VersusFit is Total Conditioning – Here’s Why

Muscular Balance, Core Stability, Injury Prevention for

Middle – and Long-Distance Runners (and any motion of the body)

Professor Ted Schtickel

Michael Fredericson, MD, Tammara Moore, PTba

 

Department of Orthopaedic Surgery,

Division of Physical Medicine and Rehabilitation,

Stanford University School of Medicine,

3000 Pasteur Drive R105B, Stanford, CA 94305, USA

Sports and Orthopedic Leaders Physical Therapy, 5297A College Avenue,

Oakland, CA 94618, USA                                                                                   

Martial artists long have recognized the importance of well-developed

core musculature. One of the main differences between a novice practitioner

and a black belt is the black belt’s development and use of his core (called

‘‘center’’ or ‘‘Ki’’) to produce balanced, powerful, and explosive movements.

For middle- and long-distance runners whose chosen sport involves

balanced and powerful movements of the body propelling itself forward

and catching itself in complex motor patternsdthis stable core, as well as

a strong foundation of muscular balance, is essential. In many runners,

however even those at an Olympic level, this core musculature is not

developed fully. Weakness or lack of sufficient coordination in core

musculature can lead to less efficient movements, compensatory movement

patterns, strain, overuse, and injury. This article discusses the importance of

muscle balance and core stability for injury prevention and for improving

a distance runner’s efficiency and performance. It includes a detailed series

of core exercises that can be incorporated gradually into a runner’s training

program. The program starts with restoration of normal muscle length and

mobility to correct any muscle imbalances. Next, fundamental lumbo-pelvic

stability exercises are introduced which teach the athlete to activate the

deeper core musculature. When this has been mastered, advanced lumbopelvic stability

exercises on the physioball are added for greater challenge.

As the athlete transitions to the standing position, sensory motor training used to stimulate

the subcortex and provides a basis for functional

movement exercises that promote balance, coordination, precision, and

skill acquisition. The ultimate goal of core stabilization is to train

‘‘movements’’ and ‘‘positions’’ rather than muscles. Exercises are most

effective when they mirror the demands of the athlete’s sport.

The role of the core

In essence, the ‘‘core’’ can be viewed as a box with the abdominals in the

front, paraspinals and gluteals in the back, the diaphragm as the roof, and

the pelvic floor and hip girdle musculature as the bottom [1]. Within this box

are 29 pairs of muscles that help to stabilize the spine, pelvis, and kinetic

chain during functional movements. When the system works efficiently, the

result is appropriate distribution of forces; optimal control and efficiency of

movement; adequate absorption of ground-impact forces; and an absence of

excessive compressive, translation, or shearing forces on the joints of the

kinetic chain. This efficiency requires an integration of the myofascial,

articular, and neural systems, which, in turn, requires optimal functioning of

the muscles, including the muscles’ ability to contract in a coordinated

manner and with sufficient motor control and neuromodulation so the joints

receive adequate compression through the articular structures. This model

supports an integrated model of joint function [2] and leads to optimal

length-tension ratios and optimal force coupling of the muscles.

Additionally, this model sets the stage for optimal postural alignment, normal

movement patterns, and a minimal potential for joint dysfunction. Biomechanical

studies showed clearly that joint dysfunction anywhere from

the spine to the feet can lead to compromise elsewhere in the kinetic

chain [3].

The first stage in developing a stable core is to develop the abdominal

muscles. Richardson and coworkers [1] discovered that there are two

different types of muscles fibers (slow-twitch and fast-twitch) that comprise

the abdominal muscles; because of this different fiber composition, different

exercise regimens are required to train the abdominal muscles properly.

Slow-twitch fibers primarily make up the local muscle systemdthe muscles

of the deeper abdominal muscle layers. These muscles are closer to the

center of rotation of the spinal segments and, with their shorter muscle

lengths, are ideal for controlling intersegmental motion, maintaining

mechanical stiffness of the spine, and are best suited to respond to changes

in posture and extrinsic loads. The key muscles of this system include the

transversus abdominus, multifidi, internal oblique, deep transversospinalis,

and pelvic floor muscles. McGill [4] described a ‘‘hoop’’ around the

abdomen that consists of the abdominal fascia anteriorly, the lumbodorsal

fascia posteriorly, and the transverse abdominis and internal obliques

muscles laterally. In combination with the intra-abdominal pressure

mechanism, activation of this system serves to tension the hoop and

provide a stabilizing corset to the spine.

Fast-twitch fibers, conversely, primarily make up the global muscle

system (superficial or outer-layer muscles). These muscles possess long levers

and large moment arms that are capable of producing large outputs of

torque, with an emphasis on speed, power, and larger arcs of movement [5].

The main muscles in this layer are the erector spinae, external oblique, and

rectus abdominis muscles — the muscles that are strengthened by traditional

back and abdominal exercises and that assist with gross spinal movements.

Hodges and Richardson [6,7]showed that it is not simply that deep-layer

abdominal muscles are recruited during stabilization of the spine, but it is how

they are recruited that is important. The transverse abdominus, the innermost

of the four abdominal muscles, has fibers that run horizontally (except for the

most inferior fibers, which run in line with the internal oblique muscle). The

transverse abdominus and the multifidi are considered ‘‘stabilizing muscles’’

(muscles that are modulated continually by the central nervous system and

provide feedback about joint position), whereas the global and larger torque

producing muscles control acceleration and deceleration. The investigators

found that the cocontraction of the deeper-layer transverse abdominus and

multifidi muscle groups occurs before any movement of the limbs. They noted

that the transverse abdominus is active 30 milliseconds before movement of

the shoulder and 110 milliseconds before leg movement; this neuromuscular

stabilization may be delayed in individuals who have low back pain. It is

believed that these muscles anticipate dynamic forces that may affect the

lumbar spine and act to stabilize the spine before movement. In agreement

with this, Hides and colleagues [8] documented that patients who sustained

a low back injury had difficulty recruiting their transverse abdominus and

multifidi muscles early enough to stabilize the spine before movement.

For a more detailed discussion on the theoretic basis for core

strengthening, the reader is referred to a recent review article by Akuthota

and Nadler [9].

Muscle imbalances

Stability work should be started only after the athlete has achieved good

mobility, because adequate muscle length and extensibility are crucial to

proper joint function and efficiency. Also required is a proper relationship

between the prime movers, synergists, and stabilizers. A prime mover is the

muscle that provides most of the force during a desired body movement.

Stabilizers and synergists are muscles that assist in the motion by means of

control or neutralizing forces. Proper timing and coordinated effort of these

muscles is paramount to the runner, and the functional exercises included

here stress these relationships.

A thorough evaluation of the muscular system should include an

assessment of the muscles for overactivity, shortening, weakness, inhibition,

and quality of motion. This is accomplished best by using muscle-length

tests, strength tests, and tests for the efficiency of basic movement patterns

and neuromuscular control. A thorough postural observation and videotaping of

the athlete’s running gait will help in assessing and identifying any

movement imbalances. Muscles that are used frequently can shorten and become

dominant in a motor pattern. If a muscle predominates in a motor pattern, its antagonist

may become inhibited and cause a muscle imbalance. An example of this is

tightness in the iliopsoas muscledthe primary hip flexor that has its origins

at the anterolateral aspect of the lumbar vertebral bodies and its transverse

processes. When the iliopsoas muscle is tight or shortened, it is believed to

inhibit the deep abdominals and the primary hip extensordthe gluteus

maximus. Inhibition of the gluteus maximus muscles may result in

inadequate stabilization of the lumbar spine, with increased anterior shear

and extension forces on the lower lumbar vertebrae.

Muscles are divided into two types: postural and phasic (Box 1). Postural

muscles are used for standing and walking. Phasic muscles are used for

running; they propel the runner. Although 85% of the gait cycle is spent on

one leg when walking [10], when running, there is a double-float phase

during which both legs are off the ground — one at the beginning and one at

the end of swing phase. Running mechanics demand efficient firing patterns

from the postural muscles, whereas phasic muscles do the work of

propelling the runner forward. Because postural muscles are being activated

constantly in the human body to fight the forces of gravity, they have

a tendency to shorten and become tight. In runners, because of training and

prolonged use, certain postural muscles are particularly likely to tighten,

shorten, and become hypertonic. This occurs predominately in muscles that

cross more than one joint [11]. We commonly see this in the gastroc-soleus

(predominantly the soleus), rectus femoris, iliopsoas, tensor fascia lata,

hamstrings, adductors, quadratus lumborum, piriformis, and sartorius.

Restricted extensibility of muscles also can lead to decreased circulation and

ischemia, which contributes to overuse injury [12].

In comparison, phasic muscles (the more global muscles) typically may

remain in an elongated state. It was shown that elongated muscles may lack

force in shortened-range test positions[13]. Weak phasic muscles might allow

excessive motion to occur at the joints upon which they act. In our experience,

common phasic muscles that have a tendency to develop weakness or become

inhibited in runners are the tibialis anterior; peronei; vastus medialis; long

thigh adductors; and the gluteus maximus, medius, and minimus.

Beginning a core strengthening program

The first step in a preventive or performance-enhancing program is to

assess which muscles have become tight and shortened. These deficits can be

addressed with stretching exercises and soft tissue mobilization techniques.

Following this, the clinician should seek to activate inhibited, or strengthen

any weak, muscle groups. The challenge for the clinician is to design an

individualized program that addresses these imbalances.

Preliminary stretches for shortened, predominant muscles should include

proprioceptive neuromuscular facilitation–type or contract-relax stretches

that strive for isometric contraction, followed by end-range stretching. These

are effective techniques for maintaining muscle length and joint mobility.

Active Release Techniques [12], (a specialized method for soft tissue

mobilization) when used in conjunction with stretching techniques, have

shown great promise in restoring muscle length and soft tissue extensibility.

Athletes also can do self-mobilization with the use of a foam roll. One example

of this technique targets the iliotibial band, is shown in Fig. 1.

Middle-distance runners have unique and specific training programs that

demand strength, power, and endurance. These runners place terrific

demands for balance and precise functioning of structures all the way from

the core to the feet. Specific exercises for the runner should progress from

mobility to stability, reflexive motor patterning, acquiring the skills of

fundamental movement patterns, and finally, progressive strengthening.

These sequences may not be applicable to all athletes; therefore, the key is to

analyze the individual in each exercise category and then to tailor an exercise

regimen that will best suit that runner’s needs. For example, it was shown

that runners who are prone to iliotibial band syndrome often have weakness

in their hip abductors that predisposes them to increased stress on the

iliotibial band [14]. Thus, a preventative training program for runners who

have this syndrome must target the hip abductors, particularly the posterior

aspect of the gluteus medius that assists external rotation or in decelerating

adduction of the hip. Other muscles that prove weak or inhibited on

evaluation also should be strengthened on a case-by-case basis.

The stages of core training

Warm-up

 

Before beginning the basic core strengthening exercises, the athlete

should warm-up the spine with the Cat-Camel motion (Fig. 2).

Fundamental lumbo-pelvic stability

 

The purposes of the fundamental core stabilization exercises are to gain

stability, but more importantly, to gain coordination and timing of the deep

abdominal wall musculature. It is extremely important to do these basic

exercises correctly because they are the foundation of all other core exercises

and movement patterns. These basic exercises emphasize maintaining the

lumbar spine in a neutral position (which is the midrange position between

lumbar extension and flexion.) This alignment allows for the natural

curvature of the spine. All of these exercises are best done with light loads

and high repetitions.

This first stage of core stability training begins with the athlete learning to

stabilize the abdominal wall. Proper activation of these muscles is considered crucial

in the first stages of a core stability program, before progressing to more dynamic and

multiplanar activities. We recommend the abdominal bracing technique as described

by McGill (Fig. 3) [4].

The exercise program should progress sequentially through the initial

fundamental movements as detailed inFigs. 4 through 8. These fundamental

exercises are to be performed three times a week to maximize results. The

athlete begins with two sets of 15 repetitions and progresses to three sets of

15 to 20 repetitions to develop fully the requisite muscle endurance for

higher level performance. Initially, these exercises are taught in a supine,

hook-lying position or an all-fours quadruped position. The athlete can

progress to more functional standing exercises as control is developed.

Important concepts that are taught at this stage include not tilting the pelvis

or flattening the spine. We also emphasize normal rhythmic breathing.

Advanced lumbo-pelvic stability

 

Once the athlete demonstrates good stability with all static core exercises,

they can be replaced with more advanced exercises as detailed in Figs. 9

through 14. The use of the physioball requires the athlete to work on

proprioception and higher level core stabilization. These exercises should be

performed two to three times weekly to maximize results. Again, the athlete

begins with one or two sets of 15 repetitions and progresses to three sets of

15 to 20 repetitions. Quality is more important than quantity. Make sure

that the lumbar spine does not go into extension or the cervical/thoracic

spine into flexion and maintain the spine in perfect alignment.

As the athlete progresses through a core exercise program, the emphasis

always should be on correct postural alignment as athletes challenge

themselves with a variety of movement patterns in the three planes of

movement: sagittal, frontal, and transverse. Although runners move

predominately in the sagittal plane, there still is body movement in the

transverse and frontal planes that must be controlled adequately by the

neuromuscular system. During midstance of the running gait cycle, the foot

and ankle unlock to allow absorption of ground reaction forces. During this

phase, the body is challenged most to control excessive or aberrant motion

in the frontal and transverse planes. Functional exercises on one leg are used

to best simulate the neuromuscular demands of running. The athlete is

trained with increasingly challenging functional patterns, with continued

emphasis on postural control and core stabilization. The ultimate goal of

core stabilization is to train ‘‘movements’’ and ‘‘positions,’’ rather than

muscles. Exercises are most effective when they mirror the demands of the

athlete’s sport.

Development of balance and motor control

 

The following movements require reflexive control. The athlete can

accomplish this control by using the numerous proprioceptors in the soles of

the feet and the exteroceptors of the skin, and by activating the neck

muscles; these are highly contributory to postural regulation. This sensory motor

stimulation is an attempt to provide the subcortex with a basis for

movement that is progressively more challenging. It involves exercises that

stimulate balance, coordination, precision, and skill acquisition.

The following exercises should be performed while standing (Figs. 15–

17). We instruct the athlete to control the feet, pelvis, and head consciously,

with the goal of making sure that the feet are aligned properly.

These exercises use a rocker board. A rocker board is a board with

a hemisphere underneath that allows single-plane rocking. (The board was

designed by Dr. Vladimer Janda to promote balance and stability of the

spine, www.optp.com).

Common errors or abnormal compensations to look for when attempting

these exercises include increased anterior pelvic tilt, increased lumbar

lordosis, increasing internal rotation of the hip, excessive valgus at the knee,

and hyperpronation at the foot. Therefore, when teaching these exercises, it

is imperative to instruct the athlete on proper spinal alignment. To aid in

this, we recommend initiating the abdominal bracing technique before

performing the stepping forward-and-backward motions of any of these

exercises (which train correct weight transfer over the feet). Additionally, it

is important to instruct the athlete on proper gait. The focus here should be

on controlling the initial heel strike in a supinated position on the lateral

edge of the foot, into pronation on the medial aspect of the foot, with flexion

of the first metatarsal head and toes. Continuing proper gait instruction, we

teach a falling-forward position into a lunge (with perfect control). The

athlete then progresses to jumps on one or two legs, assuring that there is no

increased lumbar lordosis or increased valgus moment at the knee. This

stimulates vestibular and cerebellar activity, which, in turn, leads to

automatic postural controldan important part of our training. (Readers

will note the increased muscle activity of the ankles and muscles that control

the lower extremity chain and spine.) The athlete can progress to standing

on one leg, with alternating arm movements.

Various devices are useful to challenge balance progressively, moving the

athlete from conscious to subconscious control of the muscles that are

responsible for postural maintenance and gait. These devices include

a balance board (a whole sphere underneath the board, which creates

multiplanar instability) or a rocker board (a curved surface underneath the

board, which allows single-plane motion). Dynamic foam rollers are an

inexpensive alternative to the boards that also can be used to challenge

balance, proprioception, and stability. These include half-rollers and fullsized rollers.

Two other items that are invaluable to challenge balance and

core stability and aid proprioceptive training in the standing position are the

Bosu Balance Trainer and the Dyna Disk (these can be used interchangeably). T

he Bosu has two functional surfaces that integrate dynamic balance

with sports-specific or functional training: the domed surface is convex, the

other side is flat and can be used for less challenge. The Dyna Disk is an air-

filled plastic disc that can be inflated firmly. It has a smaller diameter than

the Bosu and can be used like the Bosu Trainer because it creates an

increased proprioceptive challenge to the athlete while standing on it. The

Dyna Disk is unstable and does not have a base like the Bosu Trainer.

Functional movement training

 

Functional movements require acceleration, deceleration, and dynamic

stabilization. Figs. 18 through 24 present an array of functional, diagonal

exercises for the trunk and extremities that are essential for runners.

Exercises should be safe, challenging, and stress multiplanar motions. These

training exercises encourage functional strength, which depends on the

neuromuscular system’s ability to produce dynamic eccentric, concentric,

and isometric contractions during movement patterns.

A functional exercise regimen that is specific to the demands of running

includes single-leg drills, three-dimensional lunges, resistive diagonal

patterns of the upper and lower extremities, drills that involve plyometrics,

and triplanar movement sequences. Athletes can progress through the three

planes of motion by performing similar exercises on balance boards, the

Dyna Disk, or Bosu-type trainers, after static trunk and core stability have

been mastered.

Summary

This article is intended to provide an understanding of the importance of

core musculature to runners and to offer exercises that will help them

achieve desired mobility, stability, muscular balance, and neuromuscular

control. Please see Table 1 for an example of how to incorporate these

exercises into a periodized training program. It is highly recommended,

however, that athletes consult a skilled practitioner to address individual

needs and maximize results from a program of this nature.

References

[1] Richardson C, Jull G, Hodges P, et al. Therapeutic exercise for spinal stabilization and low

back pain: scientific basis and clinical approach. Edinburgh (Scotland): Churchill Livingstone; 1999.

[2] Lee D. An integrated model of ‘‘joint’’ function and its clinical application. Fourth

Interdisciplinary World Congress on Low Back and Pelvic Pain. Montreal, Canada, p. 138.

[3] Nicholas JA, Strizak AM, Veras G. A study of thigh muscle weakness in different

pathological states of the lower extremity. Am J Sports Med 1976;4:241–8.

[4] McGill S. Ultimate back fitness and performance. Waterloo: Wabuno Publishers; 2004.

[5] Comerford MJ, Mottram SL. Movement and stability dysfunction–contemporary developments. Man Ther 2001;6:15–26.

[6] Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain

with upper limb movement at different speeds. Arch Phys Med Rehabil 1999;80:1005–12.

Table 1

Periodization of core training program

Summer/Falldbase training Winterdsport specific Spring/Summerdcompetition

(3 /wk, 3 sets of 15–20

repetitions for each exercise)

(2–3 /wk, 2–3 sets of 10–15

repetitions for each exercise)

(1–2 /wk, 2–3 sets of 8–12

repetitions for each exercise)

Restore mobility/address

any muscle imbalances

Advanced core stability

exercises

Similar to sports specific

training with addition of

Fundamental core stability plyometric exercises

exercises

Functional movement

training

Sensory motor stimulation

688 FREDERICSON & MOORE[7] Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine

associated with low back pain. A motor control evaluation of transversus abdominis. Spine

1996;21:2640–50.

[8] Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after

resolution of acute, first-episode low back pain. Spine 1996;21:2763–9.

[9] Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 2004;85:S86–92.

[10] Janda V. On the concept of postural muscles and posture in man. Aust J Physiother 1983;29:

83–4.

[11] Kendall F, McCreary E, Provance P. Muscle testing & function. Baltimore: Williams and

Wilkins; 1993.

[12] Schiottz-Christensen B, Mooney V, Azad S, et al. The role of active release manual therapy

for upper extremity overuse syndromes-a preliminary report. J Occup Rehabil 1999;9:

201–11.

[13] Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis:

Mosby; 2000.

[14] Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance

runners with iliotibial band syndrome. Clin J Sport Med 2000;10:169–75.

Types of Body Fat and What To Do About All

VersusFit Studio Training

VersusFit is total body training simultaneously engaging all muscle groups. Your metabolism will burn more calories and more fat during and hours after a VersusFit workout. http://www.versusfit.com & VersusFit Studios.

(This article was first printed in the December 2006 issue of the Harvard Women’s Health Watch. For more information or to order, please go to http://www.health.harvard.edu/womens.)

Though the term might sound dated, “middle-age spread” is a greater concern than ever. As women go through their middle years, their proportion of fat to body weight tends to increase — more than it does in men. Especially at menopause, extra pounds tend to park themselves around the midsection, as the ratio of fat to lean tissue shifts and fat storage begins favoring the upper body over the hips and thighs. Even women who don’t actually gain weight may still gain inches at the waist.

At one time, women might have accepted these changes as an inevitable fact of postmenopausal life. But we’ve now been put on notice that as our waistlines grow, so do our health risks. Abdominal, or visceral, fat is of particular concern because it’s a key player in a variety of health problems — much more so than subcutaneous fat, the kind you can grasp with your hand. Visceral fat, on the other hand, lies out of reach, deep within the abdominal cavity, where it pads the spaces between our abdominal organs.

Visceral fat has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes. In women, it is also associated with breast cancer and the need for gallbladder surgery.
Abdominal fat locations

Generally speaking, abdominal fat is either visceral (surrounding the abdominal organs) or subcutaneous (lying between the skin and the abdominal wall). Fat located behind the abdominal cavity, called retroperitoneal fat, is generally counted as visceral fat. Several studies indicate that visceral fat is most strongly correlated with risk factors such as insulin resistance, which sets the stage for type 2 diabetes. Some research suggests that the deeper layers of subcutaneous fat may also be involved in insulin resistance (in men but not in women).

Where IS the fat?

Fat accumulated in the lower body (the pear shape) is subcutaneous, while fat in the abdominal area (the apple shape) is largely visceral. Where a woman’s fat ends up is influenced by several factors. Heredity is one: Scientists have identified a number of genes that help determine how many fat cells an individual develops and where these cells are stored (Proceedings of the National Academy of Sciences, April 25, 2006). Hormones are also involved. At menopause, estrogen production decreases and the ratio of androgen (male hormones present in small amounts in women) to estrogen increases — a shift that’s been linked in some studies to increased abdominal fat after menopause. Some researchers suspect that the drop in estrogen levels at menopause is also linked to increased levels of cortisol, a stress hormone that promotes the accumulation of abdominal fat.

As the evidence against abdominal fat mounts, researchers and clinicians are trying to measure it, correlate it with health risks, and monitor changes that occur with age and overall weight gain or loss. The most accurate measurement techniques, magnetic resonance imaging and computed tomography, are expensive and not available for routine use. However, research using these imaging methods has shown that waist circumference reflects abdominal fat. It has largely superseded waist-to-hip ratio (waist size divided by hip size) as an indicator of fat distribution, because it is easier to measure and about as accurate. There’s also evidence that waist circumference is a better predictor of health problems than body mass index (BMI), which indicates only total body fat (see “Measuring up”).
Measuring up

Researchers have tried several ways of measuring the links between health risks and body weight or fat distribution:

Body mass index (BMI). A ratio of weight in kilograms to the square of height in meters, BMI helps identify people whose weight increases their risk for several conditions, including heart disease, stroke, and diabetes. People with BMIs of 25–29.9 are considered overweight, and those with BMIs of 30 or over, obese. However, some researchers think BMI isn’t always a valid indication of obesity, because it gives misleading results in people who are very muscular or very tall. To calculate your BMI, go to http://www.nhlbisupport.com/bmi or use this formula: Weight in pounds × 703 ÷ (height in inches)2.

Waist-to-hip ratio. To find your waist-to-hip ratio, divide your waist measurement at its narrowest point by your hip measurement at its widest point. As a marker of a person’s abdominal fat, this measure outperforms BMI. For women, the risk for heart disease and stroke begins to rise at a ratio of about 0.8.

Waist circumference. The simplest way to check for abdominal fat is to measure your waist. Run a tape measure around your torso at about the level of your navel. (Official guidelines determine the level at which waist circumference is measured by locating a bony landmark: the top of the right hipbone, or right iliac crest, where it intersects a line dropped vertically from the middle of the right armpit.) Breathe minimally, and make sure not to pull the tape measure so tight that it depresses the skin. In women with a BMI of 25–34.9, a waist circumference greater than 35 inches is considered high risk, although research suggests there is some extra health risk at any size greater than 33 inches. A study in the September 2006 American Journal of Clinical Nutrition found that in women, a large waist was correlated with diabetes risk — even when BMI was in the normal range (18.5–24.9). Since abdominal fat can be a problem despite a normal BMI, health assessments should include both BMI and waist circumference. The relationship between waist circumference and health risk varies by ethnic group. For example, in Asian women, a waist circumference above 31.5 inches is considered a health risk.

The good news is that visceral fat yields fairly easily to exercise and diet, with benefits ranging from lower blood pressure to more favorable cholesterol levels. Subcutaneous fat located at the waist — the pinchable stuff — can be frustratingly difficult to budge, but in normal-weight people, it’s generally not considered as much of a health threat as visceral fat is. In fact, a study published in the New England Journal of Medicine in 2004 found that liposuction removal of subcutaneous fat (up to 23 pounds of it) in 15 obese women had no effect after three months on their measures of blood pressure, blood sugar, cholesterol, or response to insulin. Weight loss through diet and exercise, on the other hand, triggers many changes that have positive health effects.
What’s wrong with abdominal fat?

Body fat, or adipose tissue, was once regarded as little more than a storage depot for fat blobs waiting passively to be used for energy. But research suggests that fat cells — particularly abdominal fat cells — are biologically active. It’s more accurate to think of fat as an endocrine organ or gland, producing hormones and other substances that can profoundly affect our health. One such hormone is leptin, which is normally released after a meal and dampens appetite. Fat cells also produce the hormone adiponectin, which is thought to influence the response of cells to insulin. Although scientists are still deciphering the roles of individual hormones, it’s becoming clear that excess body fat, especially abdominal fat, disrupts the normal balance and functioning of these hormones.

Scientists are also learning that visceral fat pumps out immune system chemicals called cytokines — for example, tumor necrosis factor and interleukin-6 — that can increase the risk of cardiovascular disease by promoting insulin resistance and low-level chronic inflammation. These and other biochemicals, some not yet identified, are thought to have deleterious effects on cells’ sensitivity to insulin, blood pressure, and blood clotting.

One reason excess visceral fat is so harmful could be its location near the portal vein, which carries blood from the intestinal area to the liver. Substances released by visceral fat, including free fatty acids, enter the portal vein and travel to the liver, where they can influence the production of blood lipids. Visceral fat is directly linked with higher total cholesterol and LDL (bad) cholesterol, lower HDL (good) cholesterol, and insulin resistance.

Insulin resistance means that your body’s muscle and liver cells don’t respond adequately to normal levels of insulin, the pancreatic hormone that carries glucose into the body’s cells. Glucose levels in the blood rise, heightening the risk for diabetes. Together, insulin resistance, high blood glucose, excess abdominal fat, unfavorable cholesterol levels (including high triglycerides), and high blood pressure constitute the metabolic syndrome, a major risk factor for heart disease and stroke.

Excess fat at the waist has been linked to several other disorders as well. A European study of nearly 500,000 women and men found that, for women, a waist-to-hip ratio above 0.85 was associated with a 52% increase in colorectal cancer risk. A long-running community study on atherosclerosis conducted by researchers at Wake Forest University found that even among normal-weight people, those with higher waist-to-hip ratios had just as much difficulty as those with higher BMIs in carrying out various activities of daily living, such as getting in and out of bed and performing household chores.

A larger waist measurement also predicts the development of high blood pressure, regardless of total body fat, according to a 10-year study of Chinese adults published in the August 2006 American Journal of Hypertension. Finally, a study presented at the 2005 annual meeting of the Society for Neuroscience found that older people with bigger bellies had worse memory and less verbal fluency, even after taking diabetes into account.
Now for the good news

So what can we do about tubby tummies? A lot, it turns out. The starting point for bringing weight under control, in general, and combating abdominal fat, in particular, is regular moderate-intensity physical activity — at least 30 minutes per day (and perhaps up to 60 minutes per day) to control weight. In a study comparing sedentary adults with those exercising at different intensities, researchers at Duke University Medical Center found that the non-exercisers experienced a nearly 9% gain in visceral fat after six months. Subjects who exercised the equivalent of walking or jogging 12 miles per week put on no visceral fat, and those who exercised the equivalent of jogging 20 miles per week lost both visceral and subcutaneous fat.

Strength training (exercising with weights) may also help fight abdominal fat. A University of Pennsylvania study followed overweight or obese women, ages 24–44, for two years. Compared to participants who received only advice about exercise, those given an hour of weight training twice a week reduced their proportion of body fat by nearly 4% — and were more successful in keeping off visceral fat.

Spot exercising, such as doing sit-ups, can tighten abdominal muscles, but it won’t get at visceral fat.

Diet is also important. Pay attention to portion size, and emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread, refined-grain pasta, and sugary drinks. Replacing saturated fats and trans fats with polyunsaturated fats can also help. But drastically cutting calories is not a good diet strategy, because it can force the body into starvation mode, slowing metabolism and paradoxically causing it to store fat more efficiently later on.

Scientists hope to develop drug treatments that target abdominal fat. For example, studies of the weight-loss medication sibutramine (Meridia), which was approved in 1997, have shown that the drug’s greatest effects are on visceral fat. Rimonabant (Acomplia) — not yet FDA-approved — is the first of a new class of drugs that block a receptor in the brain that increases appetite. Acomplia has been shown to modestly reduce the accumulation of fat at the waist.

Because levels of the hormone dehydroepiandrosterone, better known as DHEA, decline with age, many people believe that DHEA supplementation can reverse age-related changes, including increased abdominal fat. DHEA is converted in the body to testosterone and estrogen and regulates various functions. Some studies have linked DHEA to longevity in animals and people, and others have linked it to modest health benefits. But the results of a two-year randomized trial published in the Oct. 19, 2006, New England Journal of Medicine showed that DHEA had no effect on aging markers, including body-composition measurements, in women and men ages 60 and over.

For now, experts stress that lifestyle, especially exercise, is the very best way to fight visceral fat.

(This article was first printed in the December 2006 issue of the Harvard Women’s Health Watch. For more information or to order, please go to http://www.health.harvard.edu/womens.

Why VersusFit Bodyweight Suspension Training

Professional Boxing Welterweight Champion, Jesus Soto-Karass with Darrel Clouse / VersusFit, just after knocking out Andre Berto in the 12th round on Showtime Championship Boxing.

Bigger + stronger = better? No, this is NOT always true. In fact, with the exception of weightlifting contests or bodybuilding pageants, bigger and stronger can be a hindrance. Yes, it is so. For performance fitness, or “readiness for performance based competition”, there is definitely a law of diminishing returns that, more often than not, comes into play. For example professional boxing, the champ boxer pictured above, Jesus Soto – Karass, is not as muscular as his opponent, Andre Berto. Berto looked very impressive; muscular and well defined. Jesus Soto – Karass, lean, not overly muscular, but very athletically built. Well into the fight, it became obvious which fighter had spent more time in the weight room versus being in a boxing ring. Berto is good; very, very good….however he came into this fight looking great, almost like a bodybuilder. Too much muscle. Berto became “gassed”, his boxing mechanics became flawed subject to muscle suffering from muscle fatigue. Soto – Karass did not get so fatigued that his punch execution became flawed, he saw to it that he was at a proper weight and fit. Soto – Karass was thus able to keep consistent attack on his opponent, Andre Berto, and ultimately won by a knockout in the 12th round.

These two boxers standing in the middle of the boxing ring, next to each other, anyone can tell who lifts a lot of weights; Berto. Additional muscle mass can, and usually is, very taxing on the cardiovascular system. Our bodies are not able to “fuel” or even provide enough oxygen to these vital muscles during a boxing match, a football game, tennis, or most any sport excluding weightlifting or bodybuilding. This is a very real factor even that professionals must deal with. Performance enhancing drugs? Those are shortcuts that will not necessarily make a good featherweight an even better welterweight, or even a professional football lineman better. What good are learned skills in ANY sport if you can’t complete the contest? You and I see this happen often in pro sports whether it is late in the fourth quarter of a tough football game (oxygen?) or in the the later rounds of a tough boxing fight. VersusFit Supercharged Bodyweight Training will give you just the proper physique that you need for performance, general fitness, and life. Bodyweight training is also far less likely to cause injury, or aggravate injury suffered in the ring, on the field, or at a church softball game.  Versusfit Bodyweight Training is even good therapy for healing, improving balance, coordination, and stability. It works for me and many, many others including professional boxers, pro football players, Special Forces, and SPECIAL Moms & Dads who wish to remain active and in good health for so many family members who love them so much. Thanks.         http://www.versusfit.com