Posts

The Shoulder Position – It won’t just strain your rotator cuff

So I had planned on stopping the “shoulders saga” after the previous two posts but then thought about this on the way to work today – there are a lot of ways to work on the shoulders that essentially do nothing for you, therapeutically.  I confess, in my past I have worked on shoulders for my benefit versus the benefit of my patient – but I was just a young buck, and didn’t know any better!  Dear therapists, repeat after me, “I will not punish my patients with painful soft tissue work for my own pleasure”.  Now then, what the hell am I talking about?

As you’ve read about before, the shoulder is an intricate and interesting structure with some pretty amazing functions that, when faced with a poor position to work from, will present with some problems.  I trust you’ve been doing some pre-hab, to correct your poor positioning and prevent future problems.

No doubt, at some point in your shoulder pain/discomfort/tightness past you’ve asked someone to give you a massage/shoulder rub/thumb-destroying good time.  No doubt, it hurt quite a bit, and if you were the victim of experienced hands, you may have had to use your safety word (which may or may not have been “popcorn”).  There is a decent chance you walked away and felt “better”, at least for a little bit.  Was it “better” in comparison to the excruciating pain you were just recently feeling?  Or did your shoulder pain go away only to come back in a day or two?  If you “felt a bit better” for a day or two, that’s good news, but the treatment was ultimately no different than popping a couple advil.

“Heresy!  Those patients’ muscles were sore and I stripped the hell out of their muscles and then they weren’t sore anymore!  What happened to “treating the cause???” – I fixed the problem!”

Did you?  Invariably, the rhomboids, levator scapulae, traps, rotator cuff muscles and maybe even the lats are going to be tender on a patient with an active shoulder complaint.  Taking this a step further, using trigger point therapy (or really just ischemic compression as there probably isn’t any true pain referral happening here), ART, stripping massage, or any of the other dozens of different soft tissue techniques on sore muscles is going to result in, “yeah that really hurts, but it hurts in a good way, you can press harder if you need to”.  Which means the patient believes the therapist is doing the right thing, and so does the therapist.  But WHY are the muscles tender and WHY did they develop this shoulder problem?  (The answer to this second question is not, “because they bailed awkwardly on a ring dip”)

Poor positioning and movement patterns.  This probably just sounds repetitive at this point but unless you work to correct your shoulder positioning, you are going to continue having problems.  Spend some time stretching out your “business” as Kelly Starrett would say.  Instead of being “bad” at certain movements, make sure you aren’t trying to execute those movements from a weak position and take the steps to improve your position.

Now, before I get attacked for “putting down” soft tissue work, which I’m not doing, let’s go back to how you should be approaching the solution to this problem.  You start with some poor scapulae positioning and then you do overhead work, pullups, oly lifting, etc. and experience some pain and your “bad shoulder” starts “acting up”.  By all means, see a therapist if you want to experience some serious pain, and naturally improve your pain status (after treatment) with regards to this acute situation.  Now that you’re past that, move forward and prevent future problems – ask your therapist what steps you should take (where to stretch, where to strengthen) to prevent future painful episodes.  Many times the tender muscles in an acute episode are not the muscles you should be working on to correct shoulder positioning.  For examples, the rhomboids are going to be sore in this acute situation, but they are more than likely weak and stretched away from their optimal position.  Pressing on them does nothing to improve shoulder positioning and may even make the situation worse.  Working on pec minor in an acute situation, isn’t going to do a whole lot to help with the patients pain, but would be the right step to take in improving shoulder positioning.

Now then, since you’re now seeing an awesome athletic therapist, massage therapist, physiotherapist or chiropractor that knows they’ve addressed your true problem and sent you on the path to wellness – Promise referrals, your first born, whatever, but make sure you thank your therapist for caring about you having some solid shoulders versus you coming back next time you do a work out with ring dips in it.

What’s that saying?  An ounce of prevention…?

Cheers Folks!

 

Dr. Adam Ball

The Shoulder Position or 10 minutes to a new you!

Hey Folks!

So it has taken me a little longer to get to this than I had planned, but here it is; What to do in the case of some poor shoulder positioning.  This is going to help you improve your function, meaning better pendlay rows, better overhead squats and better just about everything involving your arms, as I mentioned earlier.  It’s going to make your posture better, which is going to make you sexier and may even improve your confidence.  The world looks better when you’re standing upright with good posture.  For serious.

As a disclaimer:  I am only really speaking about the typical abducted and rolled forward shoulders that we see in the dreaded D-bag/Bridal shoulder position.  This is also known as “upper cross syndrome” but that makes it sound like you’re stuck with it.  We’re going to unstick you.  Keep in mind, there are plenty of other poor shoulder positions, but most of them just aren’t as common, especially among Crossfitters.  Now then… Let’s get started!

So first things first, have someone look at you (ideally shirtless, or with some tight clothes on) from behind and assess where your scapulae are hanging out while you stand comfortably.  If they look like the ones in this photo… then YOU are a victim of the D-bag/Bridal shoulder.  Oh the horror.  Here is what you need to do.

 

Notice the position of the “shoulder blades”

Do the following every time you’re in the gym (and if you aren’t in the gym regularly, you need to be doing this at LEAST 3x a week, and ideally 5x a week if you care about making progress):

Step 1 – roll your pecs out with a lacrosse ball (about a minute per side) – you can do this by leaning into a wall with the lacrosse ball placed just below your clavicle

Find some sore spots in your pecs with the Lacrosse ball

Step 2 – Stretch out your upper traps and suboccipitals for a minute per side – Sit on your hand and tilt your head away from the side of the hand your sitting on, search around by keeping your head tilted and looking down at your left shoulder, or trying to touch your ear to your shoulder (without cheating and shrugging your shoulder up to your ear).

Step 3 – Use either the two lacrosse balls taped together, or if you’re feeling ambitious, the foam roller – place them at the apex of your mid back (thoracic spine) curve (this is usually between the shoulder blades and with the Lacrosse balls, they’ll be straddling your spine) between you and the ground.  Place your hands on an empty barbell above your head in what would be your snatch or overhead squat position.  You can reposition the foam roller/lacrosse balls higher or lower depending on how you feel.  Spend a minute or two (depending on what you can tolerate) in this position.

Awesome.  So the goal of these stretches is to break up some adhesions and help create some “slack” in your pecs, and traps/suboccipitals.  This will also help open you up by adding thoracic extension and a stretch for your pecs.  The next step is going to involve strengthening the elements of these movements that are stretched and weakened.  Please remember… This is not Crossfit. This isn’t trying to move a large load a long distance quickly.  This is trying to hold a mild to moderate load still for a long time – so I guess it’s kind of the opposite?

Why would I want you to train these muscles differently than your glutes?  The main function of these muscles is to stabilize the scapulae, not to forcefully retract them – so we want to improve your muscular endurance, not your contractile power.  Once you’ve achieved better positioning, it WILL make developing more contractile power easier though.

You are going to ADD these exercises to your pec and trap stretches and you are essentially going to be doing them indefinitely.  Or at least until you have achieved better shoulder positioning, and the overhead squat is your new favourite lift.

Step 1 – Lie on a bench/chiro table/bed on your stomach with your head hanging off the edge.  Lift your head up as high as possible while also keeping your face parallel to the rest of your body.  You are still looking at the floor – NOT at the wall in front of you.  Hold this for 30 seconds to a minute and then relax.  Repeat once or twice more, depending on your tolerance.

Step 2 – If you’re really ambitious, you can combine this with step 1.  While you’re lying there on your stomach, point your thumbs towards the floor with your arms out at your sides and lift them up off the bed/table/bench.  You should feel the contraction between your shoulder blades.  Hold this for 30 seconds to a minute and then relax.  Repeat once or twice more, depending on your tolerance.

Chin tucked, head back, scapulae squeezed together. Hold.

Dig it!  There is all sorts of cool stuff you can do in addition to these stretches/exercises, but for now I would stick to this program.  It’s simple, it’s relatively easy and it only takes about 10 minutes.  You can spare 10 minutes to save your shoulders.  Future you will appreciate it.  Future you will also be crushing bodyweight snatches and smiling while she does it.

Cheers Folks!

 

Dr. Adam Ball

Why I care about more than your spine, Part 2

Alternate Title: Poor posture is like a rocking chair – it gives you something to do but it doesn’t get you anywhere.

 

Back from part 1, here we go again.

With all that having been said – being neurotic about who gives you advice on your health, and what you end up doing doesn’t make me any more money than I do seeing you as a chiropractic patient.  So how am I going to make any money?  Well, getting regular chiropractic care is important.  Your spine needs to be able to move in a full, happy and unimpeded range of motion for your body to express its’ optimal level of health.  If you’re eating well, exercising intelligently and de-stressing, the results we see are going to be much better – which means that hopefully you’ll want your friends and family to go to someone that cares about them as much as I care about you. It’s a lot more work, but it allows me to make a living while still being able to sleep at night.

Working at a Crossfit gym, the folks I see generally have a great grasp of the fitness/exercise side of things and a good idea of what they’re supposed to eat.  What I do see a lot of, is shoulder pain, elbow pain, low back pain and mid back stiffness (usually the mid back isn’t painful unless mobilized gently).  These are all an effect of postural adaptations that are no bueno.  These postural adaptations lead to motion restrictions (limited range of motion), muscular imbalances, injuries and more work for you.  You don’t need or want this type of thing affecting your life and performance.

As an example, consider what’s required to take care of a car.  If you run out of oil, you can’t just fill up your gas tank with premium gas and hope for the best, you need to have oil, and brake fluid, good tires, etc. for the car to operate at its’ best.  In regards to range of motion (afforded to you via chiropractic), your Ferrari can only go fast if you can push the gas pedal down all the way.  If there were a brick underneath that gas pedal, it’s going to affect how fast that car can go.  You can eat a perfect diet, exercise well and live a low stress lifestyle, but you still aren’t as healthy as you COULD be if you were doing all those things AND seeing a chiropractor.

Range of motion, optimal positioning and good posture all are interconnected endeavours.  You can muscle through crap posture to achieve full range of motion, but it won’t get you to the level of fitness you want, and you’re wasting WAY too much energy doing it.  If you follow the elite crossfit athletes (or even if you just know who they are/what they look like) you might notice something they all have in common – great posture, efficiency of movement and effortless full range of motion.

Forcing your way through impeded range of motion (folding in half with a crap shoulder position makes overhead squats hard eh?) is not the intelligent way to do things.  Stretching the appropriate areas, seeing a great athletic therapist, and getting adjusted regularly will help you achieve better positioning – making the movements more efficient, less work, and less likely to cause injury.  You’ve already made the choice to exercise intelligently and (hopefully) to eat well.  Make these choices as well.

Making good choices is the bedrock of great health and is the ultimate sign that you’ve made sustainable change.  What you CAN’T do, however, is cover up bad choices with good ones.  The late Mitch Hedberg once said,

 

“That would be cool if you could eat a good food with a bad food and the good food would cover for the bad food when it got to your stomach. Like you could eat a carrot with an onion ring and they would travel down to your stomach, then they would get there, and the carrot would say, “It’s cool, he’s with me.””

 

It would be nice if things worked that way, but they don’t.  You can’t workout really hard for a month and a half, and then spend the rest of the year sitting on your butt.  You can’t workout at the gym, but eat crappy food and be stressed out all the time and not sleep and expect to see results.  You can’t see a chiropractor, but never move your body and expect results.  We (chiropractors, athletic therapists, and other manual therapy options) give you access to a full range of motion, but we don’t provide the movement to those joints.  You do.  Address your posture, get adjusted regularly and stretch your business.  Make good choices – your body will thank you.

Cheers,

Dr. Adam Ball

Wild animals are healthy animals

 

Over/through a small stream, climbing up rocks, and I'm the tiny speck in the bottom right area. Milford Sound, New Zealand.

Humans are animals.  You know I’ve spoken about this before.  But I think we need to revisit this idea on a regular basis.

John Durant of Hunter-Gatherer.com, made a recent post with a news story about two gorillas living in a zoo in Cleveland.  According to the news story, the leading cause of death of gorillas living in zoos, is heart disease.  (Side Bar:  It would be interesting to see the cause of death of every species that lives in a zoo and is “fed” according to what we think they should eat).  Does this blast anyone else’s mind?  How many wild gorillas are dying of heart disease?  I’m willing to bet, that much like wild humans, the number of wild gorillas dying of heart disease is zero.  Why is this happening?

Even more surprising about the news story, is that someone was around to say, “Hey, why don’t we try feeding the gorillas the types of food they’d actually eat?”  Looks like the world hasn’t gone completely mad yet.  Thank goodness.  So, what did they find when the gorillas transitioned to eating genetically congruent foods?  The apes got healthier.  Their markers for heart disease decreased.  But that’s not all!  What else happened?  They stopped acting weird.  The behaviors that are typical of captive gorillas (vomiting foods back up and eating them again, pulling out their hair and eating it) started to disappear (wild gorillas apparently do not do this stuff… could this be gorilla indigestion?) and they started acting like wild gorillas again.  Amazing.

So to sum things up, when gorillas eat a diet they’re supposed to eat, they not only get healthier in regards to their heart health, but mental health improves, they achieve a healthier body composition and, I assume, they’re much happier.

Can we please step back and see ourselves as the animals that we are right now?  Take a look at a phylogenetic tree.  Homo sapiens are not too far away from chimpanzees, orangutangs, and even gorillas.  So why are we NOT asking the same questions about human health?  Humans are dying all day everyday for the exact same reason (heart disease, among many other chronic diseases).  We’re eating foods we are not designed to eat, we’re moving in ways we are not supposed to move, and our social interactions are moving further and further away from normal (remember life before the internet?).

Erwan Le Corre of Movnat.com  is building a legacy.  I hope that in the future, he wins the Nobel Prize.  If we can learn from him, build on the principles of MovNat and shape our communities and societies around those principles, we will regain the health we’re designed for.  We can return to being the species that deserves to be at the top of the food chain.  Right now, we are the sickest species on the planet.  We need to figure out how normal humans live, and we need to get back to that as much as we can.  We need to emulate it.  I’m not asking you to stop using a toilet, or to throw away your computer and all your cherished belongings.  There are advantages to having permanent dwellings, electricity and many other benefits of modern living.  What I AM asking you to do is think about how you eat, move and think.

Eat a human diet:

  • What would you eat if you were thrown out into the wild?
  • Would you avoid killing and eating even the small creatures you could find, because it’s immoral and “bad for you”?
  • Would you try to find the fields of wild grains, so that you can pick hundreds of thousands of tiny seeds, find some stones to grind them one, and some water to hold the powder together and then create a fire so that you can somehoe fry the mush that is created from all your efforts?
  • Would you look for fruits and veggies that look, smell and taste edible?
  • Would you kill and eat every possibly edible part of an animal, or would you throw away the organs because they’re “gross” and go hungry?

Move like humans are meant to move:

  • I’m not going to write a lot here, but MovNat would be ideal
  • Crossfit is a close second, when done properly – This is a good example of using modern tools to achieve/supplement natural movement patterns

Think like humans are meant to think:

  • Isn’t it weird that instead of speaking with each other there is more online communication than ever before?  IMs, texts, emails, blogs (yes, I realize I’m criticizing myself), etc.
  • We have more depression, ADD, ADHD, autism, anxiety and just about every other mental disorder there is than any other time in history.
  • There are a lot of venues where negative is funny.  This I have a particular peeve with.
  • Feeling love, trust and respect is dying it seems – let’s not let that happen.

I feel like we’re making changes slowly.  MovNat is becoming more popular, as well as many other similar pursuits from other like-minded people.  People are becoming fed up with conventional wisdoms’ ideas about health and what the next new superfood/exercise program will save us from ourselves.  There is nothing new we need learn to take action.  We just need to look at healthy people and see what they’re doing.  I’ll end this post with a quote you’ve probably seen before, “Nothing in Biology makes sense except in light of evolution.” – Theodosius Dobzhansky

Cheers Folks!

Dr. Adam Ball

When the pain isn’t because of the pain…

But it doesn’t make sense – How could the pain you’re feeling NOT be due to the pain?  Well… it’s because you can’t feel movement.

I’d always learned and read this in school, but sometimes a “refresher” is nice.  I recently read a journal article that did that for me (Changes in Aβ non-nociceptive primary sensory neurons in a rat model of osteoarthritis pain [Molecular Pain 2010, 6:37]).  Unfortunately, journal articles can be a pain to read.  You need to look through the authors opinions, crappy statistical analysis, misreporting, etc.  Anyway, that’s not what today’s post is about…

So what was the article about?

  • The authors had mice that were either “normal” (not surgically injured) and those who were given osteoarthritis (surgical removal of medial meniscus and partial removal of the ACL in the knee)
  • Time was passed and osteoarthritis developed in those rats with the surgical injuries (poor little guys)
  • The authors then tested the rats neural pathways for nociception (pain) and mechanoreception (proprioception – range of motion/body sense/knowing where you are in space)

So what did they find?  (all results are in comparison to the healthy, happy rats)

  • The injured rats were much more quick to react to stimuli that would not normally perceived as pain (they were very sensitive to stimuli that could eventually be painful – think poking the back of your hand lightly with a toothpick versus pushing it into your skin)
  • The resting potential of nerves responsible for the perception of pain were closer to depolarizing than control rats (this means less stimuli is required for these rats to experience pain)
  • Conversely, the mechanoreceptors were further from depolarizing in the injured rats (this means they weren’t just not moving as much, their movement wasn’t being recognized by the brain as much

Why does this matter to you?

Like I’ve said before, movement and pain are competitive inhibitors, meaning they cancel each other out.  This is often responsible for the good feeling you have after exercising (outside of the hormonal response) and chiropractic.  Chiropractic being the donor of full, accessible, pain-inhibiting range of motion signals to your brain.

But those mice have arthritis and I don’t!

Maybe.  Not to be a debbie downer, but most people have knee/elbow/shoulder/wrist/low back pain that isn’t really pain per se, but is inconvenient or annoying.  That’s the very early stages of osteoarthritis, unless the reason you’re having that recurring problem (posture, movement patterns, etc.) is remedied.  Besides, wouldn’t you want your brain and joints to benefit from a full range of motion?

So, as per usual my recommendations are:  See a chiropractor, exercise intelligently with regularity, eat real foods that were designed for you, and de-stress in a regular basis.

All the best folks!

Dr. Ball

p.s. If you’re in the Oakville or Mississauga areas, come in and see me!  I’m located at Element Crossfit and I’m there Monday through Friday.  Cheers!  Click here to book an appointment with me or give me a call at (647) 268-4703.

Get Healthier AND Help Children

Hey Folks!

For the month of December I will be donating a portion of every new patient visit to the Kids Health Links Foundation, specifically, their program “Upopolis”.  This charity was founded by Basile Papaevangelou and his daughter Christina to help children avoid the isolation that can accompany long stays in hospitals.  Being away from friends, family and school can cause additional stress on children, during a time when their immune systems demand the most of them.  Here is some information about Upopolis:

Upopolis™ is a private social utility that connects young hospital patients to their family, friends and school network .

Kids can use Upopolis to:

  • Build a profile, create a blog and stay in touch with people they know
  • Learn more about their conditions and treatment with kid-friendly medical information
  • Keep up with schoolwork while they’re away from class
  • Look up kids around them in hospital and share their experiences

Now then, to be able to donate money to this cause, I need you to know what I’m offering and why you should spend your time (and money) receiving chiropractic care from me.

You need chiropractic care.  You may not need a lot of it, but every single person will benefit from a properly moving spine.  For your genetics to express health, it needs a certain amount of movement.  Just like animals, plants, or any living thing on the planet, humans have optimal conditions in which to thrive.  Among many other things, a properly moving spine is one of those conditions.  Having exceptional movement in your spine means your brain is receiving full and complete input from your body, as you move it (you ARE moving your body with some regularity, right?).  When the spine isn’t moving well we set ourselves up for all sorts of problems that range from back and neck pain (the most common) to headaches, poor sleep, inadequate digestion, and an inhibited immune system.  I’ll stop there.

The point of this post isn’t to goad you into doing something you don’t want to do (because obviously that would never work).  The point is to try and present to you the reason why chiropractic care is essential to wellbeing, and from there to encourage you to tell your friends, family and coworkers to come in and receive the health care that they need.

And ultimately the more people that come in to realize their health potential, the more I can donate to the awesome cause that is “Upopolis”.

I will be providing chiropractic care @ Element Crossfit (in Mississauga/Oakville) Mondays and Wednesdays 6-8am (please call/email to make an appointment) and Tuesdays and Thursdays 5-9pm.

I look forward to helping you reach your health goals!

Dr. Ball

p.s. Here is the advertisement I’ve drawn up that (if you’d be so gracious) you can post on your facebook wall, twitter, blog, etc.  I’d really appreciate all the help I can get with this promotion as I’d like to donate as much as I can to this cause.  Thank you so much!

Put me on your FB/Twitter/Blog!

Why do I train?

I was recently asked during a workout (I work out in my driveway on a semi-busy street) by a passerby, “why are you doing that?”

As you can imagine, this particular passerby was a young, curious child with walking somewhere with one of their parents.  I didn’t have a lot of time to answer, as they were continuing their walk by, and while dripping sweat on the ground, chest heaving, I dropped my weight and said, “because it’s fun!”

Maybe the kid thought I was lying, and I’m fairly certain that the parent did, as they smiled and walked away.  After I finished my workout I got to thinking, why DO I train?  This blog post will look to answer this question.

I want to remain extremely functional as I grow old. I think if I can work hard to max out with a 500 pound deadlift now (or hopefully within the next couple years), than lifting my grocery bags off the ground when I’m 90 years young will be a breeze.  While I can appreciate the reduced work capacity associated with aging, it just gives me more reason to work hard now.  Studies have shown exercises can increase functionality in the elderly, the young, and those with disease (1, 2, 3).

I want to avoid disease and give my MD no reason to doubt my health. As we all know, obesity rates are through the roof, heart disease is killing about half of all North Americans, and diabetes rates are increasing at an alarming rate (I’ve seen they’re changing the name from “adult onset” to “age onset”, I assume this is because too many young people are suffering from this condition).  My genetics aren’t exactly stellar in the cholesterol department, the heart disease department, and to a small degree the diabetes department.  If I can optimize my blood markers and provide my body with a calm, balanced environment, I’m going to do what it takes to create that environment.  Many sources have found that insulin sensitivity is increased with exercise.  Body weight, body mass index, body fat, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and hsCRP (an inflammation marker) all respond favourably to regular exercise (1, 2, 4, 5).

I want to stay sane. Exercise is known to help reduce the occurrence of depression and lead to better well-being (6).  I know that when I exercise I feel better for that day and in the long run.  I don’t usually feel fantastic DURING the workout (sometimes I do), but shortly afterward I feel great.  I think it is due, psychologically, to a sense of accomplishment, as well as the endorphin release and further cascade of hormones released by the body in response to the stimulus of the exercise.  In my, n=1 case, I know it makes me more productive, happier, and more relaxed, consistently.

I want to look good naked. Don’t we all?  I don’t think I need to argue the fact that exercise is an important factor in body composition.  Diet is also hugely implicated, but we’ll talk about that in another post.  Exercise provides the stimulus your body requires to release hormones that will increase your insulin sensitivity, and cause you to synthesize protein to fix the damage you did to your muscles while exercising.  This protein synthesis is a metabolically expensive process, and you do it while at rest.  This means you’re burning mostly fat for the fuel used to assemble the amino acids provided by the protein in your diet (you’re eating high quality protein, right?) to restore your muscle tissue.  There is a lot more involved but that’s part of what is going on.

I like the challenge. Originally with exercise, I never stayed with my program which was usually because I didn’t HAVE a program.  I just figured going to the gym and doing some stuff was enough.  Occasionally I would follow the mens health monthly workout poster thingy.  I employ Crossfit for my training, which constantly challenges me to get better at everything as well as trying new movements or weights on a frequent basis.  It keeps me interested, and I ALWAYS feel like I have a lot of room to improve.  As long as you don’t let it get you down, it’s a great motivator to keep at it to get better.

Anyway, that’s what I can think at the moment as to why I train.  Why do YOU train?

References:

  1. Martins, R., Verissimo, M., Coehlho e Silva, M., Cumming, S. & Teixeira, A. (2010)  Effects of aerobic and strength-based training on metabolic health indicators in older adults.  Lipids in Health and Disease. 9:76.  Accessed online on 28/08/2010 from: http://www.lipidworld.com/content/9/1/76
  2. Ansari, W., Ashker, S. & Moseley, L. (2010)  Associations between Physical Activity and Health Parameters in Adolescent Pupils in Egypt.  International Journal of Environmental Research and Public Health.  7: 1649-1669.  Accessed online on 28/08/2010 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872361/?tool=pubmed
  3. Subin, Vaishali Rao, V. Prem & Sahoo (2010)  Effect of upper limb, lower limb and combined training on health-related quality of life in COPD.  Lung India. 27(1): 4-7.  Accessed online on 28/08/2010 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878713/?tool=pubmed
  4. Bradley, R., Jeon, J., Liu, F. & Maratos-Flier, E. (2007)  Voluntary exercise improves sensitivity and adipose tissue inflammation in diet-induced obese mice. American Journal of Physiology – Endocrinology and Metabolism. (295) E586-E594
  5. Kirwan, J., Soloman, T., Wojta, D., Staten, M. & Holloszy, J. (2009)  Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus.  American Journal of Physiology – Endocrinology and Metabolism.  (297) E151-E156
  6. Babyak et al (2000)  Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months.  Psychosomatic Medicine. (62) 633-638