does the spine not collapse? Has the relationship between abdominal muscles and spinal stability been over-emphasised?

Another potential source of information on the relationship between altered abdominal muscle function and back pain is the literature on obesity. One would expect, as in pregnancy, the distention of the abdomen to disrupt the normal mechanics and control of the trunk muscle, including TrA. According to CS model this should result in an increased incidence of back pain among this group. Yet, epidemiological studies demonstrate weight gains and obesity are only weakly associated with lower back pain [16]. According to the CS model we should be seeing an epidemic of back pain in over-weight individuals.

Another area that can shed light on control of stability and abdominal muscles is the study of abdominal muscles that have been damaged by surgery. Would such damage affect spinal stability or contribute to back pain? In breast reconstruction after mastectomy, one side of the rectus abdominis is used for reconstruction of the breast. Consequently, the patient is left with only one sided rectus abdominis and weakness of abdominal muscles. Such alteration in trunk biomechanics would also be expected to result in profound motor control changes. Despite all these changes there seems to be no relationship to back pain or impairment to the patient’s functional / movement activities, measured up to several years after the operation [17, 18].

One area for further study would be that of subjects who have had inguinal hernia repair. In this operation the TrA is known to be affected by the surgical procedure [19, 20]. Up to date there is no known epidemiological study linking such surgery and back pain (perhaps because it doesn’t exist?).

We can conclude from the above that healthy abdominal musculature can demonstrate dramatic physiological changes, such as during pregnancy, post-partum and obesity, with no detriment to spinal health. Similarly, damage to abdominal musculature does not seem to impair normal movement or contribute to LBP.

The timing issue

In one of the early studies it was demonstrated that during rapid arm / leg movement, the TrA in CLBP patients had delayed onset timing when compared with asymptomatic subjects [1, 2]. It was consequently assumed that the TrA, by means of its connection to the lumber fascia, is dominant in controlling spinal stability [8]. Therefore any weakness or lack of control of this muscle would spell trouble for the back.

This assumption is a dramatic leap of faith. Firstly, in our body all structures are profoundly connected in many different dimensions, including anatomically and biomechanicaly. You need a knife to separate them from each other. It is not difficult to emphasise a connection that would fit the theory, i.e. that the TrA is the main anterior muscle to controls spinal stability. In normal human movement postural reflexes are organised well ahead in anticipation of movement or perturbation to balance. TrA is one of the many trunk muscles that takes part in this anticipatory organisation [21]. Just because in healthy subjects it kicks off before all other anterior muscles, does not mean it is more important in any way. It just means it is the first in a sequence of events [22]. Indeed, it has been recently suggested that earlier activity of TrA may be a compensation for its long elastic anterior fascias [23].

It can be equally valid to assume that a delay in onset timing in subjects with LBP may be an advantageous protection strategy for the back rather than a dysfunctional activation pattern. Furthermore, it could be that during the fast movement of the outstretched arm the subject performed a reflexive pain evasion action that involved delayed activation of TrA, an action unrelated to stabilisation [24, 25]. An analogy would be the reflex pulling of the hand from a hot surface. One could imagine that a patient with a shoulder injury would use a different arm withdrawal pattern from a normal individual. This movement pattern would be unrelated to the control of shoulder stability but would be intended to produce the least painful path of movement, even if the movement is not painful at the time. A similar phenomenon has been demonstrated in trunk control where just the perception of a threat of pain to the back resulted in altered postural strategies [26].

In the original studies of CS onset time differences between asymptomatic individuals and patients with CLBP were about 20 Ms, i.e. one fiftieth of a second difference [27]. It should be noted that these were not strength but timing differences. Such timings are well beyond the patient’s conscious control and the clinical capabilities of the therapist to test or alter.

Often, in CS exercise there is an emphasis on strength training for the TrA or low velocity exercise performed laying or kneeling on all fours [28]. It is believed that such exercise would help normalise motor control which would include timing dysfunction. This kind of training is unlikely to help reset timing differences. It is like aspiring to play the piano faster by exercising with finger weights or doing slow push ups. The reason why this ineffective is related to a contradiction which CS training creates in relation to motor learning principles (similarity / transfer principle) and training principles (specificity principle, see further discussion below). In essence these principles state that our bodies, including the neuromuscular and musculoskeletal systems, will adapt specifically to particular motor events. What is learned in one particular situation may not necessarily transfer to a different physical event, i.e. if strength is required – lift weights, if speed is needed – increase the speed of movement during training and along these lines if you need to control onset timing switch your movement between synergists at a fast rate, and hope that the system will reset itself [29].

To overcome the timing problem the proponents of CS came up with a solution – teach everyone to continuously contract the TrA or to tense/brace the core muscle [4, 30]. By continuously contracting it would overcome the need to worry about onset timing. What is proposed here is to impose an abnormal, non-functional pattern of control to overcome a functional organisation of the neuromuscular system to injury: a protective control strategy that is as old as human evolution.

We now know that following injury, one motor strategy is to co-contract the muscles around the joint (amongst many other complex strategies). This injury response has also been shown to occur in CLBP patients [31-34], who tend to co-contract their trunk flexors and extensors during movement [35]. This strategy is subconscious, and very complex. It requires intricate interactions between the relative timing, duration, force, muscle lengths and velocities of contraction of immediate synergist [27, 36]. Further complexity would arise from the fact that these patterns would change on a moment-to-moment basis and different movement/postural tasks [37-39]. Whichever muscle activity is observed in standing with the arm out-stretched will change in bending forward, twisting or even the arm in a different position. Indeed, in the original studies of the onset timing of TrA delay in onset timing were observed during fast but not during slow arm movements [1]. Even during a simple trunk rotation or exercise the activity in TrA is not uniform throughout the muscle [40, 41].

These studies demonstrate the complexity that a patient re-learning trunk control may have to face. How would a person know which part of the abdomen to contract during a particular posture or movement? How would they know when to switch between synergists during movement? How would they know what is their optimal co-contraction force? If CLBP patients already use a co-contraction strategy why increase it? It is naïve to assume that by continuously contracting the TrA it will somehow override or facilitate these patterns. No study to date has demonstrated that core stability exercise will reset onset timing in CLBP patients.

The strength issue

There is more confusion about the issue of trunk strength and its relation to back pain and injury prevention. What we do know is that trunk muscle control including force losses can be present as a consequence of back pain / injury. However, from here several assumptions are often made:

1. That loss of core muscle strength could lead to back injury,
2. That increasing core strength can alleviate back pain

To what force level do the trunk muscles need to co-contract in order to stabilise the spine? It seems that the answer is – not very much. During standing and walking the trunk muscles are minimally activated [42]. In standing the deep erector spinal, psoas and quadratus lumborum are virtually silent! In some subjects there is no detectable EMG activity in these muscles. During walking rectus abdominis has a average activity of 2% maximal voluntary contraction (MVC) and external oblique 5% MVC [43]. During standing “active” stabilisation is achieved by very low levels of co-contraction of trunk flexors and extensor, estimated at less than 1% MVC rising up to 3% MVC when a 32 Kg weight is added to the torso. With a back injury it is estimated to raise these values by only 2.5% MVC for the unloaded and loaded models [44]. During bending and lifting a weight of about 15 kg co-contraction increases by only 1.5% MVC [45].

These low levels of activation raise the question of why strength exercises are prescribed when such low levels of co-contraction forces are needed for functional movement. Such low co-contraction levels suggest the strength losses are unlikely ever to be an issue for spinal stabilisation. A person would have to loose substantial trunk muscle mass before it will destabilise the spine!

The low levels of trunk muscle co-contraction also have important clinical implications. It means that most individuals would find it impossible to control such low levels of activity or even be aware of it. If they are aware of it they are probably co-contracting well above the normal levels needed for stabilisation. This would come at a cost of increasing the compression of the lumbar spine and reducing the economy of movement (see discussion below).

Is there a relationship between weak abdominals (e.g. TrA) and back pain? A common belief amongst therapists and trainers who use CS is that trunk strength will improve existing back pain. It has been shown that a muscle such as multifidus [46] can undergo atrophy in acute and CLBP (although this is still inconclusive). However, strengthening these muscles does not seem to improve the pain level or disability in CLBP patients [47]. Improvement appeared to be mainly due to changes in neural activation of the lumbar muscles and psychological changes concerning, for example, motivation or pain tolerance [48]. Similarly, it is well established that the motor strategy changes in the recruitment of the abdominal muscles in patients with CLBP [31, 49, 50], with some studies demonstrating weakness of abdominal muscles [36, 51, 52]. No studies to date have shown atrophy of abdominal muscles and no studies have shown that strengthening the core muscles, in particular the abdominal muscles and TrA, would reduce back pain (see discussion below).

There are also examples where abdominal muscle activity is no different between asymptomatic and CLBP subjects. For instance, in studies of elite golfers, abdominal muscle activity and muscle fatigue characteristics were similar between asymptomatic and CLBP subjects after repetitive golf swings [53]. Yet, this is the type of sportsperson who would often receive CS exercise.

Doubts have been also raised concerning the effectiveness of many of CS exercise in helping to increase the strength of core muscles. It has been shown that during CS exercise, the maximal voluntary contraction (MVC) of the “core muscles” is well below the level required for muscle hypertrophy and is therefore unlikely to provide strength gains [54-56]. Furthermore, in a study of fatigue in CLBP, four weeks of stabilisation exercise failed to show any significant improvement in muscle endurance [57]. A recent study has demonstrated that as much as 70% MVC is needed to promote strength gains in abdominal muscle [58]. It is unlikely that during CS exercise abdominal muscle would reach this force level [59].

The single / core muscle activation problem

One of the principles of CS is to teach the individuals how to isolate their TrA from the rest of the abdominal muscles or to isolate the “core muscle” from “global” muscles.

It is doubtful that there exists a “core” group of trunk muscle that operated independently of all other trunk muscles during daily or sport activities [37, 60]. Such classification is anatomical but has no functional meaning. The motor output and the recruitment of muscles is extensive [61, 62], effecting the whole body. To specifically activate the core muscles during functional movement the individual would have to override natural patterns of trunk muscle activation. This would be impractical, next to impossible and potentially dangerous – “Individuals in an externally loaded state appear to select a natural muscular activation pattern appropriate to maintain spine stability sufficiently. Conscious adjustments in individual muscles around this natural level may actually decrease the stability margin of safety”[63].

Training on single muscle is even more difficult. Muscle-by-muscle activation does not exist [64]. If you bring your hand to your mouth the nervous system “thinks” hand to mouth rather than flex the biceps, than the pectoral etc. Single muscle control is relegated in the hierarchy of motor processes to spinal motor centers – a process that would be distant from conscious control (interestingly even the motor neurons of particular muscles are intermingled rather than being distinct anatomical groups in the spinal cord [65]). Indeed, it has demonstrated that when tapping the tendons of rectus abdominis, external oblique and internal oblique the evoked stretch reflex responses can be observed not only in muscle tapped, but it spreads equally to muscles on the ipsilateral and contralateral sides of the abdomen [66]. This suggests sensory feedback and reflex control of the abdominal muscles is functionally related and would therefore be difficult to separate by conscious effort.

This simple principles in motor control poses two problems to CS training. First, it is doubtful that following injury only one group or single muscles would be affected. Indeed, the more EMG electrodes applied the more complex the picture becomes [67]. It is well documented that other muscle are involved – multifidus [68], psoas [69], diaphragm [8], pelvic floor muscles [70], gluteals [71] etc. Basically in CLBP we see a complex and wide reorganisation of motor control in response to damage.

The second problem for CS is that it would be next to impossible to contract a single muscle or specific group. Even with extensive training this would be a major problem [72]. Indeed, there is no support from research that TrA can be singularly activated [62]. The novice patient is more likely to contract wide groups of abdominal muscles [6, 41, 73]. So why focus on TrA or any other specific muscle or muscle group?

CS and training in relation to motor learning and training issues

Further challenges for the CS model arise from motor learning and training principles.

CS training seems to clash with three important principles:

1. The similarity (transfer) principle in motor learning and specificity principle in training
2. Internal-external focus principles
3. Economy of movement

Similarity / specificity principles – when we train for an activity we become skilled at performing it. So if we practice playing the piano we become a good pianist, hence a similarity principle. We can’t learn to play the piano by practicing the banjo. This adaptation to the activity is not only reserved to learning processes, it has profound physical manifestations – hence the specificity principle in training [74]. For that reason a weight trainer looks physically different to a marathon runner.

If a subject is trained to contract their TrA or any anterior abdominal muscle while lying on their back [75], there is no guarantee that this would transfer to control and physical adaptation during standing, running, bending, lifting, sitting etc. Such control would have to be practiced in some of these activities. Anyone who is giving CS exercise to improve sports performance should re-familiarise themselves with this basic principle.

It seems that such basic principles can escape many of the proponents of CS. This is reflected in one study which assessed the effect of training on a Swiss ball on core stability muscles and the economy of running [76]! In this study it was rediscovered that practicing the banjo does not help to play the piano. The subjects got very good at using their muscles for sitting on a large inflatable rubber ball but it had no effect on their running performance.

Trunk control will change according to the specific activity the subject is practicing. Throwing a ball would require trunk control, which is different to running. Trunk control in running will be different in climbing and so on. There is no one universal exercise for trunk control that would account for the specific needs of all activities. Is it possible to train the trunk control to specific activity? Yes, and it is simple – just train in that activity and don’t worry about the trunk. The beauty of it all is that no matter what activity is carried out the trunk muscles are always specifically exercised.

Internal and external focus in training – CS has evolved over time in response to many of the model’s limitations described above. Currently, the control of TrA is attempted in different standing and moving patterns [30]. Speed of movement, balance and coordination has been introduced to the very basic early elements of CS. The new models encourage the subjects to “think about their core” during functional activities. One wonders if David Beckham thinks about the “core” before a free kick or Michael Jordan when he slam-dunks or for that matter our patient who is running after a bus, cooking or any other daily activities. How long can they maintain that thought while multitasking in complex functional activities?

Maybe thinking about the core is not such a good idea for sports training. When learning movement a person can be instructed to focus on their technique (called internal focus) or on the movement goal (called external focus). When a novice learns a novel movement focusing on technique (internal focus) could help their learning [77]. For a skilled person, performance improves if training focuses on tasks outside the body (external-focus) but it reduces when the focus is on internal processes within the body [78, 79]. For example, there is greater accuracy in tennis serves and football shots when the subjects use external-focus rather than internal-focus strategies [80, 81]. This principle strongly suggests that internal focus on TrA or any other muscle group will reduce skilled athletic performance. (Tensing the trunk muscle has even been shown to degrade postural control! [82])

What about movement rehabilitation for a CLBP patients, would internal focus on specific muscles improve functional use of trunk muscles? Lets imagine two scenarios where we are teaching a patient to lift a weight from the floor using a squat position. In the first scenario, we can give simple internal focus advice such bend your knees, and bring the weight close to your body, etc [83, 84]. This type of instruction contains a mixture of external focusing (e.g. keep the object close to your body and between your knees) and internal focus about the body position during lifting. In the second scenario which is akin to CS training approach, the patient is given the following instructions: focus on co-contracting the hamstrings and the quads, gently release the gluteals, let the calf muscles elongate, while simultaneously shorten the tibialis anterior etc. Such complex internal focusing is the essence of CS training, but applied to the trunk muscles. It would be next to impossible for a person to learn simple tasks using such complicated internal focus approach.

Economy of movement – The advice given to CS trainees is to continuously tighten their abdominal and back muscles could reduce the efficiency of movement during daily and sports activities. Our bodies are designed for optimal expenditure of energy during movement. It is well established that when a novice learns a new motor skill they tend to use a co-contraction strategy until they learn to refine their movement [85]. Co-contraction is known to be an “energy waster” in initial motor learning situations. To introduce it to skilled movement will have a similar “wasteful” effect on the economy of movement. Minetti states: “to improve locomotion (and motion), mechanical work should be limited to just the indispensable type and the muscle efficiency be kept close to its maximum. Thus it is important to avoid: …. using co-contraction (or useless isometric force)” [86].

Such energy wastage is likely to occur during excessive use of trunk muscles as taught in CS. In sporting activity this would have a detrimental effect on performance. Anderson in a study on the economy of running states: “At higher levels of competition, it is likely that ‘natural selection’ tends to eliminate athletes who failed to either inherit or develop characteristics which favour economy” [87].

CS in prevention of injury and therapeutic value

Therapist and trainers have been exalting the virtues of CS as an approach for improving sports performance [88], preventing injury and as the solution to lower back. No matter what the underlying cause for the complaint CS was going to save the day. However, these claims are not supported by clinical studies:

Abdominal / stability exercise as prevention of back pain

In one study, asymptomatic subjects (n=402) were given back education or back education + abdominal strengthening exercise [89]. They were monitored for lower back pain for one year and number of back pain episode were recorded. No significant differences were found between the two groups. There was a curious aspect to this study, which is important to the strength issue in CS. This study was carried out on asymptomatic subjects who were identified as having weak abdominal muscles. Four hundred individuals with weak abdominal muscles and no back pain!

Another large-scale study examined the influence of a core-strengthening program on low back pain (LBP) in collegiate athletes (n=257). In this study too, there were no significant advantage of core strengthening in reducing LBP occurrence [90].

CS a treatment for recurrent LBP and CLBP

At first glance, studies of CS exercise for the treatment of recurrent LBP look promising – significant improvements can be demonstrated when compared to other forms of therapy [91-94].

However an interesting trend emerges when CS exercise are compared to general exercise (Table 1). Both exercise approaches are demonstrated to be equally effective [82, 95-101]. Systematic reviews repeat this message [102].

These studies strongly suggest that improvements are due to the positive effects that physical exercise may have on the patient rather than on improvements in spinal stability (it is known that general exercise can also improve CLBP [95, 96])

So why give the patient complex exercise regimes that will both be expensive and difficult to maintain? Indeed it is now recommended that patients should be encouraged to maintain their own preferred exercise regime or given exercise that they are more likely to enjoy. This of course could include CS exercise. But the patient should be informed that it is only as effective as any other exercise.

Core Stability Study Comparison

CS in relation to etiology of back pain

Why has CS not performed better than any other exercise? In part, due to all the issues that have been discusses above. More importantly, in the last decade our understanding of the etiology of back pain has dramatically changed. Psychological and psychosocial factors have become important risk and prognostic factors for the onset of acute back pain and the transition of acute to chronic pain states [103]. Genetic factors [104] and behavioural / “use of body” are also known to be contributing factors. Localised, minor asymmetries of the spine, which would include stability issues, have been reduced in their importance as contributing factors to back pain.

It is difficult to imagine how improving biomechanical factor such as spinal stabilisation can play a role in reducing back pain when there are such evident psychological factors associated with this condition. Even in the behavioural / biomechanical spheres of spinal pain it is difficult to imagine how CS can act as prevention or cure. This can be clarified by grouping potential causes for back injury into two broad categories:

1. Behavioural group: individuals who use their back in ways that exert excessive loads on their spine, such as bending to lift [105] or repetitive sports activities [106-108].
2. Bad luck group: individuals who had suffered a back injury from sudden unexpected events, such as falls or sporting injuries [107].

In the behavioural group, bending and lifting is associated with a low level increase in abdominal muscle activity, which contributes to further spinal compression [109]. In patients with CLBP lifting is associated with higher levels of trunk co-contraction and spinal loading [33]. Any further tensing of the abdominal muscle may lead to additional spinal compression. Since the spinal compression in lifting approach the margins of safety of the spine, these seemingly small differences are not irrelevant [110]. It is therefore difficult to imagine how CS can offer any additional protection to the lumbar spine during these activities.

Often in CS advice is given to patients to brace their core muscle while sitting to reduce or prevent back pain. Although sitting is not regarded as a predisposing factor for LBP, some patient with existing back pain find that standing relieves the back pain of sitting [111]. This phenomenon has been shown in CLBP patients who during sitting exhibit marked anterior loss of disc space in flexion or segmental instability [111]. Sitting, however, is associated with increased activity of abdominal muscle (when compared to standing) [112] as well as increased stress on the lumbar discs (compared to standing) [113]. Increasing the co-contraction activity of the anterior and back muscles is unlikely to offer any further protection in the patients with disc narrowing / pathology, and may even result in greater spinal compression. It is unknown whether core tensing can impede the movement of the unstable segments. This seems unlikely because even in healthy individual creep deformation of spinal structures will eventually take place during sitting [114]. The creep response is likely to be increased by further co-contraction of trunk muscles.

In the bad luck group, CS will have very little influence on the outcome of sudden unexpected trauma. Most injuries occur within a fraction of a second, before the nervous system manages to organise itself to protect the back. Often injuries are associated with factors such as fatigue [115] and over training [116]. These factors when combined with sudden, unexpected high velocity movement are often the cause of injury [107]. It is difficult to see the benefit of strong TrA, abs or maintaining a constant contraction in these muscles in injury prevention.

Potential damage with CS?

Continuous and abnormal patterns of use of the trunk muscles could also be a source of potential damage for spinal or pelvic pain conditions. It is known that when trunk muscles contract they exert a compressive force on the lumbar spine [45] and that CLBP patients tend to increase their co-contraction force during movement [44]. This results in further increases of spinal compression. The advice in CS for patients to increase their co-contraction is likely to come at a cost of increasing compression on the already sensitised spinal joints and discs [33, 63]. Another recent study examined the effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations [117]. The abdominal stabilization maneuvers were – abdominal hollowing, abdominal bracing and a “natural” strategy. Abdominal hollowing was the most ineffective and did not increase stability. Abdominal bracing did improve stability but came at a cost of increasing spinal compression. The natural strategy group seems to employ the best strategy – ideal stability without excessive spinal compression.

An increase in intra-abdominal pressure could be a further complication of tensing the trunk muscles [118]. It has been estimated that in patients with pelvic girdle pain, increased intra-abdominal pressure could exert potentially damaging forces on various pelvic ligaments [119]. This study for example recommends teaching the patients to reduce their intra-abdominal pressure, i.e. no CS.

Maybe our patients should be encouraged to relax their trunk muscle rather than hold them rigid? In a study of the effects of psychological stress during lifting it was found that mental processing / stress had a large impact on the spine. It resulted in a dramatic increase in spinal compression associated with increases in trunk muscle co-contraction and less controlled movements [120].

Psychological factors such as catastrophising and somatisation are often observed in patients suffering from CLBP. One wonders if CS training colludes with these factors, encouraging excessive focusing on back pain and re-enforcing the patient’s notion that there is something seriously wrong with their back. Perhaps we should be shifting the patient’s focus away from their back. (I often stop patients doing specific back exercise).

Furthermore, CS training may shift the therapeutic focus away from the real issues that maintain the patient in their chronic state. It offers a simplistic solution to a condition that may have complex biopsychosocial factors. The issues that underline the patient’s condition may be neglected, with the patient remaining uninformed about the real causes of their condition. Under such circumstance CS training may promote chronicity.

Conclusion

Weak trunk muscles, weak abdominals and imbalances between trunk muscles groups are not pathological, just a normal variation. The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote CS.

Weak or dysfunctional abdominal muscles will not lead to back pain.

Tensing the trunk muscles is unlikely to provide any protection against back pain or reduce the recurrence of back pain.

Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise. Core stability exercises are no better than other forms of exercise in reducing chronic lower back pain. Any therapeutic influence is related to the exercise effects rather than CS issues.

There may be potential danger of damaging the spine with continuous tensing of the trunk muscles during daily and sports activities. Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them.

Epilogue

Many of the issue raised in this article were known well before the emergence of CS training. It is surprising that the researchers and proponents of this method ignored such important issues. Despite a decade of extensive research in this area, it is difficult to see what contribution CS had to the understanding and care of patients suffering from back pain.

Acknowledgement

I would like to thank Jaap H van Dieen, Ian Stevens and Tom Hewetson for their help in preparing this article.

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1. Not Training Hard Enough

To stimulate muscular strength and size increases, you have to work your muscles harder than they are accustomed to, the harder the better. Specifically, you should perform each exercise until it is impossible to continue in good form, using a heavy enough weight that you are only able to perform between 5 and 15 slow, controlled reps (some people get better results with lower rep ranges, e.g. 5-8, some with highter, e.g. 10 to 15, but most would do best to start in the 7 to 10 range and adjust from there).

The exercise is not over when the muscles start to burn or when things start to become uncomfortable. The real valuable work is just starting. The exercise isn’t even over when your muscles feel like they’re on fire and your heart is pounding through your chest, you’re just getting to the best part. The greatest stimulus for muscular strength and size increases occur during the last few hardest reps, and if you give up at any point short of an all-out effort, you aren’t going to get nearly the growth stimulation.

2. Not Training Progressively

As you become stronger you must attempt to lift progressively heavier weights to stimulate further improvement. If you continue to use the same weights on all your exercises despite increasing in strength, the weights will no longer be challenging enough to stimulate further improvements. Attempt to either perform more repetitions or use a slightly heavier weight on every exercise, every time you train.

3. Doing Too Many Exercises and Sets

It is the intensity of muscular work that stimulates strength and size increases, not the volume. Doing any more exercise than minimally necessary will reduce rather than improve gains, by interfering with the process of recovery and adaptation.

In most cases, all you need is one hard set of only one or two exercises per major muscle group. More is rarely necessary, and usually counterproductive.

4. Training Too Frequently

The body must be allowed adequate time between workouts to fully recover and adapt, or gains will not occur. Exercise does not produce any improvements in the body, exercise can only stimulate the body to produce the improvements, if it is intense enough, or prevent the improvements from being produced, if it too much is performed, too often. The body produces the muscular strength and size increases stimulated by exercise, but only if it allowed adequate time between workouts to do so.

5. Not Keeping A Workout Journal or Progress Charts

Proper adjustment of training volume and frequency to avoid overtraining requires objective evaluation of progress. If you’re not keeping accurate records of your workouts, you can not objectively evaluate the effectiveness of your program and make the necessary changes to keep gaining or get your progress back on track.

6. Using Sloppy Form

Poor form reduces the effectiveness of an exercise and increases the likelihood of injury. While an entire book could be written on the specifics of proper exercise form, one of the most effective ways to improve exercise form in general can be summed up in two words: slow down. Moving more slowly makes it easier to maintain proper positioning and alignment, and allows for better focus on performing the exercise correctly and on intensely contracting the target muscles.

7. Switching Exercises or Routines Too Frequently

Real gains are made by consistent progress on the basic exercises over time. Changing routines too frequently prevents the body from getting past the initial, primarily neural/skill adaptation stage and into the more productive training that follows.

The belief that one must change their routines regularly to avoid plateaus because the muscles “adapt” to exercise is based on the observation that the fastest improvements in performance on an exercise routine occur over the first six to eight weeks after which it begins to slow down, and that changing the routine appears to solve this problem.

During the first several weeks performing a new exercise or routine a larger percentage of the improvements in exercise performance are due to neural or skill adaptations. After this initial period of neural adaptation, performance improvements slow down and the majority of adaptation is occurring in the muscles. This is where the real progress starts, however, and it is important to not change the routine at this point. It will be slower than during the initial six to eight weeks, but you will make progress if you properly adjust your workout volume and frequency.

Contrary to bodybuilding myth and uninformed opinion, the muscles do not stop adapting to a particular exercise, method, or routine – if there is sufficient overload a muscle will be stimulated to grow, and as long as volume and frequency are not excessive, and adequate rest and nutrition are provided, and one hasn’t already reached the limits of their potential, it will grow stronger and larger.

If you only performed a few, basic barbell exercises, covering all the major muscle groups, and trained hard and progressively you would eventually become as big and as muscular as your genetics allow. There is no need to constantly switch up angles, rep methods, or anything else.

8. Not Training Legs

Heavy leg work,  squats, deadlifts, leg presses, etc., can be brutal when done properly, and as a result many would-be bodybuilders avoid it, preferring to focus on the relatively easier upper body exercises. This is a huge mistake, as heavy leg work appears to have a beneficial effect on growth throughout the entire body, particularly squats and deadlifts.

Do not skip training legs. Doing so robs you of potential full-body size increases, and having a well developed upper body and chicken legs looks stupid.

9. Not Eating Enough Quality Food

Your body requires both material and energy to produce new muscle tissue. Often, when skinny guys complain they have a hard time gaining muscle mass, it turns out they simply aren’t eating enough food in general or protein in particular to support the growth they stimulate during their workouts. If you want to get big, you have to eat big. This doesn’t mean pigging out, but getting enough calories and protein daily to add at least a few pounds per month, but not so much your waist size or abdominal skinfold increases significantly.

Just like your workouts, you have to keep track of your eating and make adjustments based on how your body responds.

10. Wasting Money on Bogus Bodybuilding Supplements

While stopping wasting your money on supplements might not make your muscles suddenly start growing, it will stop your wallet from shrinking. There are a few supplements which have proven to be beneficial, but most provide little or no benefit. If you want to know which supplements work and which don’t, don’t read about them in the bodybuilding magazines – they make a large amount of their money selling advertising to supplement companies and are hardly unbiased sources of information on the subject. Almost everything you read in muscle magazines is bullshit. If you want reliable information on supplements or their ingredients, read the scientific journals, and even then, do so critically.

The diet project mentioned earlier is being put on hold, as all my time and energy is being directed towards getting this book finished. Once the book is finished, if it does well, I will be cutting back my personal training schedule to enable me to focus more on my own training experiments and writing, which will include working with locals and phone clients doing mass-building and cutting programs, as well as to work on a high intensity training certification program.

I urge anybody local who is interested in participating in these experiments to contact me at drew@baye.com

In other news, I plan to participate in the American Lung Association’s Fight for Air Climb on November 14th – a timed 25-story climb to the top of the Bank of America in downtown Orlando to raise money for research on lung diseases. If anyone is interested in donating or forming a team, contact me. If I raise $1,000 I will do the climb wearing 100 pounds of weight plates, or a 100 pound weight vest if I can borrow one or get one from a sponsor.

Editorial: Why Time Magazine’s Article on Exercise and Weight Loss Could Be Harmful to Your Health

By Cedric X. Bryant, Ph.D., F.A.C.S.M., Chief Science Officer, American Council on Exercise

The cover story of the August 9, 2009, issue of Time magazine featured an article entitled, “Why Exercise Won’t Make You Thin.” In this piece, author John Cloud made several inaccurate and unsubstantiated claims regarding the value of exercise, particularly as it relates to weight loss. What follows is a summary of some of the most misleading assertions made in this highly publicized article, as well as the American Council on Exercise’s response to these assertions:

• First and foremost, the article categorically implies that exercise has no meaningful role in weight loss. Such a conclusion is as false as it is reckless. The author’s “evidence” is the fact that he has “gut fat that hangs over his belt when he sits,” despite maintaining a regular exercise habit. In all likelihood, his unwanted abdominal girth is probably a by-product of genetics and/or consuming more calories than he expends.

First off, I should clarify most people’s goal is not indiscriminate weight loss, but improved body composition. This means improving the ratio of muscle to fat, and in most people’s case requiring a significant reduction in fat while minimally maintaining muscle mass. If a person lost 10 pounds of muscle they’d have lost weight, but would look worse and be weaker and less fit. So while ACE use the term weight loss, I’m going to write fat loss, because that’s what people really want.

Second, while genetics plays a role, with a few very rare exceptions it is not an excuse for being fat. Being fat is almost entirely a matter of overeating, and not, as Bryan partly implies in the phrase “…consuming more calories than he expends” that low expenditure is the problem.

I got ripped for a bodybuilding competition doing one high intensity strength training workout per week consisting of only one set each of a few exercises, and lasting around 15 to 20 minutes. Other than that, I was training clients, attending classes or labs, or studying, and actually went out of my way to be less active, as part of the point of entering the contest was to demonstrate it could be done without “cardio”. Clients who follow my nutritional advice consistently lose bodyfat without doing any exercise or increasing their activity levels beyond the one or two weekly workouts they do with me.

Just yesterday I performed skinfold measurements on a client who lost over 17 lbs of fat while gaining over 5 lbs of muscle since June 15 – just a little under ten weeks. He performs two high intensity strength training workouts per week lasting less than 20 minutes each, and does no other exercise. He’s invested about as much of his time working out over the past 10 weeks as organizations like ACE recommend doing in one. He is successful because he is strict with his diet. (Keep it up, Chris!)

It is neither necessary, effective, or an efficient use of time to exercise for the sake of burning calories. No kind of exercise burns enough calories to make a significant difference. Following a proper diet is far a more effective, efficient and safer way of creating a negative energy balance. Aerobics, or “cardio” is probably the biggest time and money wasting sham perpetrated by the fitness industry ever. Rather than help anyone, Ken Cooper is responsible for wasting billions of hours of people’s time, billions of dollars of people’s money, and wrecking a whole lot of joints and spines by popularizing aerobics. So is the American Council on Exercise.

Bryant is correct about exercise having a meaningful role in weight loss, but it is not calorie burning. The biggest benefit of exercise to a person trying to lose fat is the maintenance of muscle while fat is lost. A high intensity strength training program can prevent the loss of muscle while fat is lost, maintaining metabolic rate while improving strength, cardiovascular and metabolic conditioning and other aspects of fitness and health.

• Weight loss and maintenance are a matter of simple accounting that is dependent upon energy balance. In order for weight loss to occur, individuals must burn more calories than they consume. Regrettably, many individuals who regularly exercise are unable to meet their weight-loss goals because they eat too much. In reality, however, their “personal weight situation” and overall health profile would be far worse were it not for the extra calories they expend while exercising.

Fat loss is not as simple as calories in versus calories out. While energy balance is arguably the most important factor, the effect of macronutrient ratios on hormones, metabolic rate, and maintenance of lean body mass is also important.

The extra calories people expend during exercise don’t amount to much. People tend to overestimate this, most likely because people selling exercise or exercise equipment as a way to burn calories exaggerate it.

• An overwhelming body of scientific evidence exists that confirms the positive role that exercise plays in weight loss and maintenance (Hill and Wyatt, 2005; Jakicic and Gallagher, 2003; Jakicic et al., 2001). These findings refute the notion (advanced by the author) that exercise impairs weight-loss efforts by substantially and uncontrollably increasing appetite. Recent research suggests that appetite may be suppressed for 60-90 minutes following vigorous exercise by affecting the release of certain appetite hormones. It also appears that aerobic exercise is more effective at suppressing appetite than non-aerobic forms of exercise (Broom et al., 2009). In general, individuals who participate in moderate exercise tend to eat approximately the same number of calories (or only slightly more) than they would if they did not exercise. Elite-level athletes typically consume high volumes of food after their exercise workouts, but they almost always expend more calories than they consumed (Blundell and King, 1999). It is important to keep in mind, however, that appetite is influenced several factors and is a very complex process making it difficult to generalize the impact of exercise on appetite. The bottom-line is that exercise and diet go hand-in-hand with successful weight management.

I have not yet read the studies mentioned and can’t comment on them, specifically, but where there is a disconnect between the “science” and experience, I tend to trust experience, and in my experience most people who do any kind of intense physical activity work up an appetite in the process.

• Surprisingly (and disappointingly) the author failed to mention the tremendously important role that exercise plays in the maintenance of weight loss. According to data from the renowned National Weight Control Registry, consistent exercise participation is the single best predictor of long-term weight maintenance. In others words, if individuals want to be successful in getting off the weight-loss rollercoaster (i.e., repeatedly losing weight and regaining it), they need to regularly engage in physical activity.

I suspect, as is the case with a lot of studies or surveys on exercise or physical activity and other factors of health, they have confused correlation with causality, or cause and effect. Perhaps the activity isn’t a predictor of long-term weight maintenance so much as people who are a healthier weight tend to be more active because it is easier and more enjoyable for them to do so.

• Another particularly bothersome portion of the article was the misleading comments regarding children and physical activity. A preponderance of evidence shows that kids are often less active after school, not more active as the article implies. As such, community-based youth fitness programs and high-quality school physical education programs are much needed. The available statistics support the fact that well-designed fitness programs aimed at encouraging children to be more active and maintain a healthy body weight remain a significant priority (HHS, 2008).

Improving the body composition of children is more a matter of teaching proper nutrition to the children and parents than getting kids to be more active. While there are benefits of regular physical activity for children, it is not a significant factor in achieving or maintaning a healthy weight.

Youth fitness and physical education programs aren’t going to make any difference if the kids are going home to fast-food dinners, pantries full of junk food and a fridge full of soda.

Needless to say, readers of this article in Time are likely to conclude that exercise is of little to no benefit to them, which makes its publication in such a high profile and respected magazine so disappointing—and possibly even dangerous. Given the enormous economic costs associated with obesity (approximately $147 billion annually), we should be promoting and advocating scientifically proven healthful behaviors like regular exercise participation whenever and wherever we can. Beyond its weight-control benefits, regular exercise provides a plethora of health benefits, including the treatment and prevention of a wide variety of chronic illnesses (heart disease, hypertension, diabetes, certain types of cancer, to name a few), an enhancement of psychological health and well-being, and an improvement in the overall quality of life throughout the human lifespan.

The correct conclusion would be aerobics or “cardio” is of little benefit, and exercising to burn calories is an inefficient waste of time. What organizations like the American Council on Exercise and the American College of Sports Medicine should be promoting is strength training – which provides all the fitness and health benefits mentioned – and better nutrition.

I have no comments on the references at this time, but here they are in case anyone would like to look them up.

References

Blundell, J.E. & King, N.A. (1999). Physical activity and regulation of food intake: Current evidence.Medicine & Science in Sports & Exercise, 31, 11 Suppl., S573-S583.

Broom, D.R. et al. (2009). Influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin, peptide YY in healthy males. American Journal of Regulatory, Integrative and Comparative Physiology, 296, 1, R29-35.

Hill, J.O. and Wyatt, H.R. (2005). Role of physical activity in preventing and treating obesity.Journal of Applied Physiology, 99, 765-770.

Jakicic, J.M. & Gallagher, K.I. (2003). Exercise considerations for the sedentary, overweight adult.Exercise and Sport Sciences Reviews, 31, 2, 91-95.

Jakicic, J.M. et al. (2001). ACSM position stand on the appropriate intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise, 33, 2145-2156.

U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans. Washington, D.C.: Department of Health and Human Services.

Unless you enjoy these activities for their own sake, doing them to burn calories is not worth your time. You could accomplish as much of negative calorie balance in a single day with a few dietary changes as the typical recommendations for increases in activity would amount to over several weeks, without it costing a minute of your time.

In a recent post I mentioned a study from the 2009 European Congress on Obesity (Swinburn BA, et al “Increased energy intake alone virtually explains all the increase in body weight in the United States from 1970s to the 2000s” ECO 2009.) which showed a lack of activity is not the problem. Overeating is. If you want to lose fat, forget about spending a few extra minutes walking an extra block to work; you’ll barely burn the amount of calories contained in a few french fries. Instead, save yourself a few minutes and skip the french fries to begin with.

The following are just a few suggestions for dietary improvements that will make a much bigger difference in fat loss than adding a few minutes of extra activity throughout your day:

• Eliminate or minimize intake of grains and other refined carbohydrates.
• Replace them with a variety of fresh vegetables and fruits, especially leafy vegetables and berries.
• Choose leaner sources of protein – some fats are healthy in moderate amounts but fat is very calorie dense.
• Substitute water or other non-caloric beverages like tea for sodas and fruit juices.

This is not to say I believe people should be inactive. There are other benefits to getting up and moving around. However, doing so makes little or no positive difference in body composition.

The only worthwhile exercise for improving body composition is strength training. High intensity strength training in particular provides the greatest physical benefits relative to the time invested, including all of the cardiovascular and metabolic benefits of aerobics or “cardio”. Strength training directly improves body composition by increasing muscle mass and by preventing loss of muscle mass while fat is lost in people restricting calorie intake, and indirectly because more muscle mass equals a higher basal metabolic rate and more storage space for glucose (as glycogen). High intensity strength training also depletes muscle glycogen levels, so more of the carbohydrate consumed is stored as glycogen in the muscles than as triglycerides in the fat cells.

So, if you’re in a hurry to get to work or have better things to do with your time, go ahead and take the elevator or park in the closest spot – you’re not missing out on any kind of major calorie-burning or conditioning benefits. If you need to lose fat, focus on improving your diet instead.

Anyone who purchases a phone consultation or distance training package between now and the book release (estimated release date 9/14/09) will receive both the paperback and e-book versions free. For the first 30 days after the book is released, anyone who purchases either the paperback or e-book will receive a discount equal to the purchase cost on a phone consultation or distance training package.

In a few weeks I will also be offering an intensive 12-week fat loss program locally which will be available to a limited number of participants and include workout program and diet design. More information will be posted before the end of this month.

EXPERTS DEBUNK MYTH ABOUT EXERCISE, WEIGHT LOSS
Research proves value of exercise, nutrition

According to John Jakicic, Ph.D., FACSM, “There is strong evidence from the majority of the scientific literature that physical activity is an important component for initial weight loss.”

INDIANAPOLIS – Leading experts in exercise and weight management have taken strong exception to assertions that exercise can inhibit weight loss by over-stimulating the appetite.

The “experts” can take exception all they like, but it does not change the fact increased activity stimulates appetite and if a person is not measuring and restricting calorie intake they are more likely to end up with a positive energy balance, resulting in an increase in body fat. While exercise burns very few calories, hardly enough to be worth doing for that purpose, a large amount of calories is very easy to consume.

General physical activity and the types of exercise commonly recommended for fat loss contribute relatively little to a fat loss program, and will make either no difference at all or even make things worse if diet is not being controlled.

Responding to a statement recently published online and in print, Jakicic added that “The statement ‘in general, for weight loss, exercise is pretty useless’ is not supported by the scientific evidence when there is adherence to a sufficient dose of physical activity in overweight and obese adults.” Jakicic chairs a committee on obesity prevention and treatment for the American College of Sports Medicine (ACSM) and helped write an ACSM Position Stand on strategies for weight loss and prevention of weight regain for adults.

According to Jakicic and other experts, overwhelming evidence belies the assertion that exercise doesn’t necessarily help people lose weight and may even make the task harder.

“Again, it is clear in this regard that physical activity is one of the most important behavioral factors in enhancing weight loss maintenance and improving long-term weight loss outcomes,” Jakicic said. In fact, his own research, published in 2008, showed a high dose of physical activity ( 275 minutes above baseline levels) contributed to the greatest observed weight loss after a 24-month intervention. He noted that the scientific literature includes additional evidence to support physical activity, adding that a growing body of literature suggests the importance of physical activity to improve long-term weight loss following bariatric surgery.

Physical activity is definitely not one of the most important behavioral factors in weight loss. While being more active may be a minor factor, contributing to a reduction in energy balance, as I mentioned above it makes no difference unless diet is also controlled. Even then the effect is minimal at best, counterproductive at worst.

I have worked with a large number of people who had previously attempted to lose weight through increased activity, some with, and some without diet, and the increased activity alone has never made a significant difference. Those same people have no trouble losing weight even with a significant reduction in activity – typically dropping several hours of cardio for less than 40 minutes of strength training per week – once they improve their diet.

I recently trained a man who lost 34 pounds in two months, dropping from 263 to 229, with no exercise other than two weekly high intensity strength training workouts lasting less than 20 minutes each, and no additional physical activity beyond his usual daily routine. I have also trained a woman who lost 128 pounds in a little over a year, dropping from 245 to 117 and reducing her weight by over 50 percent using the same program, also without additional physical activity added to her usual routine.

Over the years, I have had clients who attempted to compensate for overeating by performing other activities in addition to their strength training workouts, but the additional activity never made up for their poor diet. In many cases, not only did the additional activity not help them lose weight, they actually got fatter. The ones that did eventually lose weight were able to because they started eating properly.

Diet is by far the most important factor in weight loss. Exercise, or physical activity in general, do not burn enough calories to be worth doing for that purpose, hardly enough to make a significant difference in energy balance alone. As I’ve stated previously, the proper role of exercise in a fat loss program is the maintenance of muscle while fat is lost, which can only be effectively accomplished with strength training, and the amount of weekly strength training required for this is far less than most believe.

Another noted expert and ACSM member, Timothy Church, M.D., Ph.D., described how his professional opinions were misrepresented in a recent news article. According to Church, the article should have touched on the following key concepts:

• Weight maintenance is different from weight loss, and should have been discussed. Virtually all people who lose weight and keep it off are exercising to maintain weight.
• Comments about children and physical activity were misleading. Studies have shown that kids are not necessarily more active after school (and therefore need good in-school physical education program), and that the focus with children should be on physical activity and prevention of excess weight gain. (Adults, however, more often must deal with losing excess weight.)
• Exercise and diet go together. Weight management is most successful when careful attention is given to both physical activity and proper nutrition.

All of these statements are based on the assumption exercise is being performed for the purpose of burning calories or that physical activity in general burns a significant amount of calories, both false.

It doesn’t matter whether a person is trying to lose or maintain weight, “cardio” or increases in general activity make little difference to either. Diet is the most important factor.

Preventing weight gain in children is more a matter of diet than physical activity.

Exercise and diet do, go together, but strength training for the maintenance of muscle, not “cardio” or general physical activity for the sake of burning calories, which is generally a waste of time.

The biggest problem I have with these “experts” telling people physical activity will help them lose weight is it is very hard for many people to change eating habits, but much easier to spend a few hours a week doing some mindless activity like running on a treadmill or participating in a group dance or kickboxing class with a fun social atmosphere, and having been misinformed by these “experts” most people are going to take the easier path. Unfortunately, the easier path doesn’t work very well, and can actually make some people fatter as explained in the Time article.

Janet Rankin, Ph.D., FACSM, an expert in nutrition and exercise, supplemented the bountiful scientific evidence with a simple observation: “A practical response to the claim that exercise makes you eat more and gain weight is to look around. If this were the case, wouldn’t those who regularly exercise be the fattest? Obviously that isn’t the case.”

Gyms are full of people who exercise regularly but are still fat. Every gym I’ve been a member of has had at least a few fat aerobics instructors, and they’re spending more hours per week “exercising” than the members.

ACSM experts stressed that, particularly when so many struggle with the health consequences of overweight and obesity, it is important that Americans have accurate information based on science and evidence.

How ironic.

The  American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 35,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

They my be dedicated, but they’re wrong on this issue. Exercise doesn’t make you lose fat. Proper exercise, strength training, can prevent the loss of muscle while fat is lost, and can contribute to an increase in metabolic rate as well as improving many other aspects of fitness and health, but fat loss is almost entirely a matter of diet.

The article by John Cloud, Why Exercise Won’t Make You Thin, explains how exercise, which does not burn a significant amount of calories to begin with, stimulates an increase in appetite and compensatory eating. According to one study, this compensatory eating may exceed the calories burned during the activity by as much as 100 – enough to cause a fat gain of over 10 pounds per year. One study mentioned showed no difference in fat loss between three exercising groups and a non-exercising control. This is bad news for aerobics instructors and trainers selling various types of “cardio” classes as an effective method of fat loss.

Actually, this is not news at all. I’ve been telling people this for years, and the people at Nautilus were saying the same thing way back in the ’70s. No activity burns enough calories to be worth doing solely for that purpose. The biggest contribution exercise makes to a fat loss program is the preservation of lean body mass while fat is lost. Any contribution to increased calorie expenditure, either as a direct result of the workout or indirectly as a result of increased muscle mass, is minor compared to the role of diet.

Aerobics, “cardio”, endurance training, etc. is a waste of time for fat loss.

If you are not measuring and restricting calorie intake all that activity will make no difference in fat loss, and may very well make you fatter. Even if you are restricting calorie intake to avoid the compensatory eating mentioned above, all that time and effort won’t result in a significant increase in fat loss, and may even result in muscle loss if overdone. A greater reduction in net calorie intake can be accomplished by simply cutting another couple hundred calories, without wasting any time or risking the kind of injuries and joint problems associated with popular “cardio” activities.

Of course, the fitness industry is going to respond to this the way they always do when profitable nonsense is being threatened: they’ll continue making the same ridiculous claims they have been for years and hope people keep believing them. Unfortunately, most people will keep believing them, because it is a lot easier to spend an hour or so performing some mindless activity a few times a week than to exert the kind of effort and discipline required to change one’s eating habits. People want to believe things like hitting the gym on Monday can make up for a weekend of drinking and overeating, or that going for a brisk walk will burn off those Oreos they had at lunch.

It can’t.

Unfortunately, although the article starts out sensibly enough, it ends up going horribly wrong, by simply recommending that rather than waste time doing traditional “cardio” activities people should try to incorporate more lower-intensity activity into their daily routine. The assumption being the more distributed but easier activity will still burn enough calories to significantly reduce energy balance without stimulating the same increases in appetite. The problem with this is, the reason so many people are overweight or obese is not due to a lack of activity, according to a study presented at the 2009 European Congress on Obesity (Swinburn BA, et al “Increased energy intake alone virtually explains all the increase in body weight in the United States from 1970s to the 2000s” ECO 2009.), it is because they eat too much. They state:

“Weight gain in the American population seems to be virtually all explained by eating more calories,” said Boyd Swinburn, M.D., of Deakin University in Australia, lead author of the study. “It appears that changes in physical activity played a minimal role.”

People don’t need more activity. They certainly don’t need “cardio”. In fact, research has shown that obese people actually tend to have higher metabolic rates than people with lower bodyfat levels. What people need is better eating habits. I have never had a client fail to lose fat if they were strict with their diet. However, I don’t know anyone who was able to lose a noticeable amount of fat, much less dramatically transform their physique with “cardio” or any other activity alone.

While fat loss is almost entirely a matter of nutrition, exercise does have a role. Not as a way to burn calories, but to maintain muscle as fat is lost. As long as adequate protein is consumed and calorie intake is not reduced too far, strength training will prevent the loss of muscle while fat is lost. Without strength training muscle may be lost along with fat, resulting in a gradual reduction of metabolic rate along with strength and a decline in related aspects of health and fitness. “Cardio” can accelerate this muscle loss if overdone. Muscle also serves as storage space for glycogen, and the more glycogen that can be stored in the muscles, the less of what is consumed is likely to be stored as fat.

The bottom line is, if you want to lose fat, you need to eat fewer calories, and it helps to also proportion your macronutrients properly (in my experience a Paleo or Zone-style diet consisting of moderate protein and fat, moderate to low carb works best). You should also perform high intensity strength training to maintain muscle mass while fat is lost, but forget “cardio” for fat loss.

http://www.sciencedaily.com/releases/2009/06/090625133215.htm

According to the article, study participants had reduced arterial functioning after consuming high glycemic index foods. More specifically, arterial distention, which the authors claim may lead to cardiovascular disease or heart attacks.

The abstract reads:

The Acute Effect of Various Glycemic Index Dietary Carbohydrates on Endothelial Function in Nondiabetic Overweight and Obese Subjects

Talya Lavi, RD*, Avraham Karasik, MD*,, Nira Koren-Morag, PhD, Hannah Kanety, PhD*,, Micha S. Feinberg, MD, and Michael Shechter, MD, MA,,*

* Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel
Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Manuscript received October 26, 2008; revised manuscript received February 18, 2009, accepted March 3, 2009.

* Reprint requests and correspondence: Dr. Michael Shechter, Leviev Heart Center, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel (Email: shechtes@netvision.net.il).

Part of this study was presented as an abstract at the XXVI Congress of the European Society of Cardiology, Stockholm, Sweden, August 30, 2005.

Objectives: This study sought to explore the effect of glycemic-index dietary carbohydrates on endothelium-dependent flow-mediated dilation (FMD) in overweight and obese nondiabetic volunteers.

Background: Post-prandial hyperglycemia has been recognized as a cardiovascular risk factor in both the diabetic and the general population. Endothelial dysfunction has been shown to occur in diabetic and hyperglycemic patients.

Methods: We prospectively assessed brachial artery FMD in 56 healthy overweight and obese nondiabetic volunteers (38 [67.9%] men, mean age 48 ± 6 years) on 4 separate mornings, 1 to 2 weeks apart. After overnight fasting, the percent FMD (%FMD) improvement and endothelium-independent nitroglycerin-mediated dilation (%NTG) were assessed, after which subjects received 1 of 4 group meals at each visit (placebo [water] or a carbohydrate meal of glucose, cornflakes, or high-fiber cereal). Meals were distributed in a rotating randomized fashion, such that eachsubject received all 4 meals once throughout the study period.

Results: Fasting and 2-h post-prandial serum glucose levels were similar in all 3 meals, whereas at 30 to 90 min, serum glucose levels were significantly higher after glucose and cornflakes (high glycemic) compared with fiber (low glycemic). Baseline %FMD, not significantly different in the 3 carbohydrate-based meals, was reduced 2 h post-prandially in all groups, showing statistical significance in only high-glycemic index meals: glucose (15 ± 9% vs. 10 ± 8%, p < 0.01), cornflakes (13 ± 7% vs. 9 ± 7%, p < 0.01). No correlation was observed between the %FMD reduction rate and glucose levels throughout the study period.

Conclusions: High- compared with low-glycemic carbohydrate consumption significantly suppresses FMD in nondiabetic overweight and obese volunteers, suggesting a mechanism whereby high-glycemic meals may enhance cardiovascular risk.