I Like to Move it Move it
Sadly, only 1 in 3 adults achieve the recommended amount of physical activity each week. Our culture is sedentary, even those who go the gym often risk prolonged sitting in today’s modern world. That’s why it’s so important to incorporate movement into everyday living.
During my second pregnancy, I had issues with my autonomic nervous system—I would randomly faint without warning. Although an athletic child and teen, during my early adult years I wasn’t particularly active so I remained relatively inactive throughout my pregnancies. I didn’t enjoy my inactive lifestyle, rather, I had no idea how to change it. Consequently, when my cardiologist informed me that in addition to midodrine, compression stockings, and high protein meals I needed to “retrain my body,” I had absolutely no clue what he meant. “You know, exercise,” he said. So, like Forest Gump, I ran. Not knowing another alternative, I just kept running. My body took well to running, and I haven’t stopped since. Early on, I focused on distance over speed and figured out that I loved to run outdoors.
My running time was like medicine to me, it helped clear my mind and rejuvenate my body. But, years later I temporarily lost the ability to run when I developed multiple upper respiratory infections and breathing became difficult. One of the many issues that I grew an awareness of during my illness, was body stiffness. Tipping over at the hips into a forward fold appeared an impossible feat with my tight hamstring, hip flexor, and calf muscles. I realized that I had an incredible amount of muscle imbalances. For years I had focused solely on running without acknowledging whole body movement needs, strength, or flexibility. Paradoxically, my level of cardiorespiratory fitness was high, but whole-body movement was restricted, I had awful posture, and random unexplained pains were an everyday occurrence.
We are not moving enough
I’m not alone in my experience of an inactive lifestyle. Sadly, only 1 in 3 adults achieve the recommended amount of physical activity each week (1). The current U.S. Physical Activity Guidelines for Americans from 2018 recommends adults complete 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise per week for cardiorespiratory fitness. In addition, whole body strength and flexibility training activities should be pursued 2-3 times per week (5). Nonetheless, despite known associations between health and fitness, 66% of the population falls short of achieving guideline fitness recommendations.
The Aerobics Center Longitudinal Study found that among 40,842 men and women low cardiorespiratory fitness was the number one cause of preventable deaths from all-cause mortality (2). While inactivity is associated with mortality, thankfully, its opposite in the form of physical activity can add years. A pooled analysis examined the association of leisure time physical activity with mortality over a 10 year follow up period. Physical activity was associated with gains in life expectancy and higher levels of physical activity were associated with greater gains (3). Any amount of movement can improve health. While more physical activity does appear better, there is a point at which gains level out (4). That’s good news for busy Americans.
Cardiorespiratory fitness has been a health focus for decades. However, strength training recommendations have only been developed in more recent years, nearly 15 years ago. Logically, strength appears important as it’s well known that muscle mass depletes with age—a phenomenon called sarcopenia. Indeed, Kraschnewski, et al studied a large cohort of 65 years and older adults (i.e., 30,162) who were tracked for 15 years. The study found that only 10% followed guideline recommendations for strength training! However, those that did follow guideline recommendations for strength training were 46% less likely to die during that period (OR 0.64;95% CI 0.57-0.7, p=0.001) (6). So, not only does physical activity benefit the body but working to make it stronger does as well.
Motion is Lotion
What about flexibility? Flexibility is the ability to stretch all soft tissues that allow the complete range of motion of a joint. One of my favorite body parts is a connective tissue called fascia. I love talking about fascia because it has so many functions but mostly because it is symbolic in so many ways. It both separates and holds us together, kind of like a wall. It functions as an anatomical boundary, but one that is relational. It is the fabric of our form joining every single part of us together (7). It has no origin or insertion, as muscles do, and instead envelopes our entire being. While muscles are very stretchy, fascia is viscoelastic. Fascia responds to stretching in a time dependent manner and recoils more slowly than muscles do. When in tension for longer periods of time, fascia can become sticky and more pliable. This leads to tissue creep, lengthening with less resistance over time. Tissue creep, can result in injury or muscle imbalances.
Muscles are never separate from fascia, which integrates movement. Areas of tension and tightness in the fascia may result in poor hydration or nutrition, chronic postural habits, lack of movement variety, chronic stress, physical trauma or scarring, limited range of motion, pain or discomfort, limited differentiation of movement, and chronic inflammation. Fascia can become dry, less pliable, less mobile, and stickier (8). For optimal function, fascia needs to be well hydrated and motion can help.
As a yoga mentor of mine says, “motion is lotion.” Chronic postural habits can change fascial length and so our bodies hold on to all our life experiences and patterns over time. Movement keeps the fascia hydrated; improves glide and slide; proprioception; interoception; endocrine, lymph, and immune function; increases positional variety; and decreases inflammation (8). Fascia engages the whole body anytime you move. Movement variety is important and key to keeping the fascia smooth, slippery, and flexible. Stretching is a central component to maintaining mobility and remaining injury free. Poor flexibility can result in altered movement patterns, which seek the path of least resistance during functional movements. This can prevent the nervous system from efficiently recruiting the correct muscle patterns and contractions during movement (9).
Yoga and Pain
Our culture breeds stiff bodies. We wear shoes and tight clothing, sit in chairs, and remain in the same position for long periods of time (e.g., working on the computer, driving, using mobile devices, etc.). For most of us, the positions we take when not moving tend to be postures we assume over and over again. It’s clear quantity of movement is important but quality movement is equally necessary. Quality body movement would include diversity in body movements. Movements that are not restricted, expansive, and free. For me, there is no better modality to achieving this than yoga practice.
A search of the National Library of Medicine’s Pub Med using the terms “yoga” and “pain” yielded 1,180 results. The best data for yoga as it relates to pain appears to be for patients with low back pain or neck pain, although, even these data are not conclusive (10). Two systematic reviews of yoga for low back pain showed that it may be beneficial but one study compared it with placebo and the other found that benefits were equal to those of exercise. There is limited evidence yoga may provide benefits for neck pain.
Given new trial data and earlier meta analyses citing low to moderate quality data, another meta-analysis evaluating the effectiveness of yoga on low back pain was conducted (11). Studies that focused on yoga as the primary intervention for low back pain were included. No restrictions were made regarding yoga tradition, length, frequency, or duration. Yoga was compared with passive control or an active comparator. Studies compiled yielded a cohort of 2,702 participants. Compared with passive control, yoga was associated with short term improvements in pain intensity and physical functioning. This was not true when yoga was compared with an active comparator in which case no differences were observed. The major limitation to this study is the lack of restriction on yoga tradition, length, frequency, or duration. As a pharmacist I am well aware, “the dose makes the poison.”
It is suggested from this study though, that movement of any type can be beneficial and the body of literature would support this. Any type of movement is better than none, even 5 minutes of physical activity has beneficial effects on mortality risk. Because movement is an all body process, movement quality in addition to quantity is important. Being sedentary in between exercise sessions can still have a negative effect on health. Our culture supports stiffness and so we must be intentional about keeping our bodies in motion. Pursuing exercise in the form of cardiorespiratory, strength, and flexibility training is absolutely a respectable goal. Equally important, is keeping our bodies in motion. Like Newton’s first law of inertia, bodies in motion stay in motion.
References:
1. US Department of Health and Human Services, President’s Council on Sports, Fitness, and Nutrition. Facts and statistics; physical activity. Updated September 16, 2020. https://www.hhs.gov/fitness/resource-center/facts-and-statistics/index
2. Blair SN. Physical inactivity: the biggest public health problem of the 21st Century. Br J Sports Med. 2009;43:1-2.
3. Moore SC, et al. Leisure time physical activity of moderate to vigorous intensity and mortality: A large pooled cohort analysis. Plos Medicine. 2012;9:e1001335.
4. Wasfy MM, et al. Exercise dose in clinical practice. Circulation. 2016;133:2297-2313. DOI: 10.1161/CIRCULATIONAHA.116.018093.
5. U.S. Department of Health and Human Services. https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines (accessed 3/23/23).
6. Kraschnewski, et al. Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Preventive Medicine. 2016;87:121-7.
7. Avison JS. Yoga, fascia, anatomy and movement. Second Edition. 2021. Handspring Publishing Limited. Pencaitland, Scotland.
8. Hinsley L. Anatomy Bites. www.anatomybites.com [accessed 3/25/23].
9. Floyd RT. 2018. Manual of structural kinesiology (20th ed.). New York, NY: McGrawhill.
10. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/yoga-for-health-science [accessed 3/25/23].
11. Anheyer D, et al. Yoga for treating low back pain: a systematic review and meta-analysis. Pain. 2022;163:e504-e517.
