Tag Archives: health

5 Reasons Tai Chi is the Most Accessible Form of Exercise

Photo courtesy of Gold Coast Tai Chi Academy

Tai Chi – or taiji ch’uan – is a popular form of exercise well recognised for its health benefits. One of the great things about Tai Chi is that it is readily accessible to everyone. It doesn’t matter how old you are, how fit you are, how much time you have, or whether you have any previous experience in sports, martial arts, or fitness: if you can breathe, you can do Tai Chi.

Here are five great reasons why Tai Chi is the most accessible form of exercise for everyone.

Tai Chi is appropriate for all ages.

You are never too young or too old to practice Tai Chi. Due to its low-impact nature, This is an important consideration when choosing exercise for both the pre-adult and the older adult. Excess forces on the body can be counter-productive for both these age groups. In the pre-adult, the developing musculoskeletal system generally responds well to the forces that various exercises place on it. However, excessive forces can alter or damage critical components – such as growth plates – which can lead to developmental problems. In the older adult, many tissues simply will not take the strain of excessive force, which ultimately leads to injury. Tai Chi movements improve strength and balance without putting a lot of strain or force through the body.

Tai Chi is suitable for all fitness levels.

Tai Chi has no prerequisite level of strength, balance, or cardiovascular fitness level in order to start practicing it. In fact, you don’t even need to be able to stand or walk in order to practice Tai Chi. However, if you have already achieved a moderate or even high level of athleticism, Tai Chi will still offer challenges to you that will benefit your existing health and fitness. The two key reasons for this are Tai Chi’s progressive nature – that is, starting with very basic movements and concepts, and advancing over time to whatever end your mind and body can achieve; and it’s adaptability – a knowledgable Tai Chi instructor will be able to recognise a person’s strengths and limitations, and adapt their training accordingly so they can participate and advance at their own pace.

Tai Chi is gender neutral.

While all forms of exercise are (or should be) equally accessible to women and men, many are developed for, targeted towards, or tend to attract, one gender in greater numbers than the other. Tai Chi is one form of exercise that is truly gender neutral. While some may stereotype the ‘soft’ nature of Tai Chi to be  more suited to females, or its martial aspects to be more appropriate for males, the very nature of Tai Chi is to strike a balance between feminine and masculine aspects. A good Tai Chi class will make women and men feel equally at ease practicing their Tai Chi with each other.

Photo courtesy of Gold Coast Tai Chi Academy

Tai Chi requires no special clothing or equipment.

Whatever you are wearing right now, you are dressed for Tai Chi. Wherever you are, you can do Tai Chi. In addition, many of Tai Chi’s forms are practiced ’empty-handed’, meaning there is no need for special equipment. Ideally you will be wearing loose, comfortable clothing, and have enough space to be able to move through the form you are doing, but neither of those are essential to being able to practice Tai Chi. You can do literally do Tai Chi anywhere. They even do Tai Chi in space!

Tai Chi is easy to learn.

Tai Chi is something that anyone, of any background or ability, can jump straight into. Quality instructors introduce new people to Tai Chi in such a way that they have something they can go home and practice right after their first lesson. It is often said of Tai Chi that it is easy to learn, difficult to master, and with good reason. Yet I’ve seen so many people who are introduced to Tai Chi so pleasantly surprised that they can walk in to a class and just join in right from the start. It’s one of the few forms of exercising that, for the beginner, holds no intimidation.

Tai Chi is easily one of, if not the, most accessible forms of exercise available to everyone. Why not give it a try for yourself?

Applying Tai Chi to Physical Therapy – Part 2: Gait Training

Walking is a skill that many of us take for granted – let’s face it, when was the last time you actually thought about the way you walk? Yet it is still a skill, and when your ability to walk is suddenly impeded, or lost altogether, you realise just how important it is to your life. Even with disease or injury, many of us find a way to maintain our ability to walk, however any deviation from ‘normal’ gait (the medical term for walking) can often result in the development or compounding of other problems: pain, muscle imbalance, and arthritis being some of the more common, not to mention the difficulty in attending to day-to-day activities.

What is ‘Normal’ Gait and Why is it Important?

I often explain gait as a “controlled fall”. In order to walk, we shift our center of mass (CoM – see Part 1 for an understanding of the importance of CoM) forwards so that our body starts to move forwards. If we allowed this shift in CoM to continue unchecked, we would fall flat on our face. To avoid this, we use a complex pattern of movements to support ourselves on one leg while we place the other one in front of us to arrest our fall. If we keep our CoM moving forward, we have to repeat the pattern again: the leg in front now becomes the supporting leg, and the leg that was supporting us must now swing forward to save us. Repeat over and over again and you are walking.

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The way our limbs and body produce this – not just the movements themselves, but the way they are coordinated – is referred to biomechanically as a ‘gait pattern’. A ‘normal’ gait pattern is a complex, ideal version of these coordinated movements that result in a stable and efficient means of locomotion which has minimal impact on our musculoskeletal system. It is defined by a number of different factors, including joint angles, distribution of mass (ie: the location of CoM), forces applied to the body, and synergy of movements. For a more in-depth explanation of normal gait, check out this article on Physiopedia.

Anything that doesn’t comply to a ‘normal’ gait pattern is considered to be an ‘abnormal’ gait pattern. This is not to say that it is wrong as such, merely that it does not conform to the ideal that is normal gait. Physical Therapists strive to teach people to walk with a normal gait pattern, or as close to a normal pattern as is achievable. For some people this might not be possible, for example, due to anatomical differences, muscle weakness, imbalances, or tightness, neurological changes or deficits, pain and/or injury, disease, aging, or some combination of these factors. However, while the ‘perfect’ gait pattern might not always be achievable, many people who experience problems with walking can be assisted through Physical Therapy to improve their gait pattern, and in doing so their overall functional capacity.

How Can Tai Chi Help?

Tai Chi

Photo courtesy of Gold Coast Tai Chi Academy

Students of Tai Chi spend a lot of time learning to walk correctly. One main example of this is the technique known as mao xing, or ‘cat walking’. In mao xing, the Tai Chi practitioner shifts weight into one leg while stepping forward with the other. The stepping leg has no weight in it right up to the point the heel makes contact with the ground. The practitioner completes the step by gradually transferring weight from the supporting leg to the stepping leg, involving a shift from side-to-side and back-to-front. As the stepping leg is loaded it becomes the supporting leg, eventually freeing up the other leg to take another step forward.

This sounds very similar to normal gait, however a key difference is the location of the person’s CoM. As already described, normal gait requires the CoM to be displaced forwards outside the person’s base of support BoS), providing momentum. In mao xing, however, the CoM is maintained within the BoS while weight is shifted from one limb into the other, effectively eliminating the “falling” part of walking. To do this successfully, the Tai Chi student must develop a deeper understanding and awareness of how their body moves, in terms of coordination, weight shift, loading and unloading of the limbs, and placement of the feet. As a Physical Therapist, if I could have all my patients mao xing I wouldn’t have to worry about any of them having falls!

Applying Tai Chi to Physical Therapy: Recovery from Joint Replacement Surgery

Recently I’ve been applying the principles of mao xing in retraining normal gait patterns in patients who’ve undergone total hip or knee replacements. In the first weeks after surgery, many joint replacement patients demonstrate a very “stiff-legged” gait pattern: they tend to hold the operated leg very stiff when attempting to mobilise, and limit the amount of time they bear weight through the limb. In some cases the patient will circumduct or swing their leg around rather than bend their hip and knee in order to take a step forwards. Some patients may also have been walking like this for sometime prior to their surgery due to the nature of the condition that required joint replacement.

It can be quite challenging to retrain patients to walk with a normal gait pattern again, and often requires very precise practice. This has been particularly true in patients who have had bilateral joint replacements, who don’t have a ‘good’ leg to support themselves on and so are very guarded with attempting to walk.Though I haven’t been trying to teach my patients mao xing as such (though I often think I would like to), I’ve found that incorporating a number of the principles of mao xing – stepping onto the heel, rolling through the foot to come up onto the toes and push-off – as well as instructing the patient in a similar manner to how I would teach the technique to a Tai Chi student, provides a much more correct and consistent result than other methods I’ve tried. I’ve also found in practice that focusing on the principles related to the foot (heel strike, weight shift, stance, toe off) produce a subsequent improvement in the pattern of movement at the knee and hip – that is, an increase in the amount of flexion at the hip and knee during swing phase – and tolerance to weight-bearing during stance phase. When I apply these principles to gait training, I seldom have to draw attention to or correct movements at the hip, knee, or lumbo-pelvic area as these seem to correct themselves when the patient is applying the principles to their feet.

Lastly, and in some ways the most exciting part, is that I’ve found that patients are more likely to practice this “creeping” (as several patients have referred to it) way of walking as part of their home exercise program than they are other techniques or exercises designed to improve their gait. The exact reason why is unclear, however I would suggest it is because it is easier for the patient to conceptualise, understand, and apply, than other techniques that are more detailed and require a higher level of cognitive processing. In practice this apparent increase in compliance and attendance to exercises between therapy sessions does appear to translate – in general – into a more timely improvement in gait and physical function.

Again, this is at best observational evidence of a specific application of Tai Chi principles to physical therapy. However, it does support the increasing body of evidence-based research advocating  Tai Chi as a means of improving balance and mobility, and in my opinion, is worth further investigation as an adjunct to physical therapy.

Why Australian Health Insurers Should Cover Tai Chi

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Photo courtesy Gold Coast Tai Chi Academy

Regular readers will be well aware of my advocacy of Tai Chi as a means of maintaining optimal health for the lifespan. (For those who are new, click on the Tai Chi tag to read past articles about the benefits of Tai Chi). There are few forms of exercise that can boast the wide range of physical and mental health benefits, whilst being accessible to people of all ages and abilities, as Tai Chi does.

Health insurers around the world have increasingly recognised the benefits of enabling their members to engage in activities designed to promote healthy lifestyles, and thereby maximise health and well-being. The rationale is simple: engaging in preventative health practices minimises the risks of developing more serious, complicated, and/or debilitating conditions, and therefore reduces both the incidence and level (not to mention the expense) of future medical care required. For example, it is far better from an insurers point of view to support a member to engage in a weight management program, gym membership, and nicotine replacement therapy, than it is to support them through coronary artery bypass surgery and the follow-up care afterwards.

As a result, most, if not all, health insurers now offer some form of support for members to engage in activities designed to maintain or improve their health. The types of activities vary between insurers: in Australia, common activities covered include gym and personal training, yoga, Pilates, and weight management programs. Yet despite its known benefits to health, Tai Chi is not currently covered by any major Australian health insurer. Why?

It’s a good question. Considering that health insurers will, for the most part, only cover treatments or activities that are supported by clinical evidence to be effective in maintaining or improving health, Tai Chi is possibly one of the better examples of evidence-based interventions for good health. A good example of this can be found in a review published in the American Journal of Health Promotion (1.). In this article, Jahnke and colleagues examined the outcomes of randomised controlled trials investigating the outcomes of both Tai Chi and Qigong exercises, and found evidence of positive outcomes for numerous health factors, including bone health, cardiopulmonary health, physical function, falls prevention, immunity, psychological conditions such as anxiety, depression and self-efficacy, and general quality of life. This is by no means an exhaustive list: research since publication continues to identify more health conditions for which Tai Chi can be beneficial. In the face of such evidence, and considering that many insurers cover a range of complimentary or alternative health practices whose evidence based is equal to or less than that of Tai Chi, it seems odd that Tai Chi would not be covered alongside options such as yoga and Pilates.

It becomes even more confusing when you consider that Tai Chi has previously been covered by at least one insurer in Australia. In 2010 the Tai Chi Association of Australia (TCAA) reported that MBF (which has since merged and is now known as Bupa) had recognised Tai Chi for inclusion in its Lifestyle Bonus option, and as much as 70% of class fees could be covered under certain conditions. At the time of writing however, Tai Chi does not appear to be covered under Bupa’s Living Well programs, whereas other forms of exercise such as yoga and Pilates are, and the reasons for this remain unknown.

Another point of consideration is the fact that Tai Chi is gaining recognition and support from the broader health and medical industry for its health benefits. An increasing number of doctors, physiotherapists, exercise physiologists and other health professionals are recommending Tai Chi as a part of maintaining a healthy lifestyle. A number of hospitals and health services either conduct, or are connected to, Tai Chi classes, and promote this to their patients and the broader community. For example, the South West Hospital and Health Service in rural south-west Queensland offers free Tai Chi classes to the general public. This is similar to programs offered by local councils, such as the Gold Coast City Council’s Active and Health Program which includes Tai Chi amongst its variety of healthy activities. In addition, the benefits of Tai Chi have been formally recognised and endorsed by a number of peak representative bodies, including Arthritis Australia, Diabetes Australia and Osteoporosis Australia.

In the light of such evidence, recognition and support, it seems to only make sense that health insurers should be including Tai Chi alongside other already recognised activities such as yoga and Pilates. Indeed, health insurers in other countries, for example the United States, have already recognised the benefits of including Tai Chi in their own benefits packages. Surely the inclusion of Tai Chi within a healthy lifestyle package can only serve to benefit health insurer’s members, and in doing so, benefit the insurers themselves.

Do you practice Tai Chi? Do you have private health insurance? Do you think health insurance should cover Tai Chi, as it does other activities such as yoga and Pilates? Please share your comments below.

References

1. Jahnke, R., et al. (2010). A comprehensive review of health benefits of Qigong and Tai Chi. American Journal of Health Promotion, 24(6): e1-e25.

3 of Tai Chi’s Lesser Known Health Benefits

Tai Chi

Reproduced with permission from Gold Coast Tai Chi Academy

Tai Chi (T’ai Chi Ch’uan) is well-known and widely practiced for its health benefits. It’s particularly regarded for its ability to improve balance, range of motion, and lower limb strength, and has been highly researched to establish its effectiveness as a form of exercise for the elderly. In fact, there has been a great deal of research conducted on Tai Chi and Qigong exercises, and both the scientific evidence and the range of health conditions Tai Chi can prove beneficial for is constantly growing.

As a physiotherapist who practices and has been involved in teaching Tai Chi, I keep an eye on the evidence-based research coming out about Tai Chi and its benefits to people, so I can use this to advocate for Tai Chi as a form of therapeutic exercise. What has been interesting is seeing the breadth of research that is being undertaken, and the health conditions that Tai Chi is being shown to produce positive outcomes in beyond the classic falls prevention, various forms of arthritis, and age-related deconditioning. Conditions that I don’t believe most people would normally associate Tai Chi as being able to influence, much less produce positive outcomes. I’d like to illustrate this by bringing three such conditions to your attention, which you may not have been aware of.

Tai Chi and Breast Cancer

g32025800000000000058a37129c5f09d9942b164d878e1e23852dd1738This has been of particular interest to me having had someone I care about recently undertake their own battle with breast cancer, as well as a number of past patients. Over the last several years researchers have been examining the effectiveness of Tai Chi as an intervention to prevent or improve secondary health conditions experienced by breast cancer survivors.

For example, a recent study by Galantino and colleagues (1.) has shown the feasibility of Tai Chi in improving the well-being of postmenopausal breast cancer survivors who have developed arthralgias (joint pain) as a side effect of being prescribed aromatase inhibitors (eg: Aromasin, Arimidex and Femara) to reduce estrogen production. Their study demonstrated statistically significant improvements amongst their test subjects for anxiety, depression, emotional well-being and fatigue, as well as the Sit-and-Reach test, and near statistical significance for pain severity, physical well-being, the Berg Balance Scale and Timed-Up-and-Go Test. This is important because, as the authors state, there are very few interventions that have been developed to counteract the side effects associated with this form of post-breast cancer therapy, and consequently many breast cancer survivors stop using their medication. If Tai Chi can limit the negative side effects of this type of therapy, not only can it improve people’s physical and emotional well-being, it can potentially increase adherence to medication regimes, and thereby reduce the risk of these survivors developing future complications.

The benefits Tai Chi can have on post-cancer symptoms experienced by many breast cancer survivors have also been demonstrated by other researchers. Huang and colleagues (2.) found that breast cancer survivors who engaged in physical activities like Tai Chi and Qigong demonstrated a proportional decrease in cancer-related fatigue compared to those who did not, while Sprod and colleagues (3.) demonstrated changes in biomarkers including insulin, glucose, and cortisol levels which correlated with improvements in health-related quality of life, physical functioning, social functioning and general mental health. Overall, the evidence is growing that breast cancer survivors – particularly those who are post-menopausal – would gain significant benefit from regular Tai Chi practice.

Tai Chi and Depression

Depression is an all-too-common, and in many ways still poorly managed, mental health condition in many societies, and one I encounter frequently amongst patients, particularly those suffering from chronic pain. While it is difficult to locate studies that have solely examined the relationship Tai Chi can have on depression, many studies exist where depression has been one of the variables measured as part of using Tai Chi as a form of therapeutic intervention.

One chronic pain condition that has been well-researched in terms of the effects of Tai Chi is fibromyalgia. An example of this is the research from Wang and colleagues (4.), who measured a number of physical, mental and emotional well-being indicators, including depression, amongst their participants who were engaged twelve weeks of Tai Chi training. Not only did they demonstrate improvements in measures of depression at the end of the twelve weeks of training, but these improvements persisted 12 weeks after the cessation of the training. Similar improvements in mental health measures, including depression, were reported the studies described for breast cancer suffers above.

Results such as these have led researchers and clinicians to call on health professionals to support patients wanting to explore Tai Chi as a form of complimentary therapy to treat issues such as depression. In their editorial in The New England Journal of Medicine, Yeh and colleagues (5.) called on physicians to ‘prescribe’ Tai Chi for patients with fibromyalgia, while psychotherapist Mary Ann La Torre (6.) advocates the use of body movement – in particular, Tai Chi, as a means of creating change and enhancing healing in psychotherapeutic treatment.

On a personal level, not only am I aware of the impact Tai Chi has on my own mental health, I have had patients with a variety of conditions where depression has been a component (for example, chronic pain, cancer, and HIV-positive status) who have all anecdotally reported improvements in their mental health and well-being having commenced Tai Chi training. It would be interesting to see future research specifically investigating the effects of Tai Chi on individual mental health conditions, such as depression, as these results would likely be transferable across a wide range of health conditions where depression is a factor.

Tai Chi and Diabetes

Another condition of close personal interest to me, not only because of its disproportionately high incidence amongst Aboriginal and Torres Strait peoples, but also because several people dear to me have either Type I or Type II diabetes. It is well-known that exercise is beneficial for the management of both types of diabetes, so it would be reasonable to expect that Tai Chi would produce similar benefits. However, what is interesting in the research being undertaken is that Tai Chi is not only beneficial for the secondary conditions associated with diabetes, for example, impaired mobility due to peripheral vascular complications (7.), it also has a direct effect on cellular physiology. For example, several studies have demonstrated that Tai Chi practice can increase insulin sensitivity and thereby reduce A1C levels (a better indicator of blood glucose levels over time, as opposed to the immediate result from a blood glucose monitor) (8.), and increase the levels and enhance the activity of regulatory T-cell levels (9.) which improves immune system functioning.

This is critical for those with diabetes, as being able to effect changes at the cellular level means better management of the primary complications associated with diabetes, which can then result in reduced risk of developing, or progression of, secondary complications, such as peripheral vascular disease and neuropathies.

IMG_9858These are only three examples of the wide range of health conditions that Tai Chi is proving itself to be able to make positive changes to. As quality of studies improve and researchers start to identify the specific ways in which Tai Chi can make changes to our health, it is my hope that we will see Tai Chi become a ‘treatment of choice’ in both managing and preventing ill-health.

Do you do Tai Chi? What ways has Tai Chi improved your health and well-being? Please feel free to share your answers in the comments section below.


 

References

1. Galantino, M. L., et al. (2013). Tai Chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study. Alternative Therapies in Health and Medicine, 19(6): 38-44.

2. Huang, X., et al. (2010). Factors associated with cancer related fatigue in breast cancer patients undergoing endocrine therapy in an urban setting: a cross-sectional study. BMC Cancer, 10: 453-459

3. Sprod, L. K., et al. (2012). Health related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan. Journal of Cancer Survivorship: Research and Practice, 6(2): 146-154.

4. Wang, C., et al. (2010). A randomized trial of tai chi for fibromyalgia. The New England Journal of Medicine, 363(8): 743-754.

5. Yeh, G. Y., et al. (2010). Prescribing tai chi for fibromyalgia – are we there yet? The New England Journal of Medicine, 363(8): 783-784.

6. La Torre, M. A. (2008). The role of body movement in psychotherapy. Perspectives in Psychiatric Care, 44(2): 127-130.

7. Orr, R., et al. (2006). Mobility impairment in Type 2 diabetes: association of muscle power and effect of tai chi intervention. Diabetes Care, 29(9): 2120-2122.

8. Bronas, U. G., et al. (2009). Alternative forms of exercise training as complementary therapy in the prevention and management of Type 2 diabetes. Diabetes Spectrum, 22(4): 220-225.

9. Yeh, S., et. al. (2007). Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease in cytotoxic T-cell population in Type 2 diabetic patients. Diabetes Care, 30(3): 716-718.

Is it Time to Say “Bye” to BMI?

bmi_flawedBody Mass Index, or BMI, has become somewhat of a catchphrase in a world of ever-increasing obesity. Doctors, dietitians, and personal trainers are just some of those who use your BMI to determine whether you are obese, or at risk of becoming obese. Even the tools we use for fitness – electronic scales, heart rate monitors, and even our smart phone apps – use BMI as a primary indicator of whether you are at your ‘ideal weight’. However, while everyone is busy calculating their BMI and worrying whether they’re outside the ‘golden range’, few seem to be asking what this number actually represents, and fewer still whether it actually has any validity.

What are we actually talking about?

Before trying to answer those questions, it’s important to define a few terms:

‘Weight’ – contrary to popular belief, your weight is not a measure of how fat you are. Your weight is a measure of the effect of gravity on your mass – that is, the resultant force that gravity is having on the total mass of matter that makes up you. Weight doesn’t care what this matter represents – fat, bone, muscle, fluid – it just tells you what gravity is doing to you. Because gravity is pretty much the same all over Earth, the only way to change your weight is to change your physical mass. By that reasoning it could be said that to be ‘overweight’ or ‘underweight’ means you either have too much or too little physical mass compared to an ideal value. However, in practice we do not define these terms in this way.

‘Overweight’ and ‘obesity’ are defined by the World Health Organisation (WHO) as, “abnormal or excessive fat accumulation that presents a risk to health.” Note that the thing that is being measured or compared in this definition is the amount of fat that makes up an individuals body composition. Therefore, to determine whether a person has an abnormal or excessive accumulation of fat, it stands to reason you need to know the amount of fat that makes up a person’s mass. WHO further defines obesity as a percentage of body fat equivalent to 25% total body weight for men, and 35% for women.

‘Underweight’ interestingly enough, is most often defined by a person’s BMI, which is discussed below.

‘BMI’ – again, contrary to popular belief, BMI is a mathematical calculation, not a measurement. BMI is calculated by dividing your weight (in kg) by the square of your height (in meters). So for example, a person weighing 70kgs at a height of 1.75m would have a BMI of: 70kg / (1.75m x 1.75m) = 22.86 kg/m2.

So what’s the problem with BMI?

Well, there are several problems which continue to be debated within the literature today, including concerns around its validity in reference to specific populations and its use as a diagnostic tool (which, by the admittance of its inventor, Belgian mathematician Lambert Adolphe Jacques Quetelet, it was never intended for). However the most glaring one should be obvious from these definitions. BMI tells us about the relationship between the height and weight of an individual, however it does not – in fact, it cannot – tell us anything about the composition of that individual’s body. Specifically, it does not – cannot – tell us anything about the fat composition of that individual’s body.

This in itself would not be a concern, if not for the fact that BMI is frequently used to categorise people as being underweight, overweight, or obese. The fact is, BMI cannot make this categorisation because it does not measure fat composition. At worst, it runs the risk of generating false positives and false negatives when attempting to categorise people based on a comparison of height and weight. This can be illustrated with a simple example using a muscular athlete, such as a competitive body-builder.

Jay-Cutler-From-2009-IFBB-Olympia

Photo courtesy HealthyCeleb.com

Meet Jay (Jason) Cutler, a four-time Mr Olympia winner from the United States. Jay is 5’9″ (1.75m) and at competition weight approximately 274 pounds (124kg). Based on his height and weight, Jay’s BMI is 40.49 kg/m2, which accordingly to WHO classification, puts him in the morbidly obese category. Looking at Jay at the 2009 Mr Olympia competition, you would be hard pressed to call this man “morbidly obese.” Why is his BMI so high? Simply because muscle has a higher density (approximately 18% greater) than fat, so for the same volume of tissue, muscle weighs more than fat. As such, Jay’s BMI is clearly a false positive result. (For interest, Jay’s weight outside of competition has been recorded at 310 pounds (140kg), which would place him in the super obese category!)

The problem of density differences between muscle and fat can also give false negative results as well. Consider someone with a low proportion of muscle mass (eg: sedentary-lifestyle) or whose muscle mass is reducing over time (eg: elderly, or active person becoming inactive). It is quite possible that this person will record a BMI that would be considered ‘normal’, yet physiologically have a body fat percentage higher than that considered ‘healthy’ by the WHO. This has been demonstrated in a number of scientific studies by comparing BMI with more accurate body composition recording techniques, such as dual energy x-ray absorptiometry (DXA or DEXA), including one study where approximately 1 in 4 men and 1 in 2 women were incorrectly classified by BMI [1]. Can these error rates be considered acceptable when screening for risks to people’s health?

So why do we use it?

Despite its problems, BMI’s simplicity is the main reason why it continues to be used. It’s quick, cheap, and easy to do. If you have the ability to measure a person’s height and weight, and basic math skills, you can categorise someone as being within a ‘healthy’ weight range, or not. Apparent anomalies are often dismissed through subjective observation by the assessor. “No, Jay, of course you’re not obese,” is what we would expect Jay Cutler’s doctor to advise him, for example. Though in light of the incidence of false negatives BMI produces, it could be argued we should be questioning whether such subjective opinions are valid, or even putting individuals at risk of being miss- or undiagnosed.

Critics of BMI have cited more potentially malicious reasons why the use of BMI persists. For example, some health insurance companies adjust their customer’s premiums based on their BMI – the higher your BMI, the more you pay – because they are considered to be at higher risk for developing problems with their health. Is this fair for the professional athlete, a person considered to be at peak physical fitness, and therefore healthy compared to the rest of the population? What about the 29 million Americans who suddenly “became fat” in 1998 when the U.S. National Institutes of Health and the Center for Disease Control (CDC) lowered the U.S. cutoff for ‘normal’ BMI from 27.8 to 25 [2]?

What’s the alternative?

There are many different ways body composition can be measured. In relation to body fat, hydrostatic weighing (weighing underwater) and whole-body air displacement plethysmography (ADP) are considered the gold standards of getting an accurate value. DXA or DEXA is also highly regarded, though primarily used in research. However, these procedures require specialised equipment and operators, and in some cases can be quite expensive to undertake.

Bioelectrical impedance analysis (BIA) is a cheaper alternative which is gaining popularity, particularly as an ‘in-home’ means of determining body composition through the use of body composition analysis scales. BIA has been demonstrated to be useful for predicting the body fat composition of groups, however shows poorer accuracy for individuals, likely due to the fact that readings can vary depending on an individual’s level of hydration (or dehydration) [3].

Skinfold calipers are another inexpensive and time-honoured method of determining body fat percentage, and chances are if you’ve been involved in college/university level sports, or been part of a sports institute, you’ve felt the skinfold pinch. There has been much ongoing debate in the scientific literature about the accuracy and usefulness of skinfold measurements in determining body fat, with issues such as inter- and intra-tester reliability (ie: whether the same person or different people can produce the same results with each test), the sites used, the methods of calculation, and again, the hydration level of the subject, identified as potential problems. At best, it seems skinfold measurements are accurate at determining body fat percentage on lean athletes, but less so for those with excess body fat or loose connective tissue (ie: the elderly) [4].

In the last two decades, waist circumference measurement has been increasingly used as a screening tool for assessing individual’s risk of developing diseases associated with excess body fat, such as diabetes and cardiovascular disease. Like BMI it is quick, easy, and inexpensive to administer, requiring only a tape measure. Current Australian guidelines state that waist measurements above 94cm for adult males and 80cm for adult females are indicator of excessive internal fat deposits, and increase the risk of chronic disease. Waist circumference has been demonstrated to be a good predictor of visceral fat (fat around the organs) [5] and a better predictor of risk of cardiovascular disease [4,5,6], type II diabetes [4,5], and metabolic syndrome [5] than BMI.

Is it time to say “bye” to BMI?

It is apparent that BMI tells us nothing about the composition of the body, and that there are problems with its use as an indicator of diseases such as obesity, and with its accuracy at identifying individuals who may be at risk of further health complications based on their body composition. It’s also apparent that there are more accurate ways of determining body composition, and these may be better indicators for people’s risk of developing diseases related to unhealthy levels of body fat [4]. Is it therefore time we stopped using BMI?

It’s not a simple question to answer. BMI still has potential in screening people who are underweight compared to a normal population, and flag the need for further examination, to determine if they may be suffering from diseases such as malnutrition or anorexia. However, while BMI can determine whether an individual is ‘overweight’ compared to a normal population, it cannot give any indication as to why that is the case. Therefore it would seem justifiable that BMI should no longer be used as a means of categorising people as being ‘obese’, as it cannot indicate what the body composition of an individual is.

Further, given that other methods of body composition analysis are better predictors of the risk of disease and other complications associated with unhealthy levels of body fat, it seems justifiable to suggest that BMI should be the least favoured tool utilised by clinicians and individuals. This is particularly true where other methods, such as waist circumference measurement, have been demonstrated to be more reliable indicators of risk of associated health problems, such as cardiovascular disease, and are just as quick, easy and cost-effective to administer as BMI.

Why, then, should we continue to use BMI?

Do you know your BMI? Do you agree with the category it places you in? Would you rather know your BMI, or your Body Fat Percentage, in terms of making decisions about your own health? Please feel free to share your thoughts in the comments section below.

References

1. Shah, N. R. and Braverman, E. R. (2012). Measuring adiposity in patients: the utility of Body Mass Index (BMI), percent body fat, and leptin. PLoSOne. 7(4): e33308 1-8.
2. Cohen, E. and McDermott, A. (1998). Who’s fat? New definition adopted. CNN: 17 June 1998. Retrieved 26 June 2014 at: http://edition.cnn.com/HEALTH/9806/17/weight.guidelines/
3. Houtkooper, L. B. et al. (1996). Why bioelectrical impedence analysis should be used for estimating adiposity. American Journal of Clinical Nutrition. 64(suppl.): 436S-448S.
4. Wagner, D. R. and Heyward, V. H. (1999). Techniques of body composition assessment: a review of laboratory and field methods. Research Quarterly for Exercise and Sport. 70(2): 135-149.
5. National Health and Medical Research Council (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council.
6. Siavash, M. et al. (2008). Comparison of Body Mass Index and Weight/Height Ratio in predicting definite coronary artery disease. Annals of Nutrition and Metabolism. 53: 162 – 166.

Why Preventative Health is More Important Than Ever

appleWith the announced changes to Australia’s healthcare system in last night’s Budget, the affordability of quality health and medical services has become an even greater concern for the average Australian. The impact upon those who already utilise services such as Medicare and the Pharmaceutical Benefits Scheme (PBS) is expected to be significant, with great concerns many will no longer attend primary health care or purchase essential medications as a result of new and increased co-payment systems. It is not a good time to get sick in Australia.

Many healthcare professionals have long advocated for people to undertake preventative health measures. There is a wealth of research showing evidence that preventative health strategies decrease the burden of illness and disease in individuals, families, and the broader community. You can liken it to running a car: most car owners have their vehicle routinely serviced to check everything is running well and identify potential problems. Early identification of problems gives an opportunity for the owner to address the issue before it becomes a major problem. Addressing the issue early not only reduces the likelihood of averting a catastrophic event in relation to the car – like a breakdown, or an accident – but also all the events that follow on as a result: expenses in relation to towing and repair, potential loss of income if reliant on it for work, inability to attend to activities due to lack of transport, potential increase in insurance premiums (in the case of an accident), and so on. Most car owners don’t think twice about undertaking preventative maintenance of their vehicle. Why then do so many of us not engage in preventative care of our health? Aren’t we more important than a car?

In its 2013 report, The Australian National Preventative Health Agency (ANPHA) reported that Australia is a world leader in preventative health practice, however we face ever-increasing problems in non-communicable – and preventable – diseases, such as obesity. The indication is that the tools are available – policy, programs and promotion – however the uptake by the Australian public seems to be lacking. There can be numerous reasons across a variety of socioeconomic factors for this, however there is one thing that remains consistent: it is up to each individual to take ownership and control of their own health, and make the decision to engage in preventative health measures.

With the costs associated with doctor’s visits and medications to rise from 2015, and expected increases to other health and medical services, including health insurance premiums, as a flow-on effect of the Budget, now is the time to make the decision to look after your health, and do your best to prevent future illness. Here’s three tips that can help you engage in preventative health:

  1. Take an Honest Look at Your Health

Sit down and ask yourself honestly, “am I as healthy as I can be?” It can be a tough question to answer, particularly if you feel well. We often believe that if we don’t feel unwell, we’re healthy, and therefore there’s no reason to change anything. Yet if you’re really honest with yourself, you will likely think of things that might not make you feel sick (yet), but that you know could put your health at risk. For example:

Sometimes it can be difficult to really take a critical look at your own health, and there might be benefit asking the opinion of someone you’re close to and trust. They may identify issues that you haven’t considered or aren’t aware of.

  1. Have a Check-Up

There is nothing wrong with going to see a doctor (or other healthcare professional) when you are well. In fact, you’ll probably find they’re happily surprised! Having a regular check-up is just like regularly servicing your car; it’s an opportunity to make sure everything is working the way it should, or if not, identify and manage potential problems. Knowing that everything is okay can be just as useful as knowing what’s wrong.

  1. Engage in Preventative Behaviours

Even without seeing a healthcare professional, most of us know that eating healthy foods, exercising regularly, stopping smoking, drinking in moderation, and reducing stress will have a positive effect on our health. If you try tips one and two above, you’ll most likely discover other ways you can maximise your health, and reduce your risk of illness or injury. However, knowing what to do isn’t enough: you need to do it, and the only person who can make you do that, is you. You need to take ownership of your health, decide what level of health you want to achieve and maintain, and take action to make your optimal level of health a reality. You do not have to do this alone, your healthcare professionals can provide advice, assistance, and education on what you can do to maximise your health and prevent future problems. The help you need is out there and available; the decision to do it is yours.

Do you engage in preventative health measures? If so, what do you find most helpful or works well for you? If not, what do you think is stopping you? Please feel free to add your comments below.