The complementary medicine claim game – scientific fact or marketing fiction?

by Tess Wilson | Tuesday, May 26, 2015

This blog post was written by Tess Wilson, a Membership Consultant with Australian Fitness Network. A former competitive swimmer, Tess is passionate about healthy living and the life-enhancing power of healthy, nourishing and delicious real food.

The use of complementary medicines in Australia has increased significantly in recent years. Supermarket and pharmacy aisles are awash with vitamins and minerals marketed to consumers with a promise to temper the risk factors associated with disease, recapture ‘lost’ energy, and ‘enhance performance’. Accessible, convenient and seemingly healthy, it’s little surprise that (propelled by powerful industry advertising) millions of Australians have been quick to adhere to the multivitamin trend. But do the health claims made by the companies producing these products stack up?

In Australia, the advertising of complementary medicines is regulated by the Therapeutic Goods Advertising Code, which aims to ensure that the ‘mad men’ marketers behind the advertising of these products do not mislead or deceive consumers. According to the code, an advertisement for a therapeutic good must not provoke unrealistic expectations of product effectiveness or imply that it is a reliable substitute for sufficient nutrition.

In many cases, however, marketing gluttony subdues genuine claims, and these products are sold on false assurances. Many Australian household vitamins have no proven health benefit, meaning that many consumers are unwittingly replacing, and at times relying on these products to provide the benefits claimed or implied by these companies.

For example, products targeted at maintaining heart health are often accompanied with a promise to lower cholesterol and sustain healthy blood pressure levels. These products, sold on the value of vitamin E, B, B12, and folic acid for heart health, are not supported by evidence-based clinical trials, or rigorous testing; unlike that which pharmaceutical drugs must undertake in order to support their claims. So how are we to know if a ‘heart health’ vitamin sold next to our Wonder White will indeed ‘reduce the risk of cardiovascular disease’?

Furthermore, the active ingredients in many multivitamins are often at very low doses; so low in many cases that the product becomes essentially useless. In some instances multivitamins targeted at older Australians contain just 100mg of glucosamine, which is not even one-fifth of the 1500mg measure of glucosamine shown to be effective in clinical studies of patients suffering pain associated with osteoarthritis.

While there is a place for supplementation – specific vitamins and minerals, for example, can be beneficial for women who are pregnant or trying to conceive, people on restrictive diets and the aged – the majority of people can fulfill their vitamin and mineral requirements by eating a healthy diet. A balance of protein, grains, fruits, vegetables, dairy and fats provide the vitamins we need for our health; choosing high-fibre foods and fish with omega-3 fatty acids can reduce the absorption of cholesterol into the bloodstream and reduce blood pressure.

There is no replacement for healthy eating; a balanced diet is the best way to take your vitamins. It is important to be aware of the facts and understand the limitations of these products and their associated claims. Your healthcare professional can guide you through the right choices and offer advice on what complementary medicines may be suitable for you.

May 2015

HIIT: EFFICIENT, EFFECTIVE AND ENJOYABLE?

As high intensity interval training enjoys newfound popularity in mainstream fitness, Wendy Sweet explores the research – and highlights the cautions – relating to HIIT training for fitness professionals.
Intermittent work:rest ratio of exercise performed to exhaustion has been a training modality of elite athletes for years. More recent research, however, suggests that the packaging of high intensity interval training (HIIT) strategies into exercise programs for clinical and overweight populations is not only an effective way to improve aerobic metabolism in more sedentary individuals, but may even provide a more time-efficient and enjoyable way to work out than steady-state endurance exercise.
As well as being employed in the training of elite athletes, sprint interval-type training has been evident in the fitness industry for some time: it is not a new concept in how to get the ‘best’ results. Since my time teaching ‘aerobics’ throughout the early 1980s and 1990s, we knew that both the intensity of the cardio component, as well as how we structured the class (‘harder’ alternated with ‘easier’ music tracks), offered the secret to success, not only for fitness improvement but also for weight management. We could see that those members who regularly attended harder 50-minute classes that were structured in a hard:easy, ‘multi-peak’ way seemed to derive greater physiological and psychological benefits from each workout compared to members who worked out in what were, back then, marketed as ‘fat burner’ classes – up to 90 minutes of continuous, low intensity exercise. Those of us teaching in the days of ‘fat burning’ classes also knew what happened after about 45 minutes – those new to exercise, and also those with perhaps the most ‘fat to burn’, left! Not only did they have other things to do with their time, but after a while they became disillusioned as the fat failed to burn off!
Fast-track nearly three decades and we now know a lot more about the physiology behind what we were seeing (but not fully understanding) in those early days of exercise-to-music classes. Firstly, thanks to the work that went into the Wingate Protocol of anaerobic power testing for cyclists in the 1970s, we know more about quick, intense (maximal) workouts and the effect on anaerobic fitness and muscular power.
Secondly, based on the exercise physiology research that has emerged over the past two decades, we have greater understanding of energy systems and intensity of training, particularly as it relates to lipolysis (fat burning) and the muscular and mitochondrial changes that accrue from the effect of the post-exercise ‘after-burn’ (Excess Post-exercise Oxygen Consumption [EPOC Response]).`
Based on this knowledge, the last decade has seen harder exercise-to-music classes being restructured accordingly, and personal trainers who keep up-to-date with the latest research including ‘aerobic interval training’ strategies in their weight loss clients’ weekly programming regimes.
Today, thanks to more recent physiological research specific to low volume (time-efficient) HIIT training, we have even more knowledge about the physiological mechanisms behind this type of exercise strategy and, more importantly, why it is emerging as a ‘hit’ with trainers, clients and medical practitioners alike.
What is HIIT?
HIIT describes a regime of training that is based on the development of the Wingate test, i.e. a sprint, interval training workout consisting of 30 seconds of ‘all-out’ cycling effort against a supra-maximal load, immediately followed by up to four minutes of ‘recovery time’. Training bouts of between four and six work efforts followed by subsequent rest intervals mean that intense, anaerobic workouts can be completed in around 20 minutes.
The physiology behind HIIT
Studies on these types of high intensity interval workouts have demonstrated substantial increases in the oxidative capacity of skeletal muscles, as reflected by the activity of mitochondrial enzymes. Increasing the oxidative capacity of muscles is critical for a host of physiological adaptations in the human body, such as improved fat burning, improved cardiovascular fitness and more efficient functioning and use of stored glucose (glycogen) in muscles and the liver. According to researchers (Gibala, Little, MacDonald & Hawley, 2012), other adaptations have also been seen. These include increased resting glycogen content (good for restoring energy quickly); reduced rate of lactate production (this means new exercisers won’t ‘burn out’ as quickly while working at a harder intensity); increased rates of whole-body as well as skeletal muscle lipid oxidation (fat utilisation); and, finally, improved exercise performance as measured by time-to-exhaustion.
For those individuals new to exercise or trying to improve their health and reduce their weight, this is exciting information. As it has been traditionally known that these adaptations mainly occurred as a result of low intensity (65 per cent effort or less) continuous, endurance exercise as advocated by current public health guidelines, i.e. 60 to 90 minutes of continuous exercise, HIIT is now seen as offering a time-efficient strategy of training. With obesity, insulin-resistance, type 2 diabetes and cardiovascular disease on the increase in both Australia and New Zealand (International Obesity Taskforce, 2010; Ministry of Health, 2012) and with ‘lack of time’ known to be the greatest disincentive to exercise for many people, HIIT offers fitness professionals and health promoters another ‘tool’ for motivating, supporting and engaging a wide range of the population, including higher-risk individuals, into structured exercise.
Structuring a HIIT session
As with interval training for elite athletes, a number of variations of the HIIT training methods are emerging in the wider fitness industry. Most studies support the notion that it takes at least six weeks of low-volume HIIT for physiological effects to be seen. A protocol of HIIT suggested through research undertaken at McMaster University’s Centre for Active Living in Canada, (Gillen, August 2012), is to have clients or participants warm up on a stationary cycle for three to four minutes, before increasing the resistance on the bike until they are at about a Level 9 out of 10 on their rate of perceived exertion (RPE). At this level of intensity they perform one minute of hard effort, cycling as fast as they can. They follow this by reducing the workload until their effort drops down to an easy Level 4 RPE. This work:rest ratio is undertaken about 10 times.
Other HIIT protocols have also emerged using either different modes of exercise (e.g. swimming, running, stepping and rowing) or, depending on the starting fitness level of new exercisers, a longer rest component is allocated, e.g. one minute hard effort, followed by up to four minutes of light activity or rest (this lengthened rest period allows for some lactate clearance).
Cautions with HIIT training
Any exercise has cautions associated with it, and fitness professionals must recognise that it’s still a case of ‘one size doesn’t fit all’ when it comes to newly promoted training regimes.
With this in mind, here are a few cautions to remember:
• New exercisers presenting with high health risk need medical clearance in accordance with best practise as promoted by ACSM (American College of Sports Medicine) Guidelines
• At present the research has only been conducted on healthy male graduate students, older males and some obese women. What is not known is the effect of HIIT for women experiencing hormonal fluctuations and associated visceral weight gain of menopause, younger females (under 25), post-natal women and youth (12-18 years).
• Exercise practitioners need to look at weekly structures of exercise which allow for recovery from HIIT. As in usual interval training regimes, two sessions a week is enough.
• As per usual exercise safety, a warm up and cool down period are crucial. In higher risk populations, such as those with cardiovascular risk, the warm up and cool down periods should be lengthened to allow for less risk associated with the adrenaline response in exercise.
• As in any intense exercise, effective monitoring of the client as they work at higher levels of intensity is crucial. Look for visual signs of stress during work intervals, monitor their heart rate and adjust the rest interval accordingly.
• Keep your clients motivated and supported. Metabolic and mitochondrial changes accrue after around six to 12 weeks.
• For clients undertaking HIIT for weight loss, it is vital that they understand nutrition and hydration options post-workout. It is known that high intensity training leads to increased exhaustion and a subsequent post-workout craving for sugar. Many people then resort to ‘quick-fix’ high sugar foods as well as caffeine. Support and educate your weight loss and diabetic clients accordingly!
References
Gibala, M., Little, J., MacDonald, M. & Hawley, J. (2012). Physiological adaptations to low-volume, high-intensity interval training in health and disease. The Journal of Physiology, 590 (5), 1077-1084
Gillen, J. (August 2012). Low-volume, high-intensity interval training: A practical fitness strategy. WellSpring Newsletter, 23,(4). University of Alberta: Alberta Centre for Active Living.
International Obesity Taskforce (2010). Obesity prevalence worldwide. Retrieved from: www.iaso.org/iotf/obesity
Ministry of Health [MoH] (2012). The health of New Zealand adults 2011/2012. Key findings of the New Zealand health survey. Wellington: Ministry of Health. ISBN: 978-0-478-40219-3

January 2015

The apple doesn’t fall far from the tree: The influence of parental physical activity on young children – Jan 2015

Author: Dr Sam Elliott, Lecturer in Sport, Health and Physical Activity at Flinders University

As readers of oh la la mummy enter 2015 with renewed motivation and optimism for health and well being, the elusive target of increasing one’s physical activity will again comprise a major goal for many under the guise of a ‘new year’s resolution’. The substantive rhetoric behind this generally surrounds individualism. That is, a concern for improving, maintaining or modifying individual health-related behaviours. However, this article encourages readers to look beyond the immediate consequences of physical activity (be it physical or otherwise) and consider the wider implications for children and youth. This is timely given the widely researched associations between parental and children’s physical activity behaviour.

I have spent the last 6 years researching the influence of parents on children’s sport participation from a social and psychological perspective. Ostensibly, the ‘science’ in this area is quite compelling. One of the most recent studies to emerge from Canada indicates that children are 86% more likely to sustain physically active lifestyles into adulthood if both parents or significant others participate in regular physical activity. While this is to be expected from a socialisation perspective, my own research from the Australian context supports this assertion.

In a society which is becoming increasingly saturated with conflicting health-related messages, the importance of regular, quality physical activity cannot be underestimated. However, it is critical to note that where parental physical activity is concerned, the benefits extend beyond merely the individual. The common consensus explaining this phenomenon usually presides with the notion of ‘parents as role models’. Although this behaviourist argument is widely accepted, the influence of parental physical activity is much more elaborate and implicit in the way that physical activity is socially constructed for children and youth. Therefore, as readers prepare to (re-)engage in group fitness training, personal training, community sport, or other variations of movement, it is important to note that they are not only making a valuable contribution to one’s self, but also to those who are shaped by the attitudes and behaviours they espouse. Ultimately, when it comes to your own physical activity, the proverbial ‘apple’ doesn’t fall far from the tree.

All the best to oh la la mummy readers for the 2015 year.

For more information on this post, please email sam.elliott@flinders.edu.au.

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