Preseason sports safety

It’s hard to believe, but preseason practice for high school sports is well underway. Not only does this indicate that summer is winding down, it also means that area athletes are getting ready for the fall sports season. This is an exciting time of year for athletes, coaches, and fans alike. Unfortunately, even the fittest young athletes can suffer injuries (or worse) during preseason training and competition during the season. Among the biggest concerns are the rigorous training schedule, exercise in the heat, and head injury. Fortunately, there are steps that coaches and parents can take to ensure the safety of young athletes during practice and games. This is the topic of my Health & Fitness column in the Aiken Standard this week.









Preseason practices typically emphasize conditioning—getting athletes in shape for the season. While coaches may expect players to arrive at practice already in shape, the reality is that many athletes still need to improve their strength, endurance, and flexibility. Preseason conditioning usually consists of vigorous exercise designed to improve fitness rapidly. Many coaches also use this time to “toughen up” the players or to weed out those who are not suited for the sport. For most young athletes this approach is safe and effective, but there is a risk of injury or, more rarely, collapse or death with intense training.

The risk of injury or death is made worse by the high heat and humidity that is common at this time of the year. For this reason, many coaches hold conditioning sessions in the morning or evening, when it is cooler. Even then, exercise alone poses a challenge to maintain a normal body temperature. Adding equipment such as pads and helmets for football players increases the risk for hyperthermia, which is even greater in the sun on a hot day. A high sweat rate makes dehydration more likely, so frequent water breaks are essential. Unfortunately, some coaches may be tempted to limit water breaks in a misguided effort to build toughness. This is absolutely inappropriate! Dehydration and hyperthermia can lead to heat stroke, which can be deadly.

This topic was covered in an NPR  interview  with Dr. Douglas Casa of the Korey Stringer Institute at the University of Connecticut in Storrs, Connecticut. You can also watch a video in which Dr. Casa discusses hydration and preventing heat illness in young athletes.

Another concern, especially among football players, is the risk of concussion. It turns out that concussions are more common than previously thought in football players and repeat concussions, even “minor” ones, can cause long-term problems. New recommendations for all levels of football call for better assessment of athletes who suffer head injuries and prevent injured athletes from returning to play. This in important during practices as well as games. While the focus is on football, nearly all sports that involve contact have a risk for concussion.

The topic of concussion is addressed in this video of a lecture given by Dr. Kevin Guskiewicz, Professor of Exercise and Sport Science at UNC-Chapel Hill and MacArthur Foundation “Genius” award winner.

These risks can be reduced by good year-round conditioning, altering practices to reduce heat injury risk, education to reduce the likelihood of concussion, and careful assessment when concussion is suspected. These responsibilities fall on the coaching staff and the certified athletic trainers who should be present at all practices and competitions. Certified athletic trainers have the knowledge and skills to assess environmental conditions and monitor athletes for signs of heat stroke, concussion, and other injuries. You can learn more about sports injury prevention and the role of certified athletic trainers in keeping young athletes safe from the National Athletic Trainers Association (NATA). All athletic trainers working in our area at certified by the NATA.

All players should also undergo a physical exam prior to participation in sports. The risk of injury can be further reduced by making sure all players are in shape prior to the start of practice. Coaches should find incentives to motivate their players to build strength and endurance in the off-season. Parents should make sure their young athletes are prepared for the physical requirements of their sport and aware of the risks of participation.

While injury is always possible, the risks can be minimized through careful planning and communication among coaches, parents, athletic trainers, and the athletes themselves.

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Mindfulness matters for making meaningful and lasting health behavior changes

Mindfulness can be described as an awareness of thoughts, feelings, bodily sensations, and the surrounding environment. This is most commonly explored through mindful meditation, a practice that is credited with improving physical and mental health. Beyond meditation, being mindful can help to improve attention and focus in nearly every aspect of life. This is important for making meaningful and lasting health behavior changes. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Mindful brain

Thinking about your actions and the effect they have on your health and the health of others can be good for you and those around you. It turns out that we engage in many health behaviors that are driven more by habit than conscious decision-making. This includes what, when, and how much we eat as well as how active we are, two of the most important determinants of health.

When was the last time you thought about what you were eating? Not just which restaurant to go to or what time to eat, but really thought about what and how much you ate? Chances are, at least some of the time you eat when you aren’t hungry or keep eating even when you are full. You probably also eat foods you know you shouldn’t or don’t intend to, sometimes without even realizing it.

This concept was explored in-depth by Brian Wansink in the 2006 book, Mindless Eating. Based on his research, this book helped to explain the hidden reasons behind what, why, and how much we eat, often without being aware of it. This includes marketing tricks as well as environmental factors, many of which operate outside of our consciousness, that drive our food choices and prompt us to eat.

This is where mindfulness comes in. By making an effort to be cognizant about your own thoughts and sensations as well as the environment you are in, you can at least decrease the instances of overeating and making poor food choices.

Furthermore, we should be aware of how our food choices influence others around us. Research shows that children of parents who eat more fruits and vegetables tend to eat more of these foods than kids without such influence. Mindful eating includes accounting for how our actions and choices can influence the decisions of other family members and friends.

The same is true for how active or sedentary we are. Being active is a choice, sometimes a difficult one, that is influenced by other people and the environment. Most people spend the majority of the day sitting at work and at home, often without thinking about it. This sedentary lifestyle has been linked to an increased risk of obesity and heart disease, so it is relevant.

Sure, it feels good to sit on the couch to watch television. Think about it: is that really the best way to spend your time? At work, taking short breaks to get up from your desk and move can make you feel more alert and energized. Isn’t that worth it?

Similar to eating, our activity choices can influence the actions of those around us. A suggestion to walk to lunch can increase your own activity and that of your friends. Planning to go for a walk or bike ride with your family after dinner is a great way to share the benefits of activity.

When it comes to health, mindfulness matters. Being mindful about what you eat and making a choice to be more active allows you to have a positive effect on your health and the health of those around you.

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Back to school: Make sure kids are ready to learn

Physical activity and good nutrition have long been recognized as essential for promoting good health in adults and children. More and more research suggests that these health behaviors can have beneficial effects beyond health, including how we perform both physically and mentally. The emphasis here is on children in school, but it applies to adults, too. This is the topic of my Health & Fitness column in the Aiken Standard this week, just in time for the first day of school here.

school lunch

Unfortunately, taking time for activity and good nutrition is seen as a luxury or a distraction to learning in most schools. Far from being a distraction, physical activity and healthy eating are prerequisites for learning and academic achievement. In short, these often ignored factors can help make sure children are ready to learn.

Regular physical activity is essential for good health, growth, and physical development, including maintaining a healthy body weight. This last point is important given the epidemic of childhood obesity and related health problems, including “adult” diseases like high blood pressure and type 2 diabetes.

Current recommendations call for all children to get at least 60 minutes of activity per day. This can include activity at school from physical education classes, recess, other classroom activities as well as games, sports, and unstructured play. Unfortunately, most kids don’t get nearly enough activity at school and many aren’t active at home.

Physical activity is also important for academic performance. Research shows that children who participated in an activity program had better executive control, which includes resisting distractions and maintaining focus, improved memory, and doing better switching between tasks. This is particularly relevant for children with ADHD, but the effects can be seen in all kids. These positive changes can maximize class time and lead to improvements in academic achievement, especially math and reading test scores.

Similarly, good nutrition is also essential for health, growth, development, and academic achievement. Eating a good breakfast improves cognitive function, alertness, and academic performance in students of all ages. It should be no surprise, then, that skipping breakfast impairs cognitive function and academic achievement. This is one reason that many schools offer breakfast to start the day or include a healthy mid-morning snack.

The same is true for lunch, too. A good lunch can support learning in the afternoon and gives a chance to teach kids about good nutrition by providing healthy food that, unfortunately, many children may not get at home.

Schools have a unique opportunity to use physical activity and nutrition to promote health, support academic achievement, and teach healthy habits. Since formal nutrition education is missing from most curriculums and PE programs are being reduced or cut completely, schools must be creative to incorporate these essential subjects.

A way around this problem is to make sure children get a chance to move and play, ideally multiple times during the day. This is what recess is for. Teachers can also incorporate activity and nutrition education in the classroom and get away from the idea that kids must be sitting still to learn. As research shows, quite the opposite is true!

Schools are often hesitant to teach about nutrition and activity because it is thought of as a responsibility of parents, not schools. But most parents don’t teach these good habits at home, which affects what happens at school. Despite the obvious benefits, it will probably take years of effort to change this view.

In the meantime, parents can encourage their kids to be active and make smarter food choices at home so they are ready to learn in school.

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What you need to know about sports doping

The use of performance-enhancing drugs has been a serious issue in competitive sports for some time. Notably, the American cyclist Lance Armstrong was found to have “doped” during the years he won seven consecutive Tour de France races and, as a consequence, was stripped of those titles. With the Olympics underway, sports doping is something we are sure to hear even more about. The purpose of this column, which was published in my Health & Fitness column in the Aiken Standard this week, is to explain what is meant by sports doping and describe how a few commonly used substances work to improve performance.

The use of performance-enhancing substances, also known as sports doping, is nothing new. Sports organizations around the world have launched a concerted effort to catch and penalize athletes, coaches, trainers, and physicians who use or promote the use of banned drugs and techniques to unfairly improve performance. Athletes are tested randomly, and those who are found guilty can be disqualified from events, have previously awarded wins and medals revoked, and even be banned from competing in future events.

The specific substance an athlete might use depends largely on the sport. Endurance athletes may use substances that improve oxygen delivery to the muscle, allowing them to exercise at a higher intensity for a longer time. Oxygen is transported through the blood by red blood cells (RBCs). Increasing the number of RBCs is called “blood doping.” Traditionally, this required an athlete to remove a unit of blood and then reinfuse that blood later, closer to the event. The body replaced the donated RBCs, so the reinfused blood carried extra oxygen to the muscle and improved performance.

There is a newer way for athletes to get the same result without having to donate, store, and reinfuse blood. After a blood donation, the blood oxygen level is lower than normal, causing the release of a hormone called EPO, short for erythropoietin. EPO causes an increase in RBC production. EPO can also be produced as a prescription drug that has the same effect. In fact, most cases of blood doping involve EPO administration rather than RBC reinfusion.

Athletes in events that depend primarily on strength and power need to develop a high level of muscle mass. Anabolic steroids like testosterone have been used for decades to build muscle. This works since testosterone promotes protein synthesis, the key step in muscle hypertrophy. Growth hormone (GH) is another natural hormone that, as its name suggests, promotes muscle growth. Both testosterone and GH can be injected to enhance the response to resistance training. Hormone precursors such as androstenedione or “andro,” which was famously used by the baseball player Mark McGuire when he broke the single season home run record, can also be used to achieve the same effect.

Knowing that the penalties for sports doping can be severe, why would an athlete take the risk and use performance-enhancing drugs? Athletes train year-round, usually for decades, to compete on an elite level. After this much training, additional gains in strength, speed, and endurance can be difficult to achieve. Considering that in most elite-level competition the difference between winning and losing can be as small as a few seconds or inches, depending on the event. Some athletes feel that the only way to gain an edge over the competition is to use performance-enhancing drugs.

Athletic competitions like the Olympics are a celebration of human strength, power, endurance, and skill. Hopefully, cases of sports doping in the news won’t overshadow the incredible accomplishments of so many athletes who succeed because of their talent, training, and dedication. We should be inspired, not made suspicious, by their performance.

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If you would use a parachute when you jump out of a plane, then you should floss your teeth!

My kids were thrilled to see the news this week proclaiming that they didn’t need to floss their teeth anymore. Apparently, there isn’t any good research showing that flossing can prevent cavities or gum disease. In this context,  “good research” means long-term, controlled studies comparing flossing to not flossing.

But most dentists agree that flossing is a good idea, even if there isn’t much research to support it. The bottom line is this: Just because there isn’t research to prove that something is good for your health does not mean that it is necessarily bad!

If you aren’t convinced, consider this: there are no long-term controlled trials examining the effect of parachutes on survival or serious injury during skydiving, but no one (well, maybe one person) would consider jumping out of an airplane without one.

So, flossing, like using a parachute, is something you should do, regardless of the evidence.

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The Elite Runner: A glimpse at a day in the life of an Olympic runner, in a way.

With the Olympics starting this week I have been thinking about elite athletes and the training that goes into their remarkable performances.

So I was intrigued to see this interesting short film, by an Olympic runner, about Olympic runners. It wasn’t what I was expecting, but it does provide a glimpse into a day in the life of an elite runner.

Check it out here: The Elite Runner

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Could you be an Olympic champion? Here’s how to do it.

The Olympics are an excellent opportunity to see some of the world’s fittest athletes in action. Endurance events like the marathon, power events like sprints, team sports like soccer or basketball, and exhibitions of individual skill in gymnastics all highlight the dedication and training of these elite athletes. You may wonder what it takes to become an Olympic champion. In my Health & Fitness column in the Aiken Standard this week that the answer is a combination of focused, intense training and some good luck.

Olympic rings

First, the training. The key to performance in long-duration events like distance running, cycling, swimming, and rowing is for the muscle to contract repeatedly and forcefully without fatigue. In order to do so, the muscle must have a steady supply of oxygen and nutrients (primarily fats and carbohydrates). These nutrients are delivered through the blood which is pumped to the muscle by the heart. The muscle takes up and uses these nutrients to produce ATP, the form of energy used by the muscle.

After months and years of endurance training the heart gets bigger and blood volume expands, resulting in the ejection of more blood to the muscle. Within the muscle there is an increase in the number of capillaries, the small blood vessels that deliver blood to the muscle, and mitochondria, the part of the cell that produces most of the ATP. Together, these adaptations allow the muscle to produce more ATP without fatigue, permitting the athlete to sustain a higher intensity (running speed, for example) for a longer time without fatigue. These adaptations are consistent with a change in muscle fiber type from fast (type IIx) to slow (type I and IIa) fibers, which are rich in capillaries and mitochondria, making them resistant to fatigue.

These adaptations occur to some extent in everyone who participates in regular exercise. Olympic-level athletes who train for years or decades can maximize these changes. But is training alone sufficient for Olympic-level performance? Could anyone who trains enough make it to the Olympics? The answer is no, because there is another important factor in athletic performance—luck. Luck refers genetics, which play an important role in performance. As much as 50% of performance in some events is attributed to genetics. Elite endurance athletes were fortunate to be born to parents who bestowed them with large hearts and muscle that was composed of a high percentage of slow fibers (the average person has about 50% slow fibers). Of course, years of training amplifies these attributes to result in a large, strong heart that can pump lots of blood to muscle that is made up of slow, fatigue-resistant fibers.

Genetics and training are the two major factors that lead to success in every other Olympic event, too. Sprinters and other power athletes have more fast (IIx) muscle fibers to generate high levels of force for a short duration. Genetics can provide a foundation of more fast fibers, upon which specialized training can build. Other events require a certain body type for optimal performance, which can be seen in female gymnasts (petite but strong) and swimmers (Michael Phelps’ arm span, for example). And beyond the physiological adaptations, years of training builds skill, technique, and mental focus that is essential for competition.

It is too late for most of us to become Olympic champions. But we can all experience many of the same benefits of training as Olympic athletes. And we can certainly appreciate the training, dedication, and good luck that the athletes bring to the games.

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