Biopsychological Integration

Biopsychological integration is a holistic approach to enhance a person’s performance, health and process of rehabilitation. The body qualifies as a system, and includes the immune and nervous system, which consist of tissues and cells. Our family is a system, and so are our community and society. As a systems, they are entities that are dynamic (consistently changing) and they have components that interrate, such as by exchanging energy, substances and information.

To illustrate how the interacting biopsychological systems concept works, let’s assume that the person having chronic pain on knee and inherited some factors that affect his weight (biological system). The meals in the family (social system) and foods taken in the family and from the hawker centres usually contain high fat and high kilo-joules foods. He preferred to engage in sedentary activities such as playing manjong, slow walk once a week and watching television (psychological system).

We can also use the biopsychological model also as a guide to promote people’s health and recovery from illness. In the biological system, understanding the aetiology of the patellofemoral joint syndrome (weaknesses of related muscles, the postural problems etc.) is important to provide immediate appropriate treatment. Weight control management through body composition monitoring on energy balance between the dietary intake and exercise energy expenditure is essential.

By using the psychological methods such as goal setting, relaxation and imagery in Taichi exercise programming (correction on increased lumbar lordosis, excess pelvic tilt, poor Taichi motor movement; and engage in the moderate Taichi/walking exercise daily etc.) to increase motivation, self efficacy and exercise adherence.

Peoples are doing Taichi practices individually, in small groups and big groups (e.g. in the Yew Tee RC, coaching by NewAgeTaichi); they have bonding, multi-racial and social harmony. People who have a high degree of social support from family, friends, instructors and coaches are healthier and live longer than people who do not.


References

1. Abernethy, B., Hanrahan, S. J., Kippers, V., Mackinnon, L. T., & Panday, M. G. (2005). The Biophysical Foundations of Human Movement (2nd ed.): Human Kinetics.
2. Brukner, P., & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). NSW: McGraw Hill.
3. Caltabiano, M. L., Byrne, D., Martin, P. R., & Sarafino, E. P. (2002). Health Psychology : Biopsychosocial Interactions (1st ed.): John Wiley & Son Australia, Ltd.

Cardiovascular Disease (CVD) Reversal

Endothelial dysfunction
Scientists had recognised that the endothelial wall of the coronary arteries plays a vital role in vascular health. Aging and hypertension are two independent cardiovascular risk factors that have been shown to exhibit increased endothelin-1 system activation (Stauffer, Westby, & DeSouza, 2008). In addition, smoking, elevated low-density lipoprotein (LDL) cholesterol, elevated blood glucose and inflammation attribute to the endothelial dysfunction, the abnormal or impaired physiological function of the biochemical processes carried out by the endothelial cells lining the inner surface of the artery walls. Endothelial dysfunction, particularly vasomotor dysregulation occurs early in the atherosclerotic process, contributes to disease development and progression, and can trigger acute cardiovascular events (Van Guilder, Westby, Greiner, Stauffer, & DeSouza, 2007).

Effect of exercise and dietary on blood lipids
High density protein (HDL) cholesterol increases nitric oxide (a potent vasodilation) production, inhibiting blood cell adhesion to vascular endothelium and reducing platelet aggregability and coagulation (Calabresi, Gomaraschi, & Franceschini, 2003) and hence reverses cholesterol transport, removing cholesterol from the arterial wall.

The positive effects of regular exercise are exerted on blood lipids at low training volumes and accrue so that noticeable differences frequently occur with weekly energy expenditures of 1200 to 2200 kcal/wk. It appears that weekly exercise caloric expenditures that meet or exceed the higher end of this range are more likely to produce the desired lipid changes (improved in HDL cholesterol concentration). This amount of physical activity, performed at moderate intensities, is reasonable and attainable for most individuals and is within the American College of Sports Medicine's currently recommended range for healthy adults (Durstine et al., 2001). Durstine, Grandjean, Cox, & Thompson (2002) had indicated similar results unless dietary fat intake was reduced and body weight loss was associated with the exercise training program, or both.

Aerobic fitness
Aerobic fitness, not merely physical activity, is associated with a reduced risk of cardiovascular disease. Vigorous intensity exercise has been shown to increase aerobic fitness more effectively than moderate intensity exercise, suggesting that exercise performed at a vigorous intensity appears to convey greater cardioprotective benefits than exercise of a moderate (Swain & Franklin, 2006).

Regular and habitual aerobic exercise
Regular and habitual aerobic exercise can prevent the age-associated loss in endothelium-dependent vasodilation (arterial aging) and restore levels (preserving vascular function) in previously sedentary middle aged and older healthy men. This represent an important mechanism by which regular aerobic exercise lowers the risk of cardiovascular disease (DeSouza et al., 2000; Seals, Desouza, Donato, & Tanaka, 2008; Smith, Hoetzer, Greiner, Stauffer, & DeSouza, 2003).

Taichi is an aerobic exercise and is suitable for participants of different ages and gender to improve their functional capacity (Lan, Chen, & Lai, 2004).

Preventive and middle age risk-free
Preventing coronary artery disease (CAD) development since teens, 20s or 30s is essential rather than try to reverse it later. Research done by Stamler and others (2000) on a total of 11,017 men aged 18 through 39 years screened in 1967-1973; men with favourable baseline serum cholesterol levels (<200 mg/dL [<5.17 mmol/L]), had an estimated greater life expectancy of 3.8 to 8.7 years.

Adults who had low risk factors in middle age demonstrated a significantly higher quality of life in older ages compared with those who had three or more risk factors (risk factors increase, quality of life decreases)(Daviglus, Lloyd-Jones, & Pirzada, 2006). It appears that 50 may be the turning point; individuals who are able to read this age with no risk factors have markedly higher survival rates than those with any combination of risk factors (Janot, Dalleck, & Bushman, 2008).

References

1. Calabresi, L., Gomaraschi, M., & Franceschini, G. (2003). Endothelial protection by high-density lipoproteins: from bench to bedside. Arterioscler Thromb Vasc Biol, 23(10), 1724-1731.
2. Daviglus, M. L., Lloyd-Jones, D. M., & Pirzada, A. (2006). Preventing cardiovascular disease in the 21st century: therapeutic and preventive implications of current evidence. Am J Cardiovasc Drugs, 6(2), 87-101.
3. DeSouza, C. A., Shapiro, L. F., Clevenger, C. M., Dinenno, F. A., Monahan, K. D., Tanaka, H., et al. (2000). Regular aerobic exercise prevents and restores age-related declines in endothelium-dependent vasodilation in healthy men. Circulation, 102(12), 1351-1357.
4. Durstine, J. L., Grandjean, P. W., Cox, C. A., & Thompson, P. D. (2002). Lipids, lipoproteins, and exercise. J Cardiopulm Rehabil, 22(6), 385-398.
5. Durstine, J. L., Grandjean, P. W., Davis, P. G., Ferguson, M. A., Alderson, N. L., & DuBose, K. D. (2001). Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med, 31(15), 1033-1062.
6. Janot, J., Dalleck, L., & Bushman, T. (2008, October). A second chance at health - While it's preferable to enter middle age risk-free, research shows you can reverse cornonary artery disease IDEA Fitness Journal.
7. Lan, C., Chen, S. Y., & Lai, J. S. (2004). Relative exercise intensity of Tai Chi Chuan is similar in different ages and gender. Am J Chin Med, 32(1), 151-160.
8. Seals, D. R., Desouza, C. A., Donato, A. J., & Tanaka, H. (2008). Habitual exercise and arterial aging. J Appl Physiol, 105(4), 1323-1332.
9. Smith, D. T., Hoetzer, G. L., Greiner, J. J., Stauffer, B. L., & DeSouza, C. A. (2003). Effects of ageing and regular aerobic exercise on endothelial fibrinolytic capacity in humans. J Physiol, 546(Pt 1), 289-298.
10. Stamler, J., Daviglus, M. L., Garside, D. B., Dyer, A. R., Greenland, P., & Neaton, J. D. (2000). Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. Jama, 284(3), 311-318.
11. Stauffer, B. L., Westby, C. M., & DeSouza, C. A. (2008). Endothelin-1, aging and hypertension. Curr Opin Cardiol, 23(4), 350-355.
12. Swain, D. P., & Franklin, B. A. (2006). Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol, 97(1), 141-147.
13. Van Guilder, G. P., Westby, C. M., Greiner, J. J., Stauffer, B. L., & DeSouza, C. A. (2007). Endothelin-1 vasoconstrictor tone increases with age in healthy men but can be reduced by regular aerobic exercise. Hypertension, 50(2), 403-409.

Stages of Rehabilitation and Exercise Programming

Stages of Rehabilitation and Functional Exercise Programming sequence.

Stages of rehabilitation

1. Initial

2. Intermediate

3. Advance

4. Return to activites

Components of rehabilitation

1. Muscle conditioning

2. Flexibility

3. Neuromuscular control (balance, proproception)

4. Functional exercises

5. Taichi/Sports skills

6. Correction of abnormal biomechanics

7. Maintenance of cardiovascular fitness

8. Psychology

Integration of individual components into progressive rehabilitation program

1. Motor re-education and motor activation

2. Proprioception, flexibility and strength

3. Skill acquisition

4. Return to Taichi/Sports

References

1. Brukner, P., & Khan, K. (2007). Clinical Sports Medicine (3rd ed.). NSW: McGraw Hill.

Taichi – Functional Anatomy

In theory, myofascial slings have no beginnings and no ends. Depending on movement, different sling activate different time. Myofascial slings (most familiar, studied and commonly used) are:
A. Anterior oblique system
B. Posterior oblique system
C. Posterior longitudinal system

Examples of Myofascial Lines
A. Superficial Back Line
B. Superficial Front Line
C. Lateral Line
D. Spiral Line

The pectorialis --> internal oblique --> gluteus medius slings form the spiral and function line; similar to TaiChi movement for 外三合 - 肩与胯合, 时与膝合, 手与足合. Symmetrical line for both side of the body such as for the spiral line is important and any unsymmetrical can cause common postural problem (head shifted/tilted to one side).

Taichi Energy Cost

Equipment
1. Wrist weight – 0.5kg /side
2. Ankle weight – 1.5kg/side
3. Elliptical Cross Trainer
4. TRX Suspension Trainer
5. Training Mat
6. Polar HR Watch S810i
7. Creative MP3 (loaded with Taichi music)

Discussion

The warm-up (approximately 10 minutes) was conducted using the elliptical cross trainer with the same uphill and downhill profile for forward and backward movement. The maximum heart rate for the backward motion was about 1.11 times higher (larger cardiovascular exertion) than the forward motion; this indicated that the energy expenditure was higher and suitable for aerobic endurance improvement with proper exercise programming. This was similar to the findings done on the some of past scientific research (Hooper et al., 2004; Minetti & Ardigo, 2001). The energy cost for thus for the backward was greater than forward motion (Williford, Olson, Gauger, Duey, & Blessing, 1998)

Regarding the energy cost of the Taichi practices, the Chen 56 steps > 42 competition set > Yang 40 steps > 24 steps; the exercises were using the same baseline heart rate for comparison purpose. The differences were due to the complexity and difficulties (e.g. Chen 56 steps has more eccentric & propulsive movements) level of the set. By practising the various sets or repeated the same set continuously (duration) will allow the subjects to exercise at moderate intensity level.

Taichi is an exercise with moderate intensity, and its exercise intensity is similar across different ages in each gender (Lan, Chen, & Lai, 2008).


References

1. Hooper, T. L., Dunn, D. M., Props, J. E., Bruce, B. A., Sawyer, S. F., & Daniel, J. A. (2004). The effects of graded forward and backward walking on heart rate and oxygen consumption. J Orthop Sports Phys Ther, 34(2), 65-71.
2. Lan, C., Chen, S. Y., & Lai, J. S. (2008). The exercise intensity of Tai Chi Chuan. Med Sport Sci, 52, 12-19.
3. Minetti, A. E., & Ardigo, L. P. (2001). The transmission efficiency of backward walking at different gradients. Pflugers Arch, 442(4), 542-546.
4. Williford, H. N., Olson, M. S., Gauger, S., Duey, W. J., & Blessing, D. L. (1998). Cardiovascular and metabolic costs of forward, backward, and lateral motion. Med Sci Sports Exerc, 30(9), 1419-1423.

Comprehensive Lifestyle Changes Impact Cancer Genes

Mind-Body Lifestyle Changes Impact Cancer Genes

Epidemiological and prospective studies indicate that comprehensive lifestyle changes may modify the progression of prostate cancer (Ornish et al., 2008).

Materials and Methods
Study subjects
- 30 males (mean age of 62.3 years (range 49–80)) with prostate cancer. All had low-risk prostate cancer and had refused immediate surgery, hormone therapy or radiation. Instead, they participate in the lifestyle program including of periodic monitoring of tumors to track any growth.

Lifestyle intervention
- 3 month comprehensive lifestyle modification was prescribed
1. Dietary change
Vegan diet
Supplement: Soy, fish oil, vitamin E, selenium and vitamin C
2. Moderate exercise
Walk 30 minutes a day, 6 days a week
3. Stress management
Yoga-based stretching
Breathing
Meditation
Imagery
Progressive relaxation
4. Group support

Discussion

After 3 months, the researchers observe changes in gene expression that affected the tumors: genes that promoted the cancer were no longer active or were less active, and genes that helped fight the cancer were switched on. More people with all ages are able to change and adherence to the program. These findings suggest that never be too old to make changes that positively affect your health (Archer, 2008).

This lifestyle intervention is related to the lifestyle filter in the hour glass model (Gallahue & Ozmun, 2006) in article presented on 15th Oct ’08. Both the moderate exercise and stress management can possible be substituted by Taichi if done correctly to achieve the moderate exercise intensity and psychological benefits.

References

1. Archer, S. (2008, October). Mind-body lifestyle changes impact cancer genes. IDEA Fitness Journal.
2. Gallahue, D. L., & Ozmun, J. C. (2006). Understanding Motor Development (Infants, Children, Adolescents, Adults) (6th ed.): McGrawHill.
3. Ornish, D., Magbanua, M. J., Weidner, G., Weinberg, V., Kemp, C., Green, C., et al. (2008). Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A, 105(24), 8369-8374.

Overweight & Obesity

An introduction: statistics on the growing trend to obesity in Asia Pacific region, number of overweight/obese in Singapore

Global and United States
Obesity is an excess body weight due to fat deposition as compared to set standards of body weight (Afridi & Khan, 2004). It is a single chronic disease that trigger many kinds of diseases such as type 2 diabetes that leading to cardiovascular disease and cancers. Type 2 diabetes is estimated to be 30 million in US and worldwide estimation of 120 million (Amos, McCarty, & Zimmet, 1997). The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030 and the total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030; the prevalence of diabetes is higher in men than women, but there are more women with diabetes than men and increase in proportion of people > 60 years of age (Wild et al., 2004). Similar trends also on childhood overweight and obesity (Wang & Lobdtein, 2006)

Asia Pacific region
There has been dramatic increase of obesity in Asia-Pacific region in recent years. In the Republic of North Korea’s National Nutrition Survey 1995, only 1.5% of the population was classified as obese (BMI > 30kg/m^2) and 20.5% overweight (BMI 25-29.9 kg/m^2); in Thailand, 4% were obsess and 16% overweight; in Malaysia, 4.7% of men and 7.7% of women were obese (Inoue et al., 2000).

Singapore
A national committee was appointed in 1991 to review the national health plan for 1990s, followed by the National Healthy Lifestyle programme in 1992 with extensive use of mass media and widespread school, workplace, and community health promotion programme emphasizing healthy diets and regular exercise (Cutter, Tan, & Chew, 2001). The obesity remained unchanged at 6% between 1992 and 1998, but among the Malay women, 11.1% were classified as obese in 1992, and 16.2% in 1998; and the Indian women are 12.5% and 17.5% comparatively (Inoue et al., 2000); the ethnic difference has implications on the acute myocardial infarction (Mak et al., 2003). In the nation health survey 2004 of age between 18 – 69 years, the diabetes rates had slight improvement from 9% in 1998 to 8.2% in 2004 and this corresponds to proportion of adults who exercise regularly increased from 16.8% in 1998 to 24.9% in 2004; no exercising drop from 54.7% in 1998 to 48.1% in 2004 ("National Health Survey 2004", 2005). In the 2005 National Sports Participation Survey (Market Probe-Precision Research Pte. Ltd., 2005), the incidence of “regular sports participants” has risen from 38% in 2001 to 48% in 2005 among adult population (i.e. aged 15 years and above). Nevertheless, the overweight and obese are still relatively high, and are at risk of obesity related diseases. To further improve the obesity condition, Ministry of Education policy requires the schools to have at least 70 minutes of physical education per week to equip young people to be well prepared starters in taking ownership and responsibility for their own health and well-being through initiatives for PRIDE (personal responsibility in daily effort) and PLAY (participation in lifelong activity for youths) programme (Chia, 2007).

Health cost
Davis, Knuiman, Hendrie, and Davis (2006) estimated the cost of diabetes for both individual and society is $A636 million based on type 2 diabetes in 2000 and projection to 2051; and as the result of aging population it will double the cost contributing to financial burden and funding to rising health-care costs. This trigger for the health and fitness industries and demand for gyms, weight-loss centres, health clubs and diet solutions.

A discussion on health problems of excess weight

Industrialization
An effect of acculturation or modernization and attributed with the reduced levels of activity increasing the prevalence of obesity. As the populations become more westernized, dietary composition changes to include more saturated fat, less fibre and exposure to obesogenic environment; and these lead to more energy dense diets causing higher energy intake leading to positive energy balance. Prentice and Jebb (2004) in his research explain the imbalance between the effectiveness of the hunger and satiety signals leads to an asymmetry in appetite control that helps to explain why current life styles create such a high level of susceptibility to obesity in most individuals. In Asia and especially Chinese ethnic group, obesity was and some cases remains, a symbol of wealth and increased social status (Dowse, Hodge, & Zimmet, 1995). Other factors of influences are occupation and education, as well as stresses from urban society.

Genes
Nevel J.V. in 1962 (as cited in Andrew, Alexandra, Blakemore, & Philippe, 2006) proposed the “thirty gene” hypothesis had a selective advantage in populations that frequently experience starvation. In today’s obesogenic environment with just only few decades that the industrialized world has done from a calorie-poor to a calorie-rich environment; these genes might be those that “overreact” not just over weight, but extremely obese. Genetics factors that affect metabolism and appetite determines to about 25% of the variation among people in percentage body fat and body mass; a larger percentage of variation relates to a transmission (cultural) effect (McArdle, Katch, & Katch, 2005). Genetic makeup does not necessary cause excessive weight gain but however in the presence of powerful environmental influences, it lowers the threshold of gaining weight. Being obese does not mean being ill and , indeed, it is likely that very good health is required to establish and to maintain obesity (Andrew, Alexandra, Blakemore, & Philippe, 2006).

Problems with excess weight
Diabetes mellitus is one of the mostly commonly encountered diseases that impaired glucose tolerance to type 2 diabetes (Dunstan, AO, Slade, & Harper, 2003), it related morbidities include diabetic retinopathy, neuropathy and cardiovascular disease (Wee, Ho, & Li, 2002). Adults with diabetes have heart disease increased to 4.5 times higher than those without diabetes and similar trend held with respect to stroke (Peck, 2002). Although much emphasis is placed on the link between obesity and life threatening health problems like coronary heart disease (CHD) and diabetes, another health consequence of obesity is knee osteoarthritis (OA) and disabling knee pain (risk is 7-10 times higher than non-obesity); it happens in older adults and about 10% of the world’s population aged 60 or older have significant health problem attributed to OA (Jinks, Jordan, & Croft, 2006). It is normally recommended that the person with knee pain and disability to use weight reduction to manage and not to alleviate these symptoms. The comorbidities of obesity include hypertension, elevated blood sugar, pulmonary dysfunction including asthmas and sleep apnea, psychiatric problems like depression and eating disorders, postmenopausal breast cancer, pancreatic cancer, gastrointestinal disorders including gallstones (risk of 5 times higher if BMI > 40), and elevated total cholesterol (high LDL and low HDL) and increase psychological burden; all these heighten an over-weight individuals exposing to risk of poor health (McArdle, Katch, & Katch, 2005).

Death due to obesity
The estimated number of death attributed to obesity per se ranges between 280,000 and 325,000; which was more than 80% of the estimated obesity-attributable deaths occurred among individuals with body mass index of more than 30kg/m^2 without taking the smokers and never-smokers into consideration because cessation of smoking increase weight gain (Allison, Fontaine, Manson, Stevens, & VanItallie, 1999). This was based on the 1991 analysis because of availability of population (1990 US census) and mortality statistics. In Singapore, the obesity had risen from 6% in 1998 to about 7% in 2004; high blood cholesterol of about 18% and high blood pressure of about 20% in 2004 ("National Health Survey 2004", 2005). Diabetes mellitus was 9%, the sixth most common cause of death in 1998, accounting for 2.2% of annual total mortality (Wee, Ho, & Li, 2002).

Monitor own body mass
When the new BMI classification report released on 16th March 2006 in Singapore, many had turned up to the measuring machine islandwide to measure their body mass index (BMI); the new classification indicated that the weight was acceptable at 18.5-23, slight over-weight from 23-25, over-weight from 25-30 and obese for >30 (Forss, 2006). The point to take note on BMI is that they is a possibly of misclassifying someone as overweight to large-size field athletes, bodybuilders, weightlifters, upper-weight-class wrestlers, and professional football players etc (McArdle, Katch, & Katch, 2005).

A critical Review of the usefulness of low carbohydrate, high protein diet: what are they, why are they popular, suitability for weight loss, long term issues/success

Popularity
Some low carbohydrate and high-protein diets are Atkin, Zone, Protein Power, Sugar Busters and Stillman. This low carbohydrate, high protein diets have recently been proposed as a “new” strategy for fast weight loss due to the increased dietary thermogenesis, increased satiety and a decreased in subsequent energy; which made the high protein intakes diet book popular. More than 10 million copies of Alkins diet books have been sold. Researchers Yancy, Olsen, Guyton, Bakst and Westman (2004) indicated a weight loss of 12.9% after 24 weeks for people using the Atkins diet. Other research by Brehm, Seeley, Daniels, and A.D'Alessio (2003) shown similar outcome result of 8.5 ± 1 kg versus 3.9 ± 1 kg (about 2 times as compare to low fat diet) weight loss for 6 months of trial. Zone diet recommends that the protein should account for 30% or more energy and this is regarding high because it is twice the typical intake or 12 – 15%. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal source.

Suitability for weight loss, long term issues/success
Nutrition Committee of the American Heart Association (AHA), noted that high protein diets may not be harmful for most healthy people for a short period of time, but there is no long term scientific studies to support their overall efficacy and safety (Jeor et al., 2001). The Nutrition Committee does not recommend high protein diets because they do not provide the variety of foods needed to adequately meet nutritional needs. In high protein diet, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression; ketosis - the body's natural response to starvation. Ketosis is triggered by low insulin levels in the blood, which can result from restricted carbohydrate intake, and can lead to a loss of appetite, another reason why high-protein dieters are often successful in shedding pounds in the short run (Eisenstein, Roberts, Dallal, & Saltzman, 2002). Weight loss benefited the effects on blood lipids and insulin resistance. Promoters of high protein diets promise successful results by encouraging high protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked out for variety of reasons for most individuals. High protein diets are not recommended because they restrict healthful foods that provide essential nutrient and individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities (Jeor et al., 2001). It also increase urinary excretion of oxalate, a compound that combines primarily with calcium to form kidney stones (Eisenstein, Roberts, Dallal, & Saltzman, 2002). High levels of urinary calcium with the diets also indicate that decreased in calcium balance and increased risk for bone loss. In addition, high protein diet usually failed to contain the highest quality amino acid mixture and lacked required vitamins and minerals particularly copper; a negative balance coincides with electrocardiographic abnormalities and rapid heart rate (Fisler, 1992). Manninen, in his paper (2004) argue that there were not enough of scientific evidence to support the negative effects. Other evident like the high intakes of meat protein accelerated renal function decline in women who had a mild renal insufficiency at the start of an 11 year study also do support the negative effect (Williams, 2005). Robert H. Eckel, MD, who chairs the AHA Nutrition Committee, warned that Atkins and Protein Power have particularly high intakes of total fat, saturated fat and cholesterol (60% of daily calories from fat), all of which raise the risk of heart disease.

There has never been a ‘weight loss breakthrough’ that simple new idea or product that will make body fat loss easy. AHA guidelines recommend a diet low in fat and high in fruit, vegetables, whole grains and low-fat dairy products. Diets should contain no more calories than necessary to maintain a healthy body weight.

Conclusion

This prevalence obesity rates reflect changes in lifestyle with economics development lead to population growth, aging, urbanization, and physical inactivity. A low carbohydrate, high protein diets have not proven to be effective in long-term weight reduction and they may pose health risks for individuals who stay on them for more than a short time. Diet and lifestyle play a significant role both in development and control of obesity.

There is strong evidence that people who are physically active are at less risk of developing obese related disease such as diabetes than those who lead sedentary lifestyles. Regular exercise of at least 30 minutes of moderate-intensity activity on most, preferably all days of the week and increased the leisure-time physical activity including planned exercise and sport. A well-rounded physical activity program should include aerobic and strength-developing activities. The education systems under the Ministry of Education umbrella enable the younger generation to take ownership and responsibility for their own health and well-being. When Singapore is moving to become a regional sporting hub in 2011, the environment will create more opportunities for physical activities that support the individuals desired behavioral changes.


References

1. Afridi, A. k., & Khan, A. (2004). Prevalence and etiology of obesity - an overview. Pakistan Journal of Nutrition, 3(1), 14-25.
2. Allison, D. B., Fontaine, K. R., Manson, J. E., Stevens, J., & VanItallie, T. B. (1999). Annual deaths attributable to obesity in the United States. American Medical Association, 282(16), 1530-1538.
3. Amos, A., McCarty, D., & Zimmet, P. (1997). The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabetic Medicine, 14(Supplement 5), S1-S85.
4. Andrew, J. W., Alexandra, I. F., Blakemore, & Philippe, F. (2006). Genetics of obesity and the prediction of risk for health. Human Molecular Genetics, 15(2), R124-R130.
5. Brehm, B. J., Seeley, R. J., Daniels, S. R., & A.D'Alessio, D. (2003). A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women The Journal of Clinical Endocrinology & Metabolism, 88(4), 1617- 1623.
6. Chia, M. (2007). PRIDE for PLAY: Personal responsibility in daily effort for participation in lifelong activity for youths. A Singapore context. Journal of Sports Science and Medicine, 6, 374-379.
7. Cutter, J., Tan, B. Y., & Chew, S. K. (2001). Levels of cardiovascular disease risk factors in Singapore following a national intervention programme. Bulletin of the World Health Organisation, 79(10), 908-915.
8. Davis, W. A., Knuiman, M. W., Hendrie, D., & Davis, T. M. (2006). The obesity-driven rising costs of type 2 diabetes in Australia: projections from the Fremantle Diabetes Study. Internal Medicine Journal, 36(3), 155-161.
9. Dowse, G. K., Hodge, A. M., & Zimmet, P. Z. (1995). Paradise lost: obesity and diabetes in Pacific and Indian Ocean populations. London: John Libbery & Co.
10. Dunstan, D. W., AO, P. Z., Slade, R., & Harper, S. (2003). The joint position statement of the International Diabetes Institute and Diabetes Australia - Victoria on the role of physical activity in the risk reduction and management of diabetes. International Diabetes Institute.
11. Eisenstein, J., Roberts, S. B., Dallal, G., & Saltzman, E. (2002). High-protein weight-loss diets: are they safe and do they work? A review of the experimental and epidemiologic data Nutrition Reviews, 60(7), 189-200.
12. Fisler, J. S. (1992). Cardiac effects of starvation and semistarvation diets: safety and mechanisms of action. American Journal Clinical Medicine 56, 230S-234S.
13. Forss, P. (2006, 17th March). Hundreds turn up at BMI machines islandwide to check health risk. ChannelNewsAsia.
14. Inoue, S., Zimmet, P., Caterson, I., Chen, C., Ikeda, Y., Khalid, A. K., et al. (2000). The Asia-Pacific perspective: Redefining obesity and its treatment: Health Communication Australia Pty Limited.
15. Jeor, S. T. S., Howard, B. V., Prewitt, T. E., Bovee, C., Bazzarre, T., & Eckel, R. H. (2001). Dietary protein and weight reduction: A statement for healthcare professionals from the Nutrition Committee of the Council on nutrition, physical activity, and metabolism of the America Heart Association Journal of the American Heart Association, 104, 1869-1874.
16. Jinks, C., Jordan, K., & Croft, P. (2006). Disabling knee pain - another consequence of obesity: Results from a prospective cohort study. BMC Public Health, 6(258), 1-8.
17. Mak, K. H., Chia, K. S., Kark, J. D., Chua, T., Tan, C., Foong, B. H., et al. (2003). Ethnic differences in acute myocardial infarction in Singapore. European Heart Journal, 24, 151-160.
18. Manninen, A. H. (2004). High-protein weight loss diets and purported adverse effects: where is the evidence ? Sports Nutrition Review Journal., 1(1), 45-51.
19. Market Probe-Precision Research Pte. Ltd. (2005). National Sports Participation Survey 2005. Retrieved 22 March 2006. from http://www.ssc.gov.sg/publish/Corporate/en/news/news/2006_News_Articles0/More_Singaporeans_Participating_In_Sports.html.
20. McArdle, W. D., Katch, F. I., & Katch, V. L. (2005). Sports & Exercise Nutrition (2nd ed.). Baltimore: Lippincott Williams & Wilkin.
21. National Health Survey 2004 [Electronic (2005). Version]. Statistics Singapore Newsletter. Retrieved 2 December 2007 from http://www.getforme.com/previous2005/260405_findingsofnationalhealthsurvey2004.htm.
22. Peck, P. (2002). Greater risk identified between diabetes and heart disease: awareness is key. Medscape cardiology, 6(2), 1-5.
23. Prentice, A., & Jebb, S. (2004). Energy intake/physical activity interactions in the homeostasis of body weight regulation. Nutrition Reviews, 62(7), S98-S104.
24. Wang, Y., & Lobdtein, T. (2006). Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 1, 11-25.
25. Wee, H. L., Ho, H. K., & Li, S. C. (2002). Public awareness of diabetes mellitus in Singapore. Singapore Medical Journal, 43(3), 128-134.
26. Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes - estimates for the year 2000 and projections for 2030. Diabetes Care, 27, 1047-1053.
27. Williams, M. H. (2005). Nutrition for health, fitness, & sport (7th ed.): McGraw Hill.
28. Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 140, 769-777.

Resistance Exercise Reverses Aging in Human Skeletal Muscle

Human aging is associated with muscle atrophy (sarcopenia), weakness and functional impairment, which commence in the fourth decade of life with a rate of strength loss of about 1.0% per year, accelerating with each passing decade (Timothy J. Doherty, 2003). A functionally debilitating sarcopenia affects approximately 7% of adults over 70, and up to 20% over age 80 years (Castillo et al., 2003; Melton et al., 2000).

Healthy older adults show evidence of mitochondrial impairment and muscle weakness, but that this can be partially reversed at the phenotypic level, and substantially reversed at the transcriptome level, following six months of resistance exercise training.

A recent study (Melov, Tarnopolsky, Beckman, Felkey, & Hubbard, 2007), involved before and after analysis of gene expression profiles in tissue samples taken from 25 healthy older men and women who underwent six months of twice weekly resistance training, compared to a similar analysis of tissue samples taken from younger healthy men and women.

The gene expression profiles involved age-specific mitochondrial function; mitochondria act as the "powerhouse" of cells. Multiple studies have suggested that mitochondrial dysfunction is involved in the loss of muscle mass and functional impairment commonly seen in older people. The study was the first to examine the gene expression profile, or the molecular "fingerprint", of aging in healthy disease-free humans.


Exercise Training (Exercise protocol used in the above research)

Resistance exercise training was performed twice weekly on non-consecutive days (Monday+Thursday, or Tuesday+Friday) or 26 weeks (6 months). Prior to, and after each, training session, subjects were required to perform static stretching.

Resistance exercise for each session consisted of 3 sets of 10 repetitions for each of; leg press, chest press, leg extension, leg flexion, shoulder press, lat pull-down seated row, calf raise, abdominal crunch, and back extension and 10 repetitions for arm flexion and arm extension.


TaiChi Training Concept

Resistance training (such as circuit training programme for small group) is used in the physical preparation stage at difference days of the week and is difference from the aerobic & endurance training days.


References

1. Castillo, E. M., Goodman-Gruen, D., Kritz-Silverstein, D., Morton, D. J., Wingard, D. L., & Barrett-Connor, E. (2003). Sarcopenia in elderly men and women: the Rancho Bernardo study. American Journal of Preventive Medicine, 25(3), 226-231.
2. Melov, S., Tarnopolsky, M. A., Beckman, K., Felkey, K., & Hubbard, A. (2007). Resistance exercise reverses aging in human skeletal muscle. PLoS One, 2(5), e465.
3. Melton, L. J., Khosla, S., Crowson, C. S., O'Connor, M. K., O'Fallon, W. M., & Riggs, B. L. (2000). Epidemiology of sarcopenia. Journal of the American Geriatrics Society, 48(6), 625-630.
4. Timothy J. Doherty. (2003). Physiology of Aging. Invited review: Aging and sarcopenia. Journal of Applied Physiology, 95, 1717-1727.