Osteoarthritis is a very common disease and is the most common cause of difficulties with mobility and disability in older people. It is also common in younger and middle-aged people. Approximately 5% of people between 35 and 54 years of age have osteoarthritis. Many of these people have injured their joint earlier in life. Approximately 30% of the population between 50 and 70 years of age have problems related to osteoarthritis and the percentage increases in older age groups.

Osteoarthritis affects the whole joint, but most of all it affects the articular cartilage (the cartilage covering the ends of the bones). This articular cartilage becomes thin and fragile. This can be due to healthy cartilage being exposed to heavy loads over a long period of time (for example, very heavy labour over several years) or unhealthy cartilage that for some reason cannot handle normal loads.

You may have heard osteoarthritis described as ‘wear and tear’ of the joint. This statement is incorrect because loads are still needed to keep cartilage healthy. In a healthy joint, there is a balance between the regeneration and degeneration of cartilage. Osteoarthritis occurs when there is more degeneration (breakdown) than regeneration of cartilage. This can cause cartilage to thin, crack, and maybe disappear. However, cartilage needs a certain amount of load to regenerate. This is why healthy loads need to be applied on joints for cartilage recovery.

Currently, there is no known way of curing cartilage loss. Treatment is used to reduce symptoms and improve function of the joint. Learning about osteoarthritis is an important part of the treatment. Special exercises can be done to relieve pain and boost joint function. When function improves, the next step is to get more active. Being physically active can help maintain weight loss and improve overall health. People who have osteoarthritis should do these things as early as possible.

Exercising has added benefit for people with osteoarthritis. Nutrients are pumped in and out of the cartilage when it is loaded and unloaded. This promotes growth and reformation of the cartilage, boosting its strength. Exercising will have your joints moving through their range of motion. This will make it easier to do everyday things you used to have trouble with (putting on socks, climbing stairs, getting in and out of the car). Exercise helps build stronger muscles, which helps make daily activities easier. Exercising will train your coordination - the ability to use the right muscles at the right time with the right amount of force. This will make it easier to control movements like walking on uneven ground.

Exercise is essential for knee osteoarthritis but currently few Australians with osteoarthritis participate in exercise despite its proven benefits.  At Intune Sports and Physio we will soon be launching a program called GLA:D® (Good Life with Arthritis: Denmark). GLA:DTM Australia is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms. GLA:DTM Australia is a program for all individuals who experience any hip and/or knee osteoarthritis symptoms regardless of severity.

The program includes two education sessions and twelve group exercise sessions over an eight-week period.  The program has been successfully run in Denmark, Canada, China and most recently here in Australia. Research from the GLA:D® program in Denmark found symptom progression reduces by 32%. Other outcomes include less pain, reduced use of joint related painkillers and increased levels of physical activity twelve months after starting the program.
Further details can be found at gladaustralia.com.au or by contacting Intune Sports and Physio on 5493 1999.
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If you or someone you know may be interested in the GLA:DTM Australia  program, come along to a free information and education session on at 11am on Thursday 21st February at our Birtinya facility. For more information and to book a place, contact Intune Sports and Physio on 5493 1999.

I’m often asked as an exercise physiologist and coach how an athlete should graduate back into training after a break, or even worse, I see the mistakes many athletes make. For many triathletes or endurance athletes in Australia, June means a return to training and putting down their first block of training for the upcoming season. For this reason I thought I’d put some insight into how you can ensure the first block of your 2018-19 season is your best, and leaves you ready to handle the increased demands of your subsequent training.
Traditionally we see many endurance athletes avoid any intensity during their first block of training and instead focus on low intensity aerobic work in training Zones 1-2. In general this can be an ok plan as the risk for injury is less at lower intensity, however there are many physiological and strength benefits you miss out on compared to if you included some slightly higher tempo or sweet spot training just below threshold.
As you can see in the table below, zone 2 training does have a large variety of physiological benefits such as increased mitochondria density, increased lactate threshold, increased muscle glycogen storage and inter-conversion of fast twitch type IIb to type IIa muscle fibres (type IIa fibres are more aerobic than type IIb so more beneficial for endurance athletes). However, as you can also see the expected physiological adaptations gained with Zone 2 training is far inferior than Tempo or Sweet Spot training.
The other issue with sticking to just Zone 1 and 2 training, which is highly applicable to running, is that at higher speeds there’s also a higher musculoskeletal requirement which we can use to our advantage. Although at high volumes increased speed can be detrimental if you get the dosage wrong, including higher Tempo or Sweet Spot training can aid towards strength development and enhancing movement kinematics. Together this also allows you to transition faster into future training blocks where a focus will include more race pace efforts, intervals, Fartlek or speed work.
So why do so many athletes still train in Zone 1 and 2? Well the issue is if we train all the time at high intensities, although we might gain superior physiological benefits, the risk for injury increases. However, if we carefully calculate and plan sessions out and combine multiple intensity training throughout the season we can minimise risk across an entire season whilst maximising training adaptations from block 1.


So how should you plan your base? The first thing to do is to start working back from your season goals which will determine what the physiological requirements required to achieve them are. For example, if your goal is to run sub 40min for 10km, we know that the body will need not only be physiologically capable of handling 24sec/100m pace for 10km, but also strong enough to handle both the race and training demands required. One simple way which I recommend is to start including run throughs at the end of easier or zone 2 runs from your first block of training and then increase these into the main set of your sessions. For example, you may want to include a session early on in block 1 such as:

10min build,
20min zone 2 finishing with 4 x 100m run throughs at 10km goal race pace.

What this will do is condition your body by the end of your first block of training to withstand higher reps or longer intervals at race pace which will no doubt become a focus of future training blocks session. In essence, you’re starting to train your body from day one to become accustomed to the training and racing demands it will be required to handle through a controlled and calculated way which will minimise future injury risk as your transition from one training phase or block to the next.
Other sessions that can be included in training block 1 would be your Tempo and Sweetspot sessions at least once per week. An example for this would be starting off by including 2 x 5min @ Tempo/Sweetspot with 2min recovery and progressing the total time spent at the higher intensity as your training progresses. By the end of block 2 I usually like to have athletes capable of handling either 30min or 2 x 20min at tempo-sweet spot pace as this will really start to maximise improving lactate threshold, increased glycogen storage and increased mitochondria density which will become vitally important as you progress through your training phases and into more high intensity work.
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As with all training, it’s best to consult with an expert coach and always remember that a single session won’t make your season as fitness is the sum of the total completed training.
 

BY Tanya Buchan

After a knee injury, recovering the functional performance and strength of the lower extremity is an important goal for rehabilitation and recovery. Some recent studies have highlighted the importance of addressing any strength deficits after knee injury or bout of knee pain to possibly prevent the development of early degenerative changes in the knee joint, and improve the knee related quality of life measures in the future.

In a study of ACL reconstructed patients by Culvenor et al (2016), those that could do at least 22 single leg rises had better knee-related quality of life at one and three years post-op than those that couldn’t do 22 repetitions. When we talk about knee-related quality of life in this way, it is a subjective measure of knee confidence, modification of lifestyle, awareness of knee symptoms and the general difficulty because of the knee. 

So the study would suggest that if you were able to perform more than 22 single leg rises now, then you have a much reduced chance of struggling with those particular measures in one year and again in three years time. It may also be important to have functionally strong legs to combat the onset of knee osteoarthritis.

​In another study of ACL injured people, Koos eta al concluded that a reduced functional performance in the lower extremity (inability to do 22 single leg rises) might predict the development of radiographic knee osteoarthritis in the future.

But what if you haven’t suffered a significant knee injury like an ACL reconstruction? Although these studies are directed at ACL patients, the ability to perform single leg squats can improve physical performance in all aspects of life for everyone.​   

Controversy has existed for a long time over whether strength training is beneficial or detrimental for endurance athletes including runners, cyclists, swimmers, triathletes or adventure racers. Recently though, there has been an abundance of research and information that supports endurance performance enhancement through strength training when applied correctly. In addition, research also confirms resistance training to be the best exercise intervention for injury prevention. 

One of the main concerns often expressed by endurance athletes and their coaches towards performing strength training is that it will increase muscle bulk and therefore add unnecessary weight to their desired lean and light bodies. However, recent research across a range of endurance sports indicates that correct exercise prescription and manipulation of load, reps (the number of times you perform the specific exercise), sets (the number of cycles of reps that you complete), intensity (how hard you perform the exercise), rest interval duration (time period between performing the exercise, or subsequent exercise) and exercise selection can avoid muscle hypertrophy as well as minimising any self-perceived heaviness or fatigue sometimes reported during the days following strength training interventions.

Previously, the typical approach to strength training for endurance athletes was to perform high repetitions with short rest (eg. 20 reps with 30 seconds rest), or to perform a standard weight based training regime (eg. 8-12 reps with moderate rest). Conversely, best-practice current strength training guidelines found to enhance endurance sports performance advocate using high loads and low repetitions. In addition, it is recommended to perform the movement explosively during the concentric phase (when you’re working against the resistance) which together stimulate increased muscle power output through improved neuromuscular function (muscle signalling pathways and recruitment) whilst minimising muscle hypertrophy.

For swimming, dryland resistance based training interventions have been shown to improve stroke length and tethered swimming force production which are both linked to better swimming performance. In running, strength training has been shown to decrease middle and long distance time trial performances as well as improving running economy (reduced oxygen cost) through decreased ground contact time, increased musculotendinous stiffness, or more efficient running biomechanics. Similarly, for cyclists strength training improves technique, reduces the oxygen cost, enhances lactate-profile power and increases absolute peak power and average power output over varying distances (1 km – 45 km).

Although often overlooked, another key benefit of strength training is its preventative effect on sports injuries (including overuse injuries). In 2014, a large meta-analysis reviewing strength training, proprioceptive training, stretching, and multiple exposure (strength, stretc hing and/or proprioception) exercises on sports injury prevention found strength training alone to have the strongest positive effect. The study reported that strength training “reduced sports injuries to less than a third and overuse injuries could be almost halved” whilst “stretching proved no beneficial effect”. Before you remove stretching from your training regime, the study only looked at stretching's preventative effect on injury and does not take into account that stretching and mobility exercises may be necessary to achieve joint range of motion to achieve efficient movement patterns such as that during catch phase of freestyle swimming.

Therefore, is strength training safe and beneficial for endurance athletes? Yes!! However, the training program needs to be well designed, functional, and sport specific with a focus on correct movement patterns and technique. Together, these guidelines will ensure your strength training intervention will enhance your endurance sports performance and decrease your risk of developing sports related injuries.

 Interested in joining our specific strength and conditioning classes? Click here to book online

In Part 1 of the series on Essential tips for international competition I covered everything you need to know regarding choosing your travel and accommodation, through to recommending you learn some of the local social etiquettes and laws at your race venue. In Part 2 here, I’ll provide you with some great tips on how to individualise your training specifically for your event to ensure you’re race-tuned and ready to perform at your peak.
My first tip is to do some simple research on the event demands. This should include determining the course profile, terrain, expected weather conditions and what your predicted finish time might be.
Once you’ve analysed the course profile, if you notice it’s substantially different to what you’d commonly encounter in local races or training (eg. has longer or steeper ascents, is likely to leave you out on course far longer etc), it’s likely you’ll benefit from some key targeted training sessions in your lead up. For example, if the course includes some significant climbs, I recommend regularly including some simulated race efforts on a local ascent that has a similar gradient or length to what you’ll encounter in your race during your final 6-8 weeks of preparation. For cycling events, you might even be able to pre-ride the exact event course at a local virtual cycling studio.
For those competing off the beaten track, knowing the course terrain you’ll tackle will provide vital information towards ensuring you optimise your equipment selection including bike, tyre or shoe choice. Further, different terrains may require you to learn an additional skill set such as being able to rock-hop over obstacles on a mountain bike or having the lower limb strength to sustain a consistent pace during a sand run. For each of these scenarios, practice makes perfect so time on task is advised.
Although weather can be highly unpredictable and you won’t know until race day the exact conditions, you can usually determine if the weather is likely to be hot and humid, or perhaps cold and rainy due to seasonal averages as well as looking at the conditions of past events.
If the race is likely to be in held neutral conditions (eg. 20°C) this is less of a concern, but for those racing in places such as Hawaii or throughout Asia where the conditions are often intense with severe heat and humidity, acclimation training is advised. For hot and humid conditions, I recommend performing at least 10-14 days of specific heat acclimation training during the preceding 2-3 weeks to competition. This may be achieved simply through arriving at the race venue early, by attending a local sports performance centre offering heat acclimation services, or creating your own hotbox at home. A recommended method is to perform regular 45 – 60 min training sessions between 35-40°C and 60-80% humidity. As the heat and humidity will add significant intensity to the training sessions alone, these acclimation sessions can be performed at a relatively low intensity which will allow your body to physiologically adjust to the change in climate without over stressing the rest of your body.
On the other end of the spectrum, if the race is likely to be cold and/or wet, this is often far easier to prepare for from a physiologically standpoint and may only require the planning of correct race  attire which might include the use of a wetsuit, arm warmers, gloves, gilet or jackets etc. However, if you’re event has specific equipment regulations (such as swimming the English channel where water temperature is often <16°C water and wetsuits are not permitted), applying a covering of petroleum jelly to any parts of the exposed body and aiming to increase your body fat percentage may also be required.
Stay tuned for the final part of the series where I’ll cover tips when packing your bags and how to minimise the stress placed on your body and immune system from long-haul flying.

I’m often asked what the difference between an Accredited Exercise Physiologist (AEP) and a personal trainer (PT) is. So to clear up a few misconceptions that both positions are one-and-the-same, I thought I’d put finger to key and note down seven of the key differences between the two qualifications and roles.
 
1. Qualification
Starting off, a large difference between an AEP and PT is the level of education required to become accredited as either. For AEP accreditation, each practitioner is required to complete a minimum of 4 years of University study of an Exercise Science degree or similar. On the other hand, a PT can become accredited with as little as a short two week private training course. Yes, you read that correctly, your PT at your gym or running your local boot camp may have completed as little as two weeks of study to gain their Certificate III in fitness. Pretty scary I know!!!
 
2. Minimum experience
As part of exercise physiology accreditation, each exercise physiologist is required to demonstrate a minimum of 500 hours of supervised practical experience across a wide range of clientele. Compulsory subgroup populations trained with includes apparently healthy clientele, and those with cardiopulmonary, metabolic, musculoskeletal, neurological, or neuromuscular conditions. In addition, many AEPs are also experienced working with oncology and renal patients, or performing cardiac stress testing. On the contrary, PT applicants often perform less than 20 hours of practical experience and work only with apparently healthy clients.
 
3. Knowledge
Although PT courses cover foundation studies in exercise science, design and instructing, I’m sure you can imagine the depth each subject would cover considering they have six subjects to complete in their short two week course. On the other hand, the education component AEP qualification is far more in-depth and requires at least a 6 month full-time equivalent University study load in the following subjects:

• Structural and functional anatomy
• Human physiology
• Psychology/ psychosocial / behavioural studies
• Exercise physiology
• Biomechanics
• Sport and Exercise psychology
• Motor control / motor learning / skill acquisition
• Human growth, development and ageing
• Exercise, health and disease
• Health, fitness and performance assessment
• Exercise programming and prescription
• Nutrition, health and body composition
• Plus a minimum of 2 – 4 advanced courses of study

In addition, AEPs are required to complete a research methods and statistics course to ensure they’re able to understand and construe the latest exercise research and findings, rather than just follow the current fads and trends.

4. Ensuring correct exercise prescription
Although I haven’t coined the terms ‘exercise prescription’ or ‘exercise is medicine’ myself, to many they are both relatively new terms. See, AEPs are trained to use exercise to improve health outcomes similar to how a doctor is trained to prescribe a pill. As part of their training, AEPs are taught how and why an exercise works, not just the muscles an exercise works. For example, an AEP is trained to identify how your reduced hip flexors range of movement are affecting your pelvic position which alters the gluteal muscles moment-arm and causes a functional weakness and instability of the hip which can contribute to your back, hip, knee or ankle pain. Following this, the AEP also knows what the best exercises are to address these imbalances and correct them. Further, not only are AEPs knowledgeable in exercise prescription for joint or muscle related conditions, they are also skilled with the knowledge of how to safely implement an exercise therapy intervention and improve health outcomes in someone with a history of cardiac complications, diabetes, high blood pressure, or weight management problems and know how the medications the client are on may affect, or be affected by exercise.
On the other side, PTs generally use a narrow approach rather than a holistic one due to their lack of training and knowledge. This might include a view where a leg extension exercise just works the quadriceps muscles, rather than looking at how excessive strengthening of the quadriceps without sufficient posterior chain strengthening may lead to muscle imbalances that can cause irreversible knee damage. In addition, PTs have very little, to zero training in the interaction between client medication and exercise.
 
5. Motivation and encouragement
As AEPs are required to study a psychology component in their studies, their approach to client motivation is generally based on evidence, rather than just industry habits. For example, most AEPs aim to intrinsically motivate their client as research shows that for long-term program adherence and best health outcomes, intrinsic motivation works best. This may include educating the client on how exercise and lifestyle modification can help to improve their health, level of energy, or general wellbeing. On the other hand, the PT often uses extrinsic motivation such as the use of shouting at you which might work in the short term, but isn’t generally advised for long-term program adherence or enjoyment. And for those who do prefer being shouted at, I’m sure if you ask you AEP, they’ll happily oblige ;)
 
6. Clientele qualified and insured to work with
While personal trainers are only qualified and insured to train with persons considered to be low risk (i.e. apparently healthy populations), AEPs are qualified and trained to deliver exercise therapy for all categories of clientele including elite athletes or those classified as high risk. Moderate-high risk clients that only AEPs should train can include males ≥45yrs or females ≥55yrs, those with a BMI ≥30kg/m2, a history of cardiac complications, the elderly, diabetics or asthmatics.
 
7. Private health fund rebates and Medicare referral eligibility
Unlike PTs who are only recognised as fitness professionals, AEPs are recognised allied-health workers (other allied-health workers include physiotherapists, chiropractors, Dietitians, podiatrists, and occupational therapists). This means clients seeing an AEP under GP referral, workcover, Department of Veteran Affairs (DVA), diabetes services, or Aboriginal health services may be entitled to receive Medicare health rebates or bulked-billed services. In addition, 30 of the leading Australian private health insurers now pay a benefit for services provided by an AEP. As many AEPs are additionally registered as fitness professionals, any private health fund rebate available for PT services are also claimable with your AEP.

 
So in summary, hopefully you can see there’s a very large difference between an AEP and PT. This is not only in terms of their education, experience, or training, but also with the wide range of clientele that AEPs are able to safely work with from elite athletes, to the chronically ill, frail or elderly. So next time you’re thinking about whether to see an AEP or PT, think about whether you’d put your life in the hands of someone with only two weeks of study to service your car brakes, or someone with the highest industry qualification. I know who I’d put my health and trust in!!