FitBits
November 15, 2003

Exercise ETC's Review of Exercise Related Research.
Compiled by
Irv Rubenstein, Ph D, CSCS

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Obesity Statistics:
Flawed or Fact?

In late October, The Center for Consumer Freedom - a nonprofit coalition supported by restaurants, food companies, and consumers working together to promote personal responsibility and protect consumer choices - gave the following testimony at a public hearing of the Federal Drug Administration's (FDA) Obesity Working Group:

The three most commonly-cited statistics associated with the obesity epidemic are 1) that obesity causes 300,000 American deaths per year; 2) that 61 percent of Americans are overweight or obese; and 3) that the economic cost of American obesity is $117 billion a year. According to testimony, all three stats are seriously flawed.

1) 300,000 U.S. deaths are attributable to excess weight. The truth is that "the data linking overweight and death ... are limited, fragmented and often ambiguous." That's from an editorial published by the respected New England Journal of Medicine in January 1998, questioning the increasingly frantic rhetoric about obesity as a public health problem.

2) Obesity costs Americans $117 billion per year. The original source of this claim was a study published in the March 1998 issue of the Journal of Obesity Research. The authors themselves admit: "We are still uncertain about the actual amount of health utilization associated with overweight and obesity," explaining that "height and weight are not included in many of the primary data sources." Furthermore, the authors defined obesity incorrectly, writing: "The current estimate of the cost of obesity defines obesity as a BMI greater than or equal to 29." Obesity is actually defined as a BMI of greater than or equal to 30. Thus the Obesity Research study erroneously included the economic cost of individuals with a BMI between 29 and 30. That's more than ten million Americans who, by definition, are not obese.

3) Sixty-one percent of Americans are overweight or obese. The definition of overweight used by the U.S. government was arbitrarily changed in 1998, following political pressure brought by the World Health Organization. The definition that was abandoned in 1998 had the virtue of distinguishing between men and women -- something our current definition does not do. And the 1998 redefinition re-classified 39 million Americans as “overweight." They literally went to sleep one night at a government-approved weight, and woke up "overweight."

Testimony from The Center for Consumer Freedom at the hearing can be found at www.ConsumerFreedom.com.

Commentary: Please note the source of the rebuttal of this data is an interest group very often implicated for having influenced Americans’ eating habits and choices. Also, please note that the research dates to 1998 which, though possibly arbitrary at that time, is fairly close to the numbers mentioned in a recent issue of ACE Fitness Matters (November/December 2003, p. 7). According to a recent estimate from the Centers for Disease Control and Prevention 64% of American adults and 13% of children are overweight; 23% of adults are obese. It was only recently, less than five years ago, that obesity was added to the list of heart disease risk factors. As such, the numbers the Center for Consumer Freedom is contesting are likely more accurate today as a result of this new understanding of the role overweight/obesity has in morbidity and mortality.

A “Killer Workout” Can Kill - - Literally

Have you heard of exertional rhabdomyolysis?

Exertional rhabdomyolysis is a condition that indicates severe muscle damage. It presents with very high levels of myoglobin and creatine kinase in the urine, which turns the urine very dark, almost brownish. It is associated with extremely high exercise workloads and volume of exercise.

This report documented two clients who got exertional rhabdomyolysis from a single session with a personal trainer. The first case was a 22 year old female in good physical condition whose trainer encouraged her to increase reps and weights for her lower body exercises. At one point the trainer actually had to help her walk to the next machine, but had her continue the routine. Two days later she went to the hospital; it took 7 days after the exercise session before her urine levels returned to normal. Her trainer said he had never heard of the condition.

The second case was that of a 37-year-old male physician who had not trained in a long while. The trainer had him perform 3 sets of 4 types of exercises for the upper back, 3 sets of biceps on machines and with dumbbells, and several sets of torso exercises. Two days post exercise, he noticed the dark color of his urine and, suspicious of rhabdomyolysis, had his urine tested. It took another 4 days to return to normal values.

In the first case, when told of the medical complications, the trainer said he’d never heard of exertional rhabdomyolysis.

Commentary: Exertional rhabdomyolysis can lead to kidney failure and even death. In one case the client was experienced but her trainer pushed her too hard; in the other, the client was less trained and pushed by his trainer way too hard. The problem is you can’t immediately tell whether you pushed the client too hard. The take-home message is use RPE to determine intensity. On the 10 point RPE scale an RPE of 7-8 is generally sufficient for your average client; 9 may be OK for your advanced clients but think hard before going to an RPE of 9 or 10.

B.L Springer & P.M. Clarkson, Two cases of Exertional rhabdomyolysis precipitated by personal trainers. Medicine & Science in Sports and Exercise 35(9):1499-1502, 2003

Comparing Treatments
for ACL Injury

This study reviewed the long term outcomes (2 years post surgery) of 40 male soccer players who had had ACL repair by one of two methods – Hamstring (semitendinosus) grafts or patellar tendon grafts. One group served as controls. They had all been rehabbed similarly and returned to soccer play after about 3 months. Leg circumferences were measured at several points above the patella and maximal isometric strength was tested for the quadriceps and hamstrings.

EMG testing was done during several functional tests such as one- and two-legged jumps, squats, and during gait analysis. As one might expect, those with the hamstring grafts had weaker hamstrings than those with the patellar tendon grafts; they also had a lower hamstring to quadricep ratio relative to the uninjured leg.

Interestingly, the patellar graft group showed greater functional asymmetries and deficiencies: less flexed landing from a one-leg jump, lower vertical jump-off force with the leg at a higher angle of flexion, and a longer stance phase during walking.

The implications of some of these results suggest that the repair of the patellar tendon may predispose the knee to another ACL injury; this type of repair may increase the potential for poor landing technique and increased weakness at the angle the knee should be most stable – when flexed.

Commentary: Trainers are not doctors, so we can’t prescribe treatment for our clients who get injured. However, we are in a unique position to positively contribute to the functional re-development of lower body strength and function both after release from physical therapy and for years thereafter. This may be another indication of the value of functional training as it is known in our field.

T. Rudroff, Functional capability is enhanced with semitendinosus than patellar tendon ACL repair. Medicine & Science in Sports and Exercise 35(9):1486-1492, 2003

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