Does Vitamin D supplementation decrease the risk of fractures?

When people think of reducing the risk of fractures, they automatically think of calcium supplementation. We’ve all heard of women in their 50’s and 60’s being told by their physician’s to start taking calcium to prevent bone mineral loss and to decrease the chance of developing osteoporosis. So why take vitamin D? There are two reasons for supplementing with vitamin D. First, a deficiency in vitamin D can lead to softening of the bones and second, vitamin D is essential for proper calcium absorption. In other words, you could be supplementing with calcium but not absorbing it properly. This is why many calcium supplements come with vitamin D.

How much vitamin D is enough to offset the risk of fractures? A recent publication in the New England Journal of Medicine set out to answer just this. They reviewed and analyzed data from 11 randomized studies of vitamin D supplementation in adults aged 65 and older and assessed hip and non-vertebral (not located in the spine) fractures. The findings from 31,022 people suggested that only a high intake of vitamin D (792–2000 IU/day) leads to a significant reduction in the risk of fracture. This reduction was approximately 30% for hip fractures and 14% for non-vertebral fractures. The authors also found that those who were most vulnerable i.e. those aged 85 and older and those with low baseline levels of vitamin D, had the greatest benefit from vitamin D supplementation. The most interesting part of the study was perhaps that a smaller amount of calcium supplementation (<1000 mg per day) with the highest intake level of vitamin D was more protective against fractures than a higher calcium intake.

This study highlights the need for taking calcium in conjunction with vitamin D. Further, it highlights the importance of taking high doses of vitamin D to actually reap the benefits of supplementation. Again, this is most beneficial for those who are at high risk for fractures i.e. it might not be beneficial for those without the risk factors of older age and low baseline vitamin D. Interestingly, vitamin D levels tend to be quite low among those living in Canada and other developed countries. One way to increase vitamin D is by getting natural sunlight as this synthesizes vitamin D in the body.

TAKE HOME MESSAGE: If you are at high risk for fractures, be sure to supplement your diet with vitamin D as well as calcium (please consult your physician first). Higher doses (approximately 800 IU/day) seem to be optimal for protection against fractures. After starting such supplementation, be sure to do some follow-up tests with your physician to ensure that you are taking the optimal dose of vitamin D. Another great way of ensuring you maintain bone mineral density is through weight bearing exercise, a topic I will cover in a future article.

Don’t let low bone mineral density become a problem in your life. Remember, you have control of your HALF!


Want to improve your running performance? Less might be more!

As a recreational runner you understand the frustration with not being able to increase your pace. You do your long-slow runs and you cross-train and you run up hills and you speed through those shorter runs, but you can’t seem to get faster. Well, the answer to your pace problems might just be 10-20-30.

High intensity intervals are the “new” way to workout. They’re good for your health, they’re good for performance and they’re used by athletes around the world. But the question is, what type of intervals are optimal for a recreational runner? A recent study published in the peer-reviewed Journal of Applied Physiology showed that 10-20-30 might be the answer. Two scientists in Copenhagen conducted a small experiment with recreational runners (5K times of approximately 23 minutes). They split the participants in to two groups. The intervention group was asked to do a 10-20-30 training regime. This consisted of approximately 1.2k of warm up at low intensity followed by three to four 5 minute running sessions with 2 minute breaks between each session. Each of the 5 minutes of running consisted of 5 consecutive 10-20-30 second runs at an intensity of <30%, <60% and 90-100% of their max intensity respectively (see the note below for more information on how to determine these intensities). The other group (control group) continued to train as they were before with an average weekly volume of 24-25k/week (around 120-130 min/week). The authors found that those in the 10-20-30 group significantly improved their aerobic fitness, 1.5K time and 5k time compared to the control group in just 7 weeks. Another advantage to those in the 10-20-30 group was that their systolic blood pressure (the higher of the two blood pressure numbers) and their cholesterol ratio (total cholesterol to good cholesterol (HDL)) improved significantly while it did not change in the control group.

It seems that high intensity exercise sessions can lead to significant improvements in performance and in health. By simply doing 3-4 repetitions of the 5 minute 10-20-30 intervals, young and healthy participants were able to able to improve their 5K time by 4% and their 1.5K time by 6%! Moreover, they improved their already healthy levels of cholesterol and blood pressure; a difficult task for most. The greatest part of this story is that the runners in the 10-20-30 group were only training three times/week for no more than 30 minutes each session. In other words, less time + higher intensity = greater gains in performance and health.

TAKE HOME MESSAGE: If you are a runner, no matter the level, you can benefit from incorporating high intensity intervals. The intervals in this particular study were 10-20-30 seconds in length, but there are others out there that have been proven beneficial. The benefit of a workout such as 10-20-30 is that it takes less time and is of a lower volume. This gives your body more time for rest and recovery, making it stronger and faster!  If you are not a runner and are not regularly active, be careful when taking on high intensity exercise. It is certainly beneficial, but if you push yourself too hard, too fast, you could get injured. Also, be sure to get clearance if you have high risk for heart disease or have been inactive, before starting high intensity training.

NOTE: You can estimate your 10-20-30 intervals based on heart rate or speed/incline on the treadmill. For the heart rate method, determine your age-predicted maximal heart rate by subtracting your age from 220. Take this number and determine 30%, 60% and 100% of it. Use these heart rate zones to determine the appropriate intensity. The heart rate method will underestimate your zones, but is an easy method. The alternative is to use the treadmill to determine your maximum capacity/workload. Start running on the treadmill at an easy speed with an incline of 2%. Every two minutes, increase the speed by 1mph until you are at your maximum running speed. Then start increasing the incline every 2 minutes. When you get to a point where you can’t run the full two minutes anymore, you have determined your maximum capacity. From this, you can calculate the 30% and 60% workloads on the treadmill. This latter method should not be done without a buddy standing close by. It is also essential that you be screened for exercise prior to attempting this method if you have been inactive up until now. Please use this method with caution!


Can Pilates help with your Lower Back Pain?

It is thought that 80% of the population will experience low back pain at some point in their lifetime. Whether this is chronic (lasts for a long period of time, 3 months or more) or whether acute (short period of time) will depend on the cause of the back pain. One of the most common reasons for low back pain is weak abdominal muscles and tight low back muscles. This is often a result of having a large waist. Thus, any physical activity will help with back pain of this nature because it will help with weight loss and will also help strengthen and stretch the appropriate muscles. Of course, there are many other causes of low back pain, such as an injury sustained at work or in a car accident. In these cases, more specific exercises targeting the cause of injury may be required. These are generally prescribed by a health care professional such as a physiotherapist. Nevertheless, even for such injury related low back pain, general physically active has been found to be beneficial.

Supervised exercise sessions for chronic low back pain can be expensive and may not be enough to counter the pain. In recent years, exercises such as yoga and Pilates have been investigated as exercise options for those with low back pain. In a recent study published in the peer-reviewed journal Medicine and Science in Sports and Exercise Wajswelner and colleagues investigated the benefits of Pilates compared to a general exercise program for those with low back pain. Participants were adults who reported symptoms of pain or stiffness in the lower back with or without lower limb symptoms (no leg pain or numbness) on most days of the week for 3 months or more. They also had to report significant pain to participate in the study. For 6 weeks, twice per week (60 minutes each), participants attended group sessions of either Pilates or general exercise with a physiotherapist. At the end of the 6 weeks all participants showed significant improvements in pain and disability scores; the improvement was the same between groups. In other words, Pilates led to similar improvements in low back pain symptoms as did general exercise.

This is great news for those with low back pain. It seems that you can safely and effectively use Pilates to improve pain in your lower back. If you don’t have access to a health care professional, then an instructor led Pilates class might be a good alternative. If you do have access, then you could add Pilates to your program for some variety!

TAKE HOME MESSAGE: If you have low back pain, adding physical activity to your daily schedule is essential! There is no doubt in the scientific community that physical activity is good for your back health, but be cautious in choosing the type of activity you do. It would be ideal to consult with a health care practitioner prior to beginning an exercise program, but if you can’t, choose a safe and effective physical activity like walking or Pilates. Don’t let low back pain control your life.

Remember, you have control of your HALF!!!