There is much confusion on whether cyclists and triathletes should use strength and conditioning (S&C) as part of their cycling training. The traditional thinking has been that spending time on a bike will make a more accomplished rider and will improve an individuals ability. Whilst I can’t disagree with this thinking, there are caveats to it. As PT’s and trainers we can help cyclists become better riders through strength training.  Periodising this into an appropriate stage of training can help improve a cyclists endurance, speed and power.

By spending all our training time on the bike we will become a better cyclist by being more in tune with the bike, being more comfortable in a cycling position and hopefully (with correct guidance) create a more efficient and functional pedal stroke, whilst also increasing our cardiovascular fitness.

This said, I personally believe that S&C has a vital part to play in making you a better cyclist, whether it be for triathlon or for cycling alone. What we have to do is understand what we mean by S&C and that it doesn’t solely mean strength training and lifting or pushing heavy weights, it also takes into account core stability and flexibility.

Flexibility improves posture and increases the range of motion of the joints, so we don’t have any sticking points within the pedal stroke, It also is a great injury preventer.

GB cycling S&C coach has been quoted as saying “it’s like the difference between a door that has oiled hinges and one that grinds to and fro. The more freely you move, the more power you can put out.”

Core stability is vital in cyclists due to the position we spend the majority of the time in. A weak core will lead to postural problems and thus make this riding position very uncomfortable, especially the more aerodynamic we look to be. A strong core will not only allow us to be comfortable and aerodynamic but also allow a greater transfer of power through the legs.

Later, we will talk about specific areas that need flexibility attention.

More and more top athletes are making S&C a vital part of their training. Below I will talk about what will make up this part of their training:

Strength training:

Calves – Strong calves will contribute to a more powerful pedal stroke as illustrated by the diagram below.

Exercises: Calf raises

Hamstrings and Glutes – the forgotten muscle groups, the hamstrings and glutes are vital for an efficient pedal stroke, especially when clipped into pedals. If there is too much of a muscle imbalance between hamstrings/glutes and quadriceps, it will create a very uneven pedal stroke and put a huge emphasis on the quads. Strong hamstrings will allow you to pull up and over on the pedal stroke and not have to rely on the quadriceps.

Exercises: Lunges, Swiss ball hamstring curls, Romanian deadlifts, Glute-ham raises.

Quadriceps – You only need to take a look at Chris Hoy to see that strong quadriceps play a ‘big’ part in cycling! They often provide the power, this is not only important in sprint events on the track but also in endurance riding in the tour events.

Exercises: Squats (plus all the varieties of squats), Deadlifts, Leg extensions.

Upper body – Although, cycling is a predominantly lower body sport, upper body training will give you balance throughout the body and also help with your posture.

Exercises: Lat Pull down, Bent-over row, Chest press.

As you can see from this diagram, a huge number of lower body muscles play a part in the pedal stroke and that to have an efficient stroke you need to be strong in all the right areas.

We talked about the importance of flexibility and core stability and now we need to discuss what we need to do in these disciplines.

Flexibility:

Hamstrings: These become tight because of the position we adopt when cycling. Tight hamstrings are also the number one cause for lower back pain in the general population so need particular attention. They are also needed when we run, so for triathletes, flexible and functional hamstrings will not only improve cycling but also the running element.

Hip flexors: As human beings, we are designed to be in an upright position, due to various reasons, we spend most of our time in a seated position and so exercising in an even more bent over position like we do when we cycle causes our hip flexors to be very tight

Gluteals: Unlike the hip flexors, the glutes are in an open position when we are in a riding position, however, as you can see from the diagram above they are used for a large portion of the pedal stroke (hopefully), thus the more you ride, the tighter they will become. This becomes more important for triathletes as like the hamstrings the glutes play a major role in running.

Core stability:

Plank: The plank makes the whole core work in an isometric contraction and thus makes us stronger in a fixed position, like we are when we ride. To make this more functional to cycling we can use a swiss ball and perform knee tucks as if we are pedalling.

Superman: This puts our body into a position of instability and so we learn to contract or brace the core in order for us to keep a strong rigid position.

Back extensions: The more time we spend on the bike, the more time the back is in a tight flexed position. Thus we want to be able to move dynamically in the opposite direction, so these muscles don’t switch off and become weak.

 V-sits: These work both the upper and lower abdominals and give us the ‘six-pack’ for pure aesthetic reasons!!!

Hopefully this will go some way to helping your clients make their minds up about what they should be doing to make themselves a better cyclist.

Share this article with your cycling clients and invite them to book some personal training for your cycling with you

More About Sam

Sam is a Sports Scientist and personal trainer with a distinguished sporting career.  Starting as a professional Rugby player he now competes as a GB age group triathlete at the Iron Man distance. Sam was selected for the GB team for the World Championships in Vegas in 2011. Sam’s clients include top sports people to a number of celebrities, pop groups, journalists and television personalities at the Drummond Clinic and in London. His knowledge of movement and functional training makes him a sought after leading national trainer. Presenting has become a passion to Sam over the last few years and his easy relaxed style makes him well liked and easy to listen to.

Article by Erica Ryder

How to manage behaviour in younger age children’s physical activity sessions

Have you ever left a children’s activity session feeling completely drained and inadequate? Have the children run you ragged for the entire 60 minute session?  Consider this scenario; you have spent time planning and organising a fantastic children’s activity session with primary and secondary learning outcomes.  You feel full of enthusiasm and positive that you can inspire the future generations and lead them to a healthy future.  The school bell goes and a number of unruly, excitable children fill your activity space and immediately display a number of disruptive behaviours.  Relax, you are not alone…

Our challenge as a coach is to create a balance of enjoyment and focus, allowing the children to achieve fitness benefits and build technical skills whilst still maintaining a fun and motivating environment.  Avoid letting control become the primary objective of your session.  If you are constantly battling with the children in a bid to restore order, you may find that session interactions become hostile and you become heavily reliant on punishments.

At the other end of the spectrum is the coach who tries to be a ‘friend’ to the children in the class.  This can lead to blurred boundaries; children need to know what is acceptable and what isn’t.  Without clear limits, children are bound to test how far their behaviour can go but rest assured this is a natural and healthy part of their development.  The truth is you cannot control anyone’s behaviour but your own.  You can however, influence and promote good behaviour.  Set a good example by role modelling good sportsmanship, manners and conduct. Give plenty of positive reinforcements by noticing and praising good behaviour and give clear and consistent messages about what they can and can’t do.

Don’t expect all children to change their behaviour immediately, they may need time and space to make better choices.  So give them a chance; it can take some children longer than others to reflect and alter their conduct.   Provide some positive feedback elsewhere and continue with your session.    The longer you spend on control the more chance there is for defensive reactions.  Act quickly, deliver the message and continue with your class.  The message must be simple, clear and non negotiable, avoid getting caught up in lengthy reasoning, argument or confrontation.

Choose your words wisely.  Criticize the behaviour but not the person, for example, “excluding Rachael from the group work is hurtful” rather than “don’t be nasty to Rachael”.   Making threats or personal remarks can lower self esteem and be intimidating, for example, “if you do that one more time I will…”  It is better to make them responsible for their own actions, for example, “if you continue with this behaviour you are choosing to spend time in the chill out zone.”  Remember to remain consistent in terms of your language, the ground rules and penalties you apply and encourage them to make the right choices.

My final piece of advice would be to grow a ‘thick skin’ and not take anything too personally. Manage your emotions and remain optimistic to keep things in perspective.  There are many reasons for disruptive behaviour; perhaps is it to get your attention, the respect of their peers or that they are simply hot and bothered.  Rise to the challenge! Try to find solutions to behavioural issues in a professional and insightful manner.

I would recommend keeping a reflective diary and researching and implementing different behaviour management methods.  Keep a log of what works and what doesn’t.  This way you will build a bespoke ‘box of tricks’.  In the event of disruptive behaviour continuing, remember your response will be observed by the other children in your class.  Keep calm and carry on coaching; don’t let the children in your class influence your emotions and ultimately your behaviour.

Interested in training to teach children, join Erica on our Children’s Fitness Toolbox course.

Erica Ryder

Erica has helped to develop Drummond Education’s new Children’s Fitness Toolbox.  She has been heavily involved in the development of a number of other children’s fitness and training products to include Fitness Professionals’ Fitclub and Lazy town Sports club.  The latter has involved frequent trips to Iceland to film the instructor training resources and module delivery in Mexico.  She is now studying to complete her degree in Child and Youth Studies.  She is a senior tutor for Drummond Education. She is a dance trainer for Luv2dance which involves leading large groups of, often disengaged, teenage girls through street dance weekends leading them to performance.

References

http://www.tes.co.uk/article.aspx?storycode=6000095

http://www.guardian.co.uk/society/joepublic/2010/feb/09/pupil-behaviour-management-tips

Can we transfer the method to the rest of the exercising world?

Article by Gill Cummings-Bell BA (Hon’s) M.Sc. MBA. PGCE. MIfL

As an exercise teacher of 30 years, Pilates remained a mystery to me.  I couldn’t understand where the benefits were, or how to work out with intensity using the Pilates method.  I am typically the exercise teacher that wants to shout, 10 more, and drive the session hard. In my ignorance of course I would wind up my esteemed colleague, Jo Everill-Taylor, who is a national lead on Pilates and say to her  ‘I don’t get it” why does it take you so long to learn to teach 34 exercises?  Can you not learn them from a DVD? My final insulting comment is are they not just body conditioning exercises slowed down? Read on.

Jo as always remains calm! A few years ago she challenged me to take my Pilates qualification and open my eyes and my mind to its potential.  I did exactly what she asked me to do and I discovered a whole new exercising world.  Not only did I discover a whole new world, but I also couldn’t understand why the principles of Pilates are not applied in all exercise teaching. They just make sense. Thank you Joseph Pilates. The light has gone on and at last someone is at home!

As a fast mover, high intensity exerciser for want of a better word, training myself to slow down and take control felt nigh on impossible.  Once I did, I saw the benefits of working with the Pilates Method. What became a light bulb moment for me was understanding that the intense fast sort of exercise I normally taught would put people more at risk of injuries, if they didn’t have the control that is taught through the Pilates method. Now I apply the method not just in my Pilates classes, but also in all of my teaching across different modes of exercise including PT and outdoor sessions.

The Pilates Method

The method has six main principles.

Centering

Through the Pilates method we are looking to create a strong, stable foundation for movement.  We develop a ‘powerhouse’ by bringing the focus to the centre of the body between the lower ribs and the pubic bone. We use this power throughout each exercise position. The powerhouse is the deep stabilsing core

Pilates puts a special emphasis on training the deep ‘local stabilising core’ muscles which are often underdeveloped.  This includes pelvic floor, iliopsoas, multifidus, quadratus lumborum, deep erector spinae, transverse adbominus, internal oblique, and diaphragm. These muscles are all connected from the pelvic floor, vertically through to the diaphragm and laterally through TVA and obliques. You can’t leave any of them out or stabilization of the spine will be compromised.

Throughout exercise classes and PT sessions I hear the term ‘engage the core’.  We need to deepen our understanding of what that means so that we engage the stabilisers before using the mobilisers  ‘the global’ surface muscles. If you don’t the spine is at risk and that doesn’t make any sense, does it?

At this stage I go back to my first point. What can all exercise learn from Pilates?  Build stability through the stabilizing core and engage this prior to any movement to ensure the spine is protected.

Concentration

This principle engages the ‘mind body’ connection.  Concentrating helps recruit the neuro-muscular pathway correctly through the kinetic chain and therefore full benefit will be gained from the exercise, posture or movement pattern. Concentrating on the precision of a movement or the correct movement pattern over time will lead our clients to really understand how to exercise and move in everyday life  i.e. I often see a squat initiated at the knee when the initiator of the movement should be a lumbar-pelvic movement referred to as lumbar pelvic rhythm. This takes concentration.  Often clients lose concentration and therefore stability the more reps they complete through a set.  Helping them concentrate to the last rep is important.

Control

This is one of the biggest principles of Pilates. Every exercise is executed with complete muscular control.  Parts of the body that are supposed to remain still, do so as we teach full control of a movement.  This can’t be achieved without centering and concentration.  I see many an exercise executed in the gym and classes, where the control of the movement is not there, not precise and sometimes not being spotted by trainers. Again its goes back to what we can learn from Pilates

Precision

In Pilates awareness is sustained throughout every movement.  There is an appropriate placement, alignment, trajectory and muscle recruitment through the kinetic chain for every body part, relative to other body parts. What this means is that if you are executing a side lying kick (in any exercise programme), to have control and precision, only the leg will have any movement.  Often I see movement in the torso or thoracic region in an exercises like this where the momentum of moving the leg swings the torso. With precision and control this would not be the case.

Another example is the spine. Being able to articulate through the vertebrae one at a time when rolling up or rolling down is a precise movement pattern. I often see people pivot from one point rather than articulating through each vertebrae using precision.

To truly get the benefit from an exercise should not all exercises have precision. To get precision, we also need centering, concentration and control.

Breath

Breathing is needed for all exercise to avoid the Val Salva effect (blood pressure variations).  Joseph Pilates emphasised using a very full breath in all exercises.  Most Pilates exercises co-ordinate with the breath in one of two ways.  Either, inhale to prepare before a movement and exhale through the movement (used for larger movements), or inhale one way and exhale the other on shorter time movements.

To use full breath you must have centering, control and precision.  In Pilates it is referred to as lateral breathing, I like to think of it as 360 degree breathing.

To enable this, the stabilising core must be engaged (centering) as the diaphragm is part of the core. You must align the spine by elevating the sternum vertically (not flaring the ribs) and the scapula must be at home in their pockets. If the scapula is forward at all, they will lock down the two floating ribs, which will not allow the diaphragm to contract into its 360 dome.  Try it, bring your shoulders slightly forward into a relaxed posture, and take a big breath in.  Take them back home, engage the centering and take a big breath in.  See which one gives you the deeper breathing.

Flow

I love flow. I think of it as beauty and grace. Executing an exercise with fluidity, grace and ease.  This is a strong goal of all Pilates exercises.  This has really helped my teaching across all my exercise disciplines.  Instead of jerk the lift up, pause , and lower the lift.  I think of flow and lift under control using all the seconds I can through the movement, no pause at the top end, and lower with the same control, precision and flow.

I ask the question again. What can we learn from Joseph Pilates?  What I have learn’t is this.  To teach solid exercise in a way that supports good movement for life, I have to know and understand the Pilates Method.  It’s not just a case of do I want to teach Pilates or not.  Whatever I teach it makes me a better diagnostic exercise practitioner.  Consider taking on the Pilates method and you will see things differently, even outside of a Pilates session.

Serves 4

K’cals 322 per portion  34g Carb -2g Fat- 25g Protein

Variation Thin rice noodles can be used instead of the udon noodles. Cheat… Use some ready-made teriyaki sauce – you’ll find it with other Asian ingredients in most supermarkets.

Ingredients

4 cod loins, about 150g (5 1 / 2 oz) each (use sustainable cod)
250g medium udon noodles
4 spring onions, sliced
1 handful fresh coriander, leaves only

Sauce

1 tbsp soy sauce,
1 tbsp honey,
2 cm fresh root ginger, grated
1 pinch sugar
1 tbsp mirin or dry sherry,

4 lime quarters, to serve

Method

1 Preheat the oven to 200°C (400°F/Gas 6).

To make the teriyaki sauce, put all the ingredients in a bowl, and mix well. Pour all over the fish, and leave to marinate for about 10 minutes.

2 Sit the fish pieces with the sauce in a roasting tin, and bake in the oven for about 15 minutes, until the fish is cooked through.

3 Meanwhile, put the noodles in a bowl, and pour over boiling water. Leave for few minutes, then drain and toss with the spring onions and coriander. Serve with the fish and a squeeze of lime.

Source: Ocado.com

The Coaching Sequence – Be Inspirational

Are you an ‘Inspirational Coach’?  Do you inspire, motivate, educate and coach a whole room of people at the same time?  You do and you must is the answer.  I’m sure for most of you this will merely be a reminder not anything new. By ensuring a solid foundation is built into your skill set using the coaching sequence you will be worthy of the title ‘Inspirational Coach’.

What is the Coaching Sequence?

The coaching sequence for many GroupEx teachers is a value belief that they live by and teach by.  To stand out from the crowd it must become part of our inner ID to be unconsciously evident in class. It’s what I call your ‘presence’.  By taking yourselves on the journey from conscious incompetence, the stage where you are consciously working on your coaching skills, to unconscious competence where your interaction and connection with your individual members is natural and part of your personality. It becomes a trait not an effort. As a reminder follow the coaching sequence.

The sequence has a number of layers that you have to consistently apply. Take responsibility for the members you coach, for their accomplishments, enjoyment and for their health and well-being.

1. Form

Firstly the coaching sequence requires you to have excellent form yourself. During your training you should be taught and learn the science of movement (Kinesiology) and be able to move displaying excellent static and dynamic posture across all modes of exercise.  This takes years of work.  You should be able to move well through choreographed sequences in all planes of movement, through functional resistance training/body conditioning exercises, poses, flexibility training to name just a few modes. Any form of exercise you teach must be executed correctly.  You are the expert!

I see many teachers with form that is poor or is not as correct as it should be.  Would you take advice from any professional who was second best? Of course not. So why should you expect your class members too?

The time to practice your own form is when you are not teaching.  You also must have a sound anatomical knowledge, understand the kinetic chain and understand movement patterns.  This requires studying anatomy & kinesiology as your bread and butter, not just during your training.  There are many apps available to help you keep this up.  Try MB Anatomy 3D by Real Body Works.

Apply anatomical knowledge to your own movement.  Video yourself, get in front of mirrors, analyse your movement and feedback to yourself. This will really help.

 2. Inspirational Choreography

There are two aspects to your choreography.  One of which often takes second place to the other.

The first goal with choreography is to effectively achieve the principles of training through movement.  i.e. if  we take a fitness goal for your class such as  ‘maximum calories out’ for the next 12 weeks for weight loss, then your choreography needs to achieve this physiological goal through the correct intensity of the movement. It’s not what you do but how you do it. This can take on many forms such as interval training as outlined below.

High Intensity Interval Training, commonly referred to as HIIT would be an example. There are many applications of this. Tabata training which is short 20:10 second blocks, repeated 8 times (not rocket science I know) or lactate tolerance training on 3:1 minute intervals are both examples that sit under the HITT title.

Your job is to achieve this level of work and rest through your choreography. In the work stage movement must executed at the highest intensity, not short small steps and in the rest phase the movement is less intense.  This must be achieved for everyone in the group.  Not an easy task for a full room. The secret is to ensure that the size of movement for everyone in class achieves the correct physiological goal at the correct time.

If you can inspire that with your choreography you will get results. So whatever the fitness goal is the choreography should reflect it.  This is often neglected at the expense of remembering over complicated choreography.

Second, your choreography needs to be motivational and inspiring and set to music. It must also match your ability to build the combinations in class so that everyone can follow.  Whether this is ‘add on’, chorus verse, pre-choreographed, layered or continuous you need to know your music and fit your choreography to it to build the movement patterns successfully so that everyone can follow. This again takes a lot of time and practice. I often see on my travels teachers using choreography that is more advanced than their skill to deliver it, leaving class members lost and de-motivated. A good teacher uses verbal and visual cues to communicate the choreography and builds it with flow, balance and movement sense.

3. Connection Cueing

Group connection is vital.  If you cannot connect with individuals in your group then you can’t coach and inspire, you will merely only lead.  Without the connection you have made the choice to merely lead your group not coach them. Connection cueing is a vital skill.

Set-Up Cues

Set-up cues are the first initial instructions that you use to set up a movement, a combination or an exercise.  They need to be clear simple instructions that tell a class member what the move is going to be, set position, which direction, how many and when etc. Use verbal and visual cues with non-technical language. You can use count ins, association cues, directional cues, hand signals and body postures to assist.

Follow Up Cues & Education

These take a number of forms.  When you repeat the exercise or combination a second time you can teach the class member how you would like the move executed using good form and why.  This can include, precision, intensity, depth, posture, breathing and control.  You are a coach and if you went to a swim coach you would expect them to tell you how to swim a stroke.  It is no different for a group exercise teacher.  The follow up cues are vital. Look at your class members and say to yourself, “what would they benefit from me telling them that would help them get perfect form and the best out of this movement or exercise”.  Use this as your follow up cue. Emphasise it both visually and verbally.

4. Movement Correction

This is the difference between leading a class and being a teacher. Whether you call it CRC, as in a Les Mills module, or whether you undertake it silently as a Dance teacher would or a Zumba teacher, it is a vital part of your skill set.  Through this you can effectively correct a movement pattern, ensure safety and good form in your class members ensuring they get the best out of the exercise.  It also means that your members will maintain good kinetic chain function every time they move.

This should be clearly distinguishable to your class members and use different language from cues.

Firstly ‘connect’ with your member by making eye contact, smiling, and indicating a change by using ‘two words’ only.  This is body part and direction.  At the same time give a visual demonstration yourself by emphasizing your body part and the direction.  i.e. chest lifted, pointing to your breastbone and elevating it.  Promoting change in our class members encourages them to achieve positive physical results.  This is your responsibility.  I can always tell a participant who has been to an inspirational teacher from their form and movement quality.

5. Motivation

Its important class members know why they are working what they are working.  Towards the end of your repeats of choreography in a track, perhaps, 3^rd or 4^th time of a patter just use motivational statements, let your personality run free and encourage them to ‘burn those calories’ or ‘work those glutes’.

Its important that your personality comes out and that you carry your class members with you to the end.  You don’t want them to be thinking about those emails or shopping list.  Retain their focus on their workout right to the end so they finish on a high

6. Be Inspirational

If you do all of the above every time you teach a GroupEx class you will inspire your members to keep exercising and keep them wanting more.  You can’t fail to be the teacher/coach you want to be and they all want to workout with.  Don’t let your self down by only leading your group.  Get involved! Coach! Be Inspirational!

If you want to learn how to apply the coaching sequence join the Drummond Education team on the Exercise To Music (GroupEx) course. Dates are available throughout the year in all of our venues.

Hypothyroidism (under active thyroid) is a consequence of deficient secretion by the thyroid gland of the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine). Hypothyroidism accounts for up to 80% of thyroid disease cases. (Hyper-thyroidism is not the scope of this article)

When working effectively the thyroid hormones travel through the bloodstream and control the rate at which energy in the body is converted (we refer to this as metabolism). The hormones keep the metabolism working at the correct pace. They are also responsible for regulating body temperature and blood calcium levels.

Hypo-thyroidism often presents with non-specific symptoms or symptoms which are masked by other things, such as dry skin, tiredness or weight gain. It can be congenital (at birth) or developed in later life.  It is classed as primary or secondary.  Primary is a dysfunction of the thyroid gland itself and is usually the low level production of one or more of the hormones or the complete lack of production of one or more of the thyroid hormones. Secondary classification is the pituitary gland (the stimulating gland) or hypothalamic (brain control centre) dysfunction.

Women are much more likely to develop thyroid problems than men. Around 1 in 50 women and 1 in 1000 men develop hypo-thydroidism at some time in their life.  Most commonly it develops as an adult women.  The most common cause is due to an autoimmune disease called autoimmune thyroiditis.  The immune system fails to recognise the gland as being one of your bodies own organs and attacks it with antibodies as if it is a virus.  The antibodies then attach themselves to the thyroid and affect its function. It then gradually develops the condition. It can swell and develop into a ‘goitre’. This is then referred to as Hashimoto’s disease.

The condition can also be caused by lack of iodine (not common in a normal UK diet), a side effect of some medications, a pituitary gland problem or a congenital defect (1 in 400 babies are born without a thyroid gland).

Thyroid Physiology

The hypothalamus (brain), pituitary gland and the thyroid gland all play a part in the feedback and regulatory mechanisms involved in the production of thyroxine (T4) and triiodothyronine (T3) from the thyroid gland. It’s a cascade of events leading to full function.

• Thyroid releasing hormone (TRH) is secreted by the hypothalamus (brain) and stimulates the production of the thyroid stimulating hormone (TSH) from the anterior pituitary gland.
• TSH then stimulates the production and release of T4 from the thyroid gland and its conversion hormone T3. T3 is the hormone directly used by the cells
• Once released, T4 and T3 then exert a negative feedback loop mechanism on TSH production. In other words it signals to the pituitary gland to switch off the production of TSH indicating that everything is functioning normally and effectively
• T4 is the main hormone produced by the thyroid.
• T3 is mainly produced by peripheral conversion of T4.
• T3 and T4 both act to increase cell metabolism. This is the turnover of ATP in each cell.

When the thyroid gland doesn’t produce enough thyroxine T4 or conversion to T3 is low, it causes many of the functions of the body to slow down including blood functions.

Symptoms

Symptoms may present as severe or mild sub clinical and can often be masked i.e. tiredness can be attributed to other causes.  The symptoms can often be missed and can sometimes be attributed to the aging process by mistake.  Symptoms may be mild at first and increase over a number of years also making them easy to miss as you get used to living with them

How is it diagnosed?

Thyroid function testing by blood test is the most common method of diagnosis. This is an endocrine (hormone) function test.  Over 10 million tests per year are conducted in the UK at a cost of £30 million.  It can be a problematic test and will not necessarily diagnose the condition. The mechanism for use of the thyroid hormones is intra-cellular and not utilized by the blood and the test does not test this. There can also be a problem with low blood volume in a hypo-thyroid individual therefore blood panel readings will appear higher.

TSH – The pituitary gland produces the hormone TSH (see above physiology), which is measured in the blood.  This hormone stimulates the production of thyroxine (T4).  If the levels of TSH are elevated this means the levels of thyroxine are low and the TSH levels are trying to encourage the thyroid to make more.

T4 – if T4 levels are low it is confirmed.

Sometimes you can have normal levels of T4 produced by they thyroid but elevated TSH which means the pituitary is working harder to stimulate the thyroid. This means you may well develop hyop-thryoidism in the future.

Getting an accurate test to diagnose hypo-thyroidism can be difficult. After doing tests your doctor may tell you that you are in the “normal range”, even if you still have hypo-thyroid symptoms and know something is very wrong in your body.

This could be because you are at the very edge of the range, either at the bottom or at the top, you could be classed as “borderline”. It is difficult to diagnose normal range. Unless you were tested prior to being ill its impossible to know what ‘normal range’ for you would be.

The blood test may not pick up dysfunction at cellular level or be testing level conversion to T3. If you are not converting from T4 to T3 or if your cells are not taking up the T3 normally, your T4 levels and your TSH levels will still show as normal.

Thyroid UK believe that you need to know your Free T3 level because this will often show low if you are not converting, and high if you have blocked receptor cells. Even if you are converting, the body needs the extra T3 that a normal thyroid produces.

It is worth asking your doctor to conduct further testing and ensure that they look at the global condition and take your symptoms into consideration.

Treatment

The treatment is to take thyroxine replacement therapy each day to normalize the TSH and obtain a positive thyroid state in the body. To obtain this, FT4 and TT4 have to be maintained at, or just above, the upper reference interval”. This replaces the thyroxine that your thyroid gland is not making. Most people feel much better soon after starting treatment however it can take some time to get the dosage correct. The British Thyroid Foundation state that the correct dose is what resumes good health.

How Can Nutrition Help?

As with all bodily functions (you are what you eat), your diet plays a major role in the health of your thyroid. There are some specific nutrients that your thyroid needs for effective function and it’s important to include them in your diet:

•  Iodine: Your thyroid cells absorb iodine, which it uses to make the T3 and T4 hormones. Iodine deficiency is not typical in the UK because of the prevalent use of iodized salt.

• Selenium: This mineral is an antioxidant mineral and is critical for the proper functioning of your thyroid gland, and is used to produce and regulate the T3 hormone.

Selenium can be found in shrimp, snapper, tuna, cod, halibut, calf’s liver, button and shitake mushrooms and Brazil nuts, sunflower seeds, rice, wheat and oatbran

• Zinc and Iron: These are needed in tiny amounts for healthy thyroid function, metabolic rate and immune function. Low levels of zinc have been linked to low levels of TSH, whereas iron deficiency has been linked to decreased thyroid efficiency.

Foods such as prawns, lamb, grass fed beef, calf’s liver, spinach, mushrooms, sunflower, pumpkin and sesame seeds can help provide these trace metals in your diet.

•  Omega-3 Fats: These essential fats (fish oils), play an important role in thyroid function, and may help your cells become sensitive to thyroid hormone.

• A C E Antioxidants and B Vitamins: The antioxidant vitamins A, C and E can help your body combat free radical damage caused by oxidative stress that may damage the thyroid. In addition, B vitamins help to manufacture thyroid hormone and play an important role in healthy thyroid function.

Vitamin A or retinol is found in liver, animal fats, oils such as olive and soy, cereal grain germs like wheatgerm and egg yolks. Fruit and vegetables contain beta-carotene in their yellow and orange pigments, which is converted to vitamin A in your body.

B-complex vitamins. Most of the B-complex vitamins are found in pork, grains, vegetables and milk. Thiamine is found in pork, cheese, dried fruit and peas; riboflavin in small quantities in milk, eggs and mushrooms; and niacin in beef, milk, wheat flour and eggs. Pyridoxine can be found in a wide variety of foods including chicken and turkey, eggs, oatmeal, rice, peanuts and bread. Vitamin B12 is present in most meats, seaweed, salmon, milk, yeast extract and eggs.

Vitamin C or ascorbic acid is found in fresh fruit and vegetables, sweet potatoes and fresh milk. The foods highest in vitamin C are: black currants at 220 mg per 100 g, guavas at 180 mg, bell peppers at 100 mg, cauliflower at 120 mg, cabbage at 120 mg and parsley at 150 mg.

Vitamin E is found in high quantities in nuts, seeds and vegetable oils such as olive and soy.

Following a healthy eating plan for hormonal balance is the key to thyroid health.  This includes oily fish, lean meats, lots of vegetables particularly root vegetables, seeds and nuts.  For further information or an eating plan to follow contact www.drummondclinic.co.uk

How can exercise help?

Regular exercise is important to maintain good health. It is especially important in the treatment of hypo-thyroidism to maintain a healthy weight, increase tissue sensitivity to the thyroid hormone, stimulate normal hormone secretion and improve respiratory function.  Exercise can also help control stress, which can help normalise hormone control.  Exercise will help combat the symptoms of fatigue and improve the metabolism.

An exercise regime of between 15-20 minutes per day initially will be beneficial with hypo-thyroidism, increasing as you progress to 40 minutes per day.

This exercise should include cardiovascular training and muscle conditioning.

Cardio-vascular

Exercising at low intensity can increase blood levels of T3, T4 and TSH. This can include interval training, aerobics, dance, walking, swimming and cycling.

Muscle Conditioning

Improving muscle tone particularly in the slow twitch muscle fibres (type 1) which are the aerobic fibres and the fast twitch type 2A which are also aerobic will help increase metabolism.  Low to moderate resistance training working compound functional movement patterns is the most effective form of training.

Contact www.drummondeducation.com to join the nutrition course or personal training course and learn more about this area and metabolic exercise training.

Makes 12   Preparation time: 10 minutes   Cooking Time 10-20 mins

Most biscuits you can buy from the supermarket are made with highly refined high-GI flour and lots of saturated fat. These, however, keep the fat content and the GI low by using a small amount of oil and a combination of whole meal flour and oatmeal.

Ingredients

75g stone ground whole meal flour
150g medium oatmeal
1 teaspoon vanilla extract
2 tablespoons rapeseed oil
50g light muscavado sugar
50g dried soft apricots, chopped
35g chopped walnuts
1 large egg, lightly beaten
(add sprinkling of mixed seeds)

A baking sheet, lightly greased

NUTRITIONAL INFORMATION

Kcal:  118, Fat: 3g (0.4g saturated), Protein: 3g  Carbohydrates: 23g

Method

Put the flour, oatmeal, vanilla extract, oil, sugar, raisins and beaten egg in a large bowl and mix well.

Put 1 large tablespoon of the mixture onto the prepared baking sheet and flatten to 7.5 cm round with a spatula or the back of a spoon. Repeat with the rest of the mixture, spreading the biscuits well apart on the baking sheet.

Bake in a preheated oven at 180ºC (350ºF) Gas 4 for the 10 minutes, or until the biscuits are firm to the touch.

Remove from the oven and let cool on the baking sheet for about 2 minutes or until firm enough to transfer wire rack to cool completely. Store in an airtight container for up to a week

Variation: replace the vanilla extract with the finely grated zest of 1 unwaxed orange on the tops of the biscuits with a few toasted chopped hazelnuts before baking.

According to latest BHF statistics cardiovascular disease (CVD) is the main cause of death in England. In 2010, there were over 147,000 deaths from CVD, nearly a third of all deaths. The main component of CVD is coronary heart disease (CHD), which causes more deaths in England than any other single disease. In 2010, around 38,000 men and 27,000 women died from CHD.

What is CHD?

CHD is an umbrella term for several cardiac pathologies, including myocardial infarction (MI), coronary artery disease (CAD), heart valve disease and heart failure. The underlying cause of CHD is normally a result of atheroma (fatty plaque), which builds up in one or more of the coronary arteries resulting in poor blood flow to the myocardium. The build up of atheroma is normally caused by several risk factors such as inactivity, smoking, diabetes, high blood pressure, high cholesterol, family history and advancing age.

Over the past 30 years the mortality rate in CHD patients has fallen due to the advances in medical and surgical interventions. However, there are a large number of people living in the UK with CHD, which causes significant disability.

Can exercise help manage CHD? 

Exercise-therapy forms an integral component of the management of patients with CHD. CHD patients are encouraged to take part in cardiac rehabilitation (CR), which aims to reduce disability, reduce CHD risk factors and empower healthy lifestyle changes through physical activity, diet, medication, education and counselling. This is normally achieved through the four phases of CR (phase I inpatient, phase II discharge home, phase III hospital-based supervised exercise programme and phase IV long-term community-based exercise programme).

The benefits of exercise-based CR have been well documented in two recent meta-analyses, which demonstrated that exercise reduces the risk of total mortality, cardiac mortality and the recurrence rate of CHD by 27%, 31% and 38% respectively. The mechanisms associated with exercise and the reduction in cardiac mortality is not fully understood, although research has identified four key benefits that exercise has on reducing CHD;

• Modifies CHD risk factors
• Halts and regresses the build-up of atheroma in the coronary arteries
• Prevents thrombus (clot) formation
• Enhances vasodilatation of the coronary arteries, which promotes better coronary blood flow to the myocardium

What is the provision of Cardiac Rehabilitation?

The National Audit of Cardiac Rehabilitation Project (NACR), believe that there are around 335 programmes throughout England, Wales and Northern Ireland. The number of CR programmes has grown enormously over the past decade; however, only 44% of eligible patients are offered CR. These figures tend to reflect those who attend a hospital-based programme (Phase III) and it is estimated that around 50% will drop out before the end of the programme and only 30% will continue exercising at one year (Phase IV). Therefore, the exercise professional plays a key role in maintaining long-term exercise habits.

The usual paths of care following a hospital-based CR programme are community based exercise sessions. These community sessions are known as Phase IV and they are normally led by an exercise professional who has undergone specialist training provided by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR).

What is the role of the exercise professional in cardiac rehabilitation?

The role of the exercise professional is crucial in the long-term management of patients with CHD. Exercise professionals form part of a multi-disciplinary team, which includes:

• Doctors
• Cardiac Nurses
• Practice Nurses
• Physiotherapists
• Dietitians
• Psychologists
• Occupational Therapists
• Pharmacists
• Counsellors

The role of the exercise professional within this team is vital in delivering an effective phase IV service, which involves liaising with the primary care team (Practice Nurse) regarding the patient’s risk factor management and maintaining communication with the Phase III CR team. During Phase IV the exercise professional is responsible for delivering regular supervised exercise classes, designing and monitoring home exercise programmes and encouraging healthy lifestyle behaviours.

What qualifications does the exercise professional need?

To prescribe exercise programmes to clients with CHD the exercise professional should hold a level 4 qualification in exercise and cardiac disease e.g. the BACPR exercise instructor qualification. To gain access to the BACPR exercise instructor course you must hold a level 3 qualification in Exercise and Fitness including an exercise referral qualification and have gained at least 150 hours of teaching adults land-based exercise within the last 2 years. For more information visit www.bacpr.com  01252 854510

Final words

Working as an exercise professional in Phase IV CR is an interesting and exciting area to work in. It provides opportunities to be part of a multi-disciplinary team, which enhances networking with health professionals. Furthermore, it is also a very rewarding role as it promotes the health and longevity of patients who suffer from CHD.

Tim Grove M.Sc. Exercise Specialist in Cardiovascular Prevention and Rehabilitation. MyAction, Imperial College London Healthcare NHS Trust.

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It is vital that we have enough cholesterol if our bodies are to work properly. But too much cholesterol can cause our arteries to become blocked, which increases our risk of heart disease and stroke.

Blocked arteries occur when excess cholesterol and other fatty substances attach themselves to the walls of the arteries, causing them to become narrower or ‘furred up’, meaning that blood cannot pass through as easily. Over time partially blocked arteries also become hardened and inflamed, increasing the risk of breakage.

All this increases the risk of a range of vascular diseases, such as heart disease, stroke and kidney disease.

High cholesterol itself doesn’t cause any symptoms. This means that you could have high cholesterol and not know about it. The only way to know your cholesterol level is to have it tested.

You don’t need to be a Doctor to offer Cholesterol Testing

By taking a small finger stick sample it is possible to obtain an accurate cholesterol result in under 2 mins with a simple two button hand held unit.  UK guidelines recommend that your cholesterol level should be less than 5mmol/l however the actual average is currently around 5.7mmol/l.

With an increasing amount of personal trainers emerging every year it’s important to differentiate your service from your competitors. Offering a Cholesterol testing service not only gives you the edge over your rivals but gives you essential health information for your client which can be used as an initial bench mark, as part of an assessment and to highlight health concerns. Within a health club environment it can be used for corporate outreach, boosting secondary spend or as a membership benefit.

Fitech Cholesterol kit

The Fitech entry level Cholesterol kit gives you everything you need to run a testing service designed for health clubs and personal trainers priced at only £199. It comes with 25 tests and by charging just £10 per test you can pay off your initial cost straight away. On-going tests cost just £2.46 per test plus consumables and training courses are run every two months to help get you started.

Click here for more information about the Fitech Cholesterol kit

Professional Reporting

Fitech V5 system can manage your results and produce a professional report for your client. You can calculate the percentage likelihood of your client developing CVD, cardiovascular disease (CHD and stroke added together) over a 10 year period using the Cardiac Risk assessments.

See example report

For further information call Fitech on 0118 324 0061 or email sales@fitech.co.uk

Referenced from the JBS2: Joint British Societies Guidelines on Prevention of Cardiovascular Disease in Clinical Practice and NHS guidelines.