Active Education is pleased to announce that preliminary data recently collected by King Juan Carlos University and AWRC-Sheffield Hallam University reveals extremely low levels of Covid-19 risk in fitness clubs and leisure facilities.

With more than 62 million visits analysed, the average infection rate sits at 0.78 per 100.000 visits.
Since the study’s official launch on 25th September 2020, research and evaluation partners have collected data based on more than 62 million visits to fitness clubs and leisure facilities with only 487 positive cases (of both members and staff) reported from operators based in Germany, France, Sweden, Belgium, Netherlands, Spain, Portugal, Norway, Switzerland, Czech Republic, Poland, Denmark, Luxembourg and The United Kingdom.

The SafeACTiVE study, commissioned by EuropeActive’s Research Centre THINK Active, aims to demonstrate the relative risk of Covid-19 infection in fitness clubs. The data collected seeks to mitigate public health concerns (of both users and members), confirm that fitness clubs are safe environments with a relatively low risk of Covid-19 infection, and offer the fitness and physical activity sector a strong argument for keeping our resources open during any future outbreaks of infectious diseases.
The director of the Advanced Wellbeing Research Centre at Sheffield Hallam University Prof. Rob Copeland stated that “Data from the SafeACTiVE Study shows that gyms across the EU are a safe place to work and to exercise. The prevention of further spread of Covid-19 has to be our primary objective but we also need to ensure that our communities have support and opportunity to remain active. We know that being physically fit can help reduce the severity of Covid-19 infection and moreover being active can help us cope psychologically when faced with the challenges of a second wave of the pandemic across Europe”.

Furthermore, he expressed that “keeping leisure centres and fitness clubs open and fully operational is critical to ensuring the health and wellbeing of our communities. I would go further and suggest that governments across Europe should be thinking about how we can increase access to activity, not reduce it, as we learn to live with Covid-19”.
Prof. Alfonso Jimenez, head of THINK Active, also commented that “I am delighted to confirm such a low level of infection risk in fitness and health clubs, reinforcing the message that fitness and physical activity are a fundamental part of the solution during the Covid-19 pandemic in helping strengthen and improve immune functioning and lower risk of viral illness”.
He elaborated on the primary research method, which “is based on a survey conducted among European fitness operators. The survey consists of a series of questions about your facility/facilities and any positive Covid-19 confirmed cases (users/members and staff). Fitness and leisure facilities who participate are asked to provide information on total weekly visits since reopening on a week-by-week basis, and by using data provided by their access/membership systems. We trust to release the full report in November 2020, that will include detailed information by regions and countries across Europe considering differences in infections rates”.

As a health and fitness professional, it’s easy to feel like your clients’ health behaviors are your responsibility. While you can guide and encourage your clients, lasting behavior change ultimately has to come from within an individual.

To better support clients in creating their own personal goals, utilize motivational interviewing (MI).

Psychologists William R Miller and Stephen Rollnick developed MI as a client-centered counseling style to encourage healthy behavior change. First used in treating those with alcoholism, MI is characterized by its non-directive, collaborative and exploratory approach.

According to the self-determination theory of human motivation, individuals are compelled to engage in behaviors when they have high feelings of competency, autonomy and relatedness to others. MI supports this by putting clients in control of their own behavior change.

Whether you are helping clients adopt healthier eating habits, stress-reduction strategies or regular physical activity, use the following MI strategies to enhance client autonomy and success.

Open-ended Questions

Let clients explore their underlying thoughts, feelings, fears and goals through open-ended questions. These questions require clients to answer with more than a “yes” or “no.” Here is an example of an open-ended question: “So, you’d like to lose 20 pounds in the next five months. What would this weight loss mean for you?”

Open-ended questions can also be used in the face of client ambivalence. For example, if a client says she’s always hated exercise, you might ask, “What experiences have led you to feel so negatively about exercise?” Rather than telling the client her feelings are wrong by expressing how wonderful you think exercise is, this question allows her to explore the reasons underlying her dislike of physical activity.

 

Non-Judgment

Approaching clients with an accepting and non-judgmental attitude creates a safe space for behavior change to occur. If clients fear being judged by their health coach, they are less likely to be honest about their thoughts, feelings and behaviors, and more likely to commit to things just to please the coach. You can explicitly create a non-judgmental environment by stating something like, “There are no failures here, only learning opportunities. Nothing you do is inherently bad (even binging on a carton of ice cream) and will only teach us more about what factors might lead you to engage in an unhealthy behavior (such as overeating).

 

Reflect and Affirm

Let clients know that they are being heard by reflecting their thoughts and feelings back to them. This helps clear up any potential confusion and let’s clients know that you are trying to understand and value how they feel. For example, if a client who dislikes exercise goes into a story about embarrassing experiences he had in high school gym class, you could say, “It sounds like your past experiences have really affected the way you feel about exercising. Does this sound true?” This will both clarify your understanding of the client’s feelings and help him recognize thoughts and feelings he has, but may not have paid attention to.

 

Empower

It can be tempting to dictate health behaviors to your clients. While you may be an expert in fitness or nutrition, you are not an expert in your client’s feelings, lifestyle, needs or goals. Rather than telling clients what to do, help them explore viable healthy behaviors, understand the benefits of these behaviors, and recognize and overcome barriers getting in the way.

Ensure any goal a client sets is both relevant and achievable. Telling a client to jog for 30 minutes five days a week may be adherent to national guidelines, but if it isn’t meaningful to the client and doesn’t fit in the context of his or her life, it’s useless. Present clients with options that meet them where they are. An easy way to gauge the potential efficacy of a behavior is to ask the client. For example, if you and the client work together to come up with a specific goal around eating vegetables, you might ask, “How important is it to you that you eat at least two servings of vegetables at two meals each day?” and “How confident are you that you will stick with this goal every day for the next week?” This way, you and the client can collaborate to create goals that are meaningful to him or her and more likely to be achieved.

As a health and fitness professional, your ultimate goal is to create healthier, happier and more vibrant individuals and communities. Motivational interviewing is an excellent strategy to help you empower clients to develop intrinsic motivation and create meaningful healthy behaviors that last a lifetime.

As an Active Education® Certified Professional, I am guided by Active Education’s principles of professional conduct whether I am working with clients, the public or other health and fitness professionals. I promise to:

• Provide safe and effective instruction.
• Provide equal and fair treatment to all clients.
• Stay up-to-date on the latest health and fitness research and understand its practical application.
• Maintain current CPR and AED certificates and knowledge of first-aid services.
• Comply with all applicable business, employment and intellectual property laws.
• Uphold and enhance public appreciation and trust for the health and fitness industry.
• Maintain the confidentiality of all client information.
• Refer clients to more qualified health or medical professionals when appropriate.
• Establish and maintain clear professional boundaries.

 

ACE Professional Practices and Disciplinary Procedures

The professional practices and disciplinary procedures of Active Education® are intended to assist and inform certificants, candidates for certification and the public of the Application and Certification Standards relative to professional conduct and disciplinary procedures. Active Education may revoke or otherwise take action with regard to the application or certification of an individual in the case of:

• Ineligibility for certification.
• Irregularity in connection with any certification examination.
• Unauthorized possession, use, access, or distribution of certification examinations, score reports, trademarks, logos, written materials, answer sheets, certificates, certificant or applicant files, or other confidential or proprietary documents or materials (registered or otherwise).
• Material misrepresentation or fraud in any statement to Active Education® or to the public, including but not limited to statements made to assist the applicant, certificant, or another to apply for, obtain, or retain certification.
• Any physical, mental, or emotional condition of either temporary or permanent nature, including, but not limited to, substance abuse, which impairs or has the potential to impair competent and objective professional performance.
• Negligent and/or intentional misconduct in professional work, including, but not limited to, physical or emotional abuse, disregard for safety, or the unauthorized release of confidential information.
• The timely conviction, plea of guilty, or plea of nolo contendere in connection with a felony or misdemeanor, which is directly related to public health and/or fitness instruction or education, which impairs competent and objective professional performance. These include, but are not limited to, rape, sexual abuse of a client, actual or threatened use of a weapon of violence, the prohibited sale, distribution, or possession with intent to distribute, of a controlled substance.
• Failure to meet the requirements for certification or recertification.

 

Note: As an Active Education Certification candidate and/or certified professional, you are deemed to be familiar with and comply with these Professional Practices and Disciplinary Procedures. Please contact Active Education to request a complete copy of our Professional Practices and Disciplinary Procedures.

To jointly address the rapid progression of chronic diseases and skyrocketing healthcare costs, Exercise is Medicine® is working with a new international collaboration to bring together healthcare systems, providers, fitness professionals and community resources across the US to better integrate physical activity into the nation’s healthcare.

Exercise is Medicine® is a global health initiative managed by the American College of Sports Medicine (ACSM), along with the American Council on Exercise (ACE) and the Medical Fitness Association (MFA). This partnership represents nearly 50 percent of certified fitness professionals worldwide.

“Too few health systems and health care providers routinely include physical activity as part of their patient’s treatment plans,” says Felipe Lobelo, MD, Ph.D., Director Exercise is Medicine® Global Research and Collaboration Center.

“Our goal is to elevate the status of physical activity so that it becomes a standard on health care. If we truly believe that exercise is indeed medicine, then physical activity-related care needs to be standardized, from patient activity assessments as a vital sign, to counseling and referrals to certified community resources meeting high quality control standards, just as other medical therapies and interventions are standardized.”

EIM is now working towards health systems in the United States to adopt the EIM Solution. Components in the EIM solution include:

• Incorporating Exercise is Medicine as required teaching into all four years of curriculum to educate future physicians on the health benefits of exercise.
• Incorporating physical activity as a vital sign in their EPIC Electronic Medical Record (EMR)
• Using EIM Your Prescription for Health patient education material in the EPIC EMR
• Employing a full-time EIM Coordinator to take patient referrals and work with them to refer to either Greenville Healthcare System Medical Fitness Center or one of the Greenville community Y locations
• Onboarding Coordinator at the Y will receive all patient referrals, meet with them for onboarding and assign them to an EIM group physical activity class

“This initiative mobilizes all of our nation’s resources to embrace the health promises of physical activity,” says American Council on Exercise Chief Science Officer Cedric Bryant, Ph.D. “The strategy of simply recommending people exercise hasn’t been enough. We are helping to facilitate the integration of fitness directly into our nation’s infrastructure, our healthcare system and our communities.”

Despite international efforts to encourage exercise, physical inactivity remains the fourth leading risk factor for death worldwide and 82.7 million Americans lead sedentary lifestyles. Exercise is Medicine® promises to improve health across the nation and reduce the direct costs of physical inactivity, which are predicted to increase from the current $24 billion to $191.7 billion by 2030.

“Many of the most common health issues today can be directly tied to sedentary lifestyles,” says Jim Whitehead, CEO of the American College of Sports Medicine. “We know that physical activity is one of the best tools we have to solve our chronic disease epidemic, but until now our nation hasn’t been able to implement fitness successfully. Exercise is Medicine® is a major step forward in solving this crisis.”

The Exercise is Medicine® initiative began in 2007 to make the scientifically proven benefits of physical activity the standard in the U.S. healthcare system. Through partnerships with international public health, medical and scientific organizations the initiative became a global effort, now with seven regional centers and 43 national centers internationally.

For more information on Exercise is Medicine®, visit exerciseismedicine.org and activeeducation.global

Whether it’s the World Series or Wimbledon, pro athletes seem to have superhuman abilities. But what sets an All-star apart from every other young athlete with a dream?

It takes more than talent to make a childhood dream into reality. The success comes from their habits — the little things they do consistently. Here are five pro athlete habits that you can adopt to succeed on the field, at home, or in the business world.

 

1. They set specific goals.

Professional athletes don’t make it to the big time by accident. It takes determination and focus to achieve their goals, and that grit is what helps them make it to the top. “Most elite athletes are hyper focused on what’s driving them and what their motivators are,” says Victor Hall, vice president of facilities at EXOS. “Because of that, they often go through a more formal goal-setting process than your typical youth athlete or the general population.”

Whether it’s an award they want to win, a stat they’re aiming for, or a world record they want to break, everything they do is aligned with that vision. And there’s a reason for that. “The professional sports world is centered around metrics. Stats are key to success, and all measurable variables can easily have goals behind them. This is very different from someone whose occupation is subjectively evaluated,” says Brent Callaway, performance director of pro and elite sports at EXOS.

Your game plan: To bring some of this champion mindset into your day-to-day life, set SMART goals: specific, measurable, achievable, relevant, and time-bound. And keep those goals at the forefront of your mind. Professional athletes use everything from notes on the mirror to acronyms written on their shoes to a token they carry in their wallet that helps remind them to stay on track.

 

2. They feed their performance.

If you’ve ever seen a teenager eat, you know it’s often more about quantity than quality. In contrast, professional athletes are more educated about nutrition and work with dietitians to create meal plans. “Their diet is more focused on performance, and fueling that performance, than overall food preference,” says Hall.

Callaway says it’s all about the support they receive: “Imagine if you were sitting at your desk and the company dietitian came up to you to evaluate your lunch selections and measure your hydration levels, and followed that up by paying you a bonus to weigh in optimally for your success. It’s likely many of us would hold our standards higher if we were supported and guided to make good food choices.”

Your game plan: Match your diet to your performance goals, and ask a dietitian to help you come up with a plan if you need extra guidance. Poor nutrition can degrade your performance, slow your recovery time, and make it harder for you to stay focused when it matters most.

 

3. They reduce their injury risk.

At the top of any pro’s training priority list is reducing their risk of injury. After all, their career depends on their ability to stay off the bench. “Professional athletes who take physical wellness seriously build a system of support around themselves. They establish a network of people who can guide them through offseason strength and conditioning, recovery strategies, and nutrition,” says Callaway.

Inquisitive athletes also ask questions, read books, and even sit in on classes and workshops created for coaches to gain as much insight as possible. And they use that insight to better listen to their body. “Professional athletes are more in-tune with what their body is telling them. If they start to feel a tweak or something is more sensitive than normal, they pick up on those signals a lot better than most folks,” says Hall.

Your game plan: Even non-athletes can feel better and work better if they avoid injury. Next time you feel a tweak in your knee, don’t try to push through it without assessing what’s really going on. And take ownership of your health by building your own network of supporters and constantly asking questions, whether it’s about movement corrections, nutrition, or anything else that can help you.

4. They don’t skimp on sleep.

Sleep is one of the most undervalued aspects of recovery. And it’s something that serious professional athletes make sure not to skimp on. Top performers like LeBron James, Roger Federer, Usain Bolt, Steve Nash, and Venus Williams reportedly get over 10 hours of sleep each night.

“Whether or not they know the science behind it, athletes intuitively recognize that they perform better, think more clearly, and react sooner when they’ve had good sleep,” says Hall. “On the flip side, they can feel and see the differences when they’re a little sleep deprived. It doesn’t take much, just two or three nights of poor sleep, and there will be a significant drop-off in performance and they’ll feel it.”

Your game plan: The average person should aim for seven to nine hours of sleep a night. Create the best sleep environment by buying blackout curtains, using a fan for low-level ambient noise, setting the temperature between 67-71 degrees, and removing pets and illuminated clocks from your room. Just like the pros, you’ll notice the difference in your alertness and mood at work when you’re well rested.

5. They use physical therapy, even if they’re healthy.

For professional athletes, physical therapy isn’t just a six-week, 12-visit regimen; it’s part of ongoing, continuous maintenance to keep their bodies in top condition. This proactive approach helps them stay ahead of problems and extend the length of their careers.

They’re also careful to watch out for overuse injuries. Hall says, “Many sporting situations are repetitive and asymmetrical in nature so overuse injuries come with the territory. The pros utilize their offseason to create as much balance as possible. They’re resting, building their strength back up, and making sure they have good balance on both sides.”

Your game plan: Use your own downtime to balance out any repetitive movements you make, and talk to a physical therapist about strategies that can help you combat the aches and pains of daily life. That might include passive or active recovery, like stretching, foam rolling, or corrective exercises that are specifically designed for getting a small muscle group stronger and helping the body move more efficiently.

Many of the benefits associated with adult resistance training programs are attainable by children and adolescents, and nowadays, a growing number of fitness centers and sport training clubs offer youth fitness programs that include various forms of resistance exercise.

Global recommendations on youth physical activity suggest that children and adolescents should accumulate at least 60 minutes of moderate to vigorous physical activity (MVPA) daily in the context of family, school, and community activities. In addition to active games and aerobic exercise, regular participation in strength-building activities also should be incorporated into the weekly routine of school-aged youth. Despite traditional fears and misinformed concerns associated with youth resistance training, a compelling body of evidence has found that participation in a supervised resistance training program can be a safe, effective, and worthwhile method of conditioning for children and adolescents. Nowadays, a growing number of fitness centers and sport training clubs offer youth fitness programs that include various forms of resistance exercise.

Many of the benefits associated with adult resistance training programs are attainable by children and adolescents. However, youth resistance training programs should be supervised by qualified fitness professionals and consistent with the needs, interests, and abilities of younger populations. This is where the art of youth resistance training comes into play because the physical demands of training need to be balanced with effective instructional strategies that maximize enjoyment, foster socialization, and spark an ongoing interest in daily MVPA. That is, the most effective youth fitness professionals are able to use different pedagogical approaches to address individual learning styles and developmental needs. Notwithstanding the importance of improving muscular fitness (i.e., muscular strength, muscular power, and muscular endurance), youth fitness professionals should provide an opportunity for all participants to have fun, make friends, and learn something new.

Troubling trends in muscular fitness among modern-day youth have created an immediate need to implement safe, effective, and enjoyable resistance training programs for children and adolescents. New insights into the design of long-term physical development programs have highlighted the importance of enhancing muscular fitness and resistance training skill competency early in life to set the stage for more advanced training later in life. Fitness professionals who genuinely appreciate the uniqueness of younger populations and who understand the PROCESS of youth resistance training are best prepared to design, supervise, and instruct sustainable programs that spark an ongoing interest in health and fitness.

Despite traditional fears and misinformed concerns associated with youth resistance training, new insights into the design of youth fitness programs have highlighted the importance of enhancing muscular fitness during childhood and continuing participation in strength-building activities throughout adolescence. Although factors such as heredity, training experience, and health habits (e.g., nutrition and sleep) will influence the rate and magnitude of adaptation, seven principles that determine the effectiveness of youth resistance training are the principles of (a) Progression, (b) Regularity, (c) Overload, (d) Creativity, (e) Enjoyment, (f) Socialization, and (g) Supervision. These basic principles can be remembered as the PROCESS of youth resistance training.

 

Whether you’re training for strength, endurance, or a combination of both, the benefit of adding speed, agility, and quickness drills to your fitness routine can take your game to the next level. All athletes can benefit from improved balance, quicker feet, and a faster reaction time, and this is exactly what Speed, Agility, and Quickness (SAQ) drills help you achieve. While SAQ drills are often thought of as interchangeable, it is important to recognize how these components are related, as well as how they differ.

Speed

General refers to the speed of which you’re able to move your arms and legs, in a way that allows you to move as fast as possible in a straight line. This is often referred to as linear speed. If you notice you have difficulty keeping up with or breaking away from your teammates and competitors, you will likely benefit from adding speed drills.

 

Agility

While speed refers to moving in a straight line, agility is the ability to change direction quickly and effectively. If you struggle moving side-to-side, or find yourself off balance a lot, agility training will help improve your performance.

 

Quickness

While speed and agility rely on a combination of core and lower-body strength, quickness refers to your body’s reflexive reactions. Quickness measures your instant and rapid responses, and drills to improve these abilities usually only last several seconds. If you have trouble getting your body into position quickly or lack explosiveness in your first few steps, adding quickness drills to increase your reaction time will help you be a quicker athlete.

 

SAQ training

Speed, agility, and quickness (SAQ) training is too often associated with sports and other physically demanding activities. Upon closer observation, we realize we have missed the everyday events and activities that can greatly benefit from SAQ training. You never know when you’re going to run after your kids, play a pick up game of basketball, or cut through the trees during your next ski trip. This method of training can help with the previously mentioned scenarios, but will also enhance workouts for anyone who is involved in recreational sports, exercises on a regular basis, or simply enjoys activities such as walking a dog or playing with their child.

As fitness professionals, we see so many people that come to the health club or gym to run on treadmills, climb on elliptical machines, or pedal away on bikes almost every day. Traditional modes of cardiorespiratory work lend to repetitive motions with little, if any, emphasis towards the frontal or transverse planes of motion. In order to cater to the body’s need for stability in all planes of motion, the fitness professional should integrate movements at varying speeds and body positions into their client’s training plan. This can be made possible with SAQ training, in addition to adjusting exercise selection and techniques.

Speed is defined as the ability to move the body in one direction as fast as possible. Agility is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Quickness is the ability to react and change body position with a maximum rate of force production (1). All three components will enhance the client workout experience, satisfy the need for cardiorespiratory work, and provide variety in movement direction and position.

A gradual and structured progression is highly recommended for a client that has not incorporated a regimen for speed, agility or quickness. The following SAQ moves can be implemented 2-3 times/week into an existing workout or as a stand-alone workout with a warm-up and cool down.

A change of workout regimen will break up the monotony of the typical cardio routine. SAQ training, when implemented after a KCA, will complement the assessment results and more importantly, prepare the client for activities that they participate in, both occasionally and on a regular basis.

 

JOIN OUR SAQ WORKSHOP

Active Education regularly conducts workshops in SAQ training, open for all coaches and athletes that would like to learn more about what SAQ is and how to implement it into their training regimens. Have a look at our recent workshop in the Norwegian capital – Oslo – below:

 

Chronic low back pain is pain that lasts for 12 weeks or longer, even after an initial injury or the underlying cause of acute lower back pain has been treated. About 20 percent of those with acute low back pain develop chronic low back pain with persistent symptoms after one year.

In some cases, the treatment successfully relieves chronic back pain, in other cases the pain persists despite medical and surgical treatment.
Chronic back pain is pain that persists after an injury or surgery whose cause is difficult to determine.

 

ACUTE PAIN

Acute pain can become chronic pain for several reasons. Chronic low back pain can result from injury, illness or stress on various body structures. The type of pain can be very different and can be felt as bone pain, nerve pain or muscle aches. Less than one percent of people who develop acute low back pain have a serious cause, such as cancer or infection, to explain their pain. For example, non-radiating lower back pain is often due to muscle tension and cramping.

Acute mechanical back pain may also be referred to as acute low back pain, lumbago, idiopathic lower back pain, lumbosacral loading or sprain or lumbar syndrome. Sometimes a specific trauma in the back or a strenuous activity can cause the pain. Traumatic injury can also cause the spine to be over-compressed, which in turn can cause a disc to rupture or break and put pressure on one of the nerves that root on the spinal cord.
When the spinal nerves are squeezed and irritated, back pain and sciatica can occur.

 

SCIATICA

Sciatica is usually the result of a pinched nerve when a protruding disc puts pressure on a spinal nerve.
In sciatica, the pain often extends to below the popliteal fossa. Pain radiating to the buttocks and leg may be due to sciatica, a condition in which a protruding disc compresses the sciatic nerve, which extends across the spine to its exit point in the pelvis and is transported to the nerve fibers.
In the most extreme cases, the patient is weakened in addition to numbness and pain, suggesting that a quick assessment is needed.

 

TRANSMITTED PAIN

Transmitted pain occurs when a problem at one point in the body causes pain in another. For example, a pinched nerve in the neck can cause pain in the arm or in the hand.

 

SPINAL STENOSIS

A spinal stenosis is a narrowing of the spine that puts pressure on the spinal cord and nerves, causing pain or numbness as you walk, leading to leg weakness and sensory loss over time.
Spine fractures are often very difficult pain problems, suggesting possible osteoporosis (a bone disease characterized by progressive loss of bone density and strength, which makes bones fragile and unbreakable).

Patients with spinal fractures suffer from cramps and very high levels of pain.
In patients with back pain, where the cause is difficult to determine, especially in elderly patients with osteoporosis, a fracture of the sacrum (the bone between the two hip bones) may be the cause of the pain.

 

CAUSES AND TREATMENT

Once the causes have been determined through a medical examination, the treatment may focus on relieving back pain and improving mood and function.

MEDICAL TREATMENT

Nsaids should be used with caution as they can cause stomach and bowel problems and in some people increase the risk of heart attack and stroke.
When back pain causes lumbar radiculopathy, eg.For example, leg pain (eg sciatica), your doctor may prescribe an anticonvulsant (eg gabapentin, pregabalin) in low doses that can significantly relieve leg pain without the use of anesthetics.
A muscle relaxant prescription may be given to reduce painful muscle cramps associated with lower back strain.
The most common side effects include excessive bruising and bleeding, as well as stomach irritation. Prolonged use may cause kidney and liver problems.
However, they calm or soothe the central nervous system and may be useful to facilitate sleep, and second, to lessen the emotional or muscular tension associated with severe pain.
Narcotics (also called opioids) are powerful analgesics and relieve the symptoms of acute low back pain.
The symptoms of acute lower back pain are usually benign and self-limiting.

 

PHYSICAL ACTIVITY AS MEDICINE

There is strong evidence that people who continue their activities without bed rest after experiencing low back pain seem to have better back flexibility than those who rested in bed for one week.

Vitamin D, also known as the “sunshine vitamin,” was identified in the 17th century by Dr. Daniel Whistler and Professor Francis Glisson when they discovered the causative factors of rickets.

Circa 1920, Sir Edward Mellanby worked with dogs raised exclusively indoors. He devised a diet that allowed him to unequivocally establish that rickets was caused by a deficiency of a trace component present in the diet and that cod liver oil (an excellent source of vitamin D) was an effective antirachitic agent.24

Along with vitamins A, E and K, vitamin D is a fat-soluble vitamin. Vitamin D actually refers to several different forms. Two forms that are important in humans include:

• Vitamin D2 (Ergocalciferol)- derived from plants
• Vitamin D3 (Cholecalciferol)- derived from animal products and made in the skin when exposed to sunlight

In addition vitamin D has three analogs, each with different potencies13:

• Cholecalciferol – 1x
• 25 hydroxycholecalciferol – 5x
• 1, 25 dihydroxycholecalciferol – 10x

 

SOURCES OF VITAMIN D

Vitamin D can be synthesized in the skin after exposure to ultraviolet light or obtained from the diet either from unfortified or fortified food sources or supplements. Unfortified sources include animal products such as cod liver oil, sardines, mackerel, herring, tuna, salmon, and shrimp. Fortified sources include milk and some brands of alternative milks (rice, soy, almond, etc.).

Some vitamin D researchers suggest that approximately 5–30 minutes of sun exposure between 10 a.m. and 3 p.m. at least twice a week to the face, arms, legs, or back without sunscreen usually leads to sufficient vitamin D synthesis (and that the moderate use of commercial tanning beds that emit 2%–6% UVB radiation is also effective).

Individuals with limited sun exposure need to include good sources of vitamin D in their diets or consider supplements to achieve recommended intake levels.

 

METABOLISM

As with many nutrients, vitamin D is absorbed in the small intestine. It is transported through the lymphatic system by chylomicrons and stored in the liver, bone, brain, and skin.

Vitamin D obtained from sun exposure, food, and supplements is inactive and must undergo two hydroxylations in the body for activation. The first hydroxylation occurs in the liver, where vitamin D is converted to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second hydroxylation takes place in the kidneys, where it forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.

 

REQUIREMENTS

The Recommended Dietary Allowance (RDA) for vitamin D ranges from 400-800 IU, depending on age, pregnancy/lactation status, skin color, sun exposure, diseases affecting nutrient absorption, and health status. This RDA is considered a daily intake that is sufficient to maintain bone health and normal calcium metabolism in 97-98% of healthy people.

It is important to note that numerous studies support much higher intakes for the prevention and/or management of a number of diseases, some of which will be mentioned later. These intakes can be as high as 10,000 IU/d, or >10 times the current recommended intakes.

 

MEASURING VITAMIN D STATUS

Serum concentration of 25(OH)D is the best indicator of vitamin D status. It reflects vitamin D produced in the skin and that obtained from food and/or supplements.

Based on a review of the data on vitamin D needs, a committee of the Institutes of Medicine (IOM) concluded that people are at risk for vitamin D deficiency at serum 25(OH)D concentrations <30 nmol/L (<12 ng/mL). In addition, some are potentially at risk for inadequacy at levels ranging from 30–50 nmol/L (12–20 ng/mL). In general, the recommended range is 30–100 nmol/L.

 

DEFICIENCY

There are two primary diseases caused by vitamin D deficiency:

• Rickets – a malformation of the bones seen in children
• Osteomalacia – skeletal demineralization seen in adults

 

FUNCTIONS AND HEALTH EFFECTS OF SUPPLEMENTATION

A primary function of vitamin D includes calcium absorption in the gut for normal mineralization of bone and to prevent hypocalcemic tetany. In addition, vitamin D modulates cell growth, neuromuscular and immune function, and inflammation.

Vitamin D has been extensively reviewed for potential health relationships warranting supplementation. Some of these include resistance to chronic diseases (such as cancer and cardiovascular diseases), physiological parameters (such as immune response or levels of parathyroid hormone), and functional measures (such as skeletal health, physical performance and falls).

 

MORTALITY

Low 25(OH) D levels have been associated with all-cause mortality and even more pronounced with cardiovascular mortality. It is still unclear whether vitamin D deficiency is a cause or a consequence of a poor health status, though vitamin D supplementation could perhaps be an approach to consider in reducing mortality and cardiovascular disease.

 

BONE HEALTH

Vitamin D plays an essential role in maintaining a healthy mineralized skeleton. Sunlight causes the photoproduction of vitamin D3 in the skin. Once formed, vitamin D3 is metabolized sequentially in the liver and kidneys to 1, 25-dihydroxyvitamin D. The major biological function of 1, 25-dihydroxyvitamin D is to keep the serum calcium and phosphorus concentrations within the normal range to maintain essential cellular functions and to promote mineralization of the skeleton. It is generally accepted that an increase in calcium intake to 1000-1500 mg/day, along with an adequate source of vitamin D of at least 400 IU/day, is important for maintaining good bone health.

 

CANCER

1, 25-dihydroxy vitamin D [1, 25-(OH)2 D] exerts its effects via the vitamin D receptor that belongs to the steroid/thyroid hormone receptor superfamily leading to gene regulation and a number of biological responses. Moreover, it has been demonstrated that 1, 25(OH)2 D can induce differentiation and inhibit proliferation of a wide variety of cell types. The anti-proliferative action makes 1, 25-(OH)2 D and its analogs a possible therapeutic tool to treat hyperproliferative disorders, such as certain forms of cancer.

 

CARDIOVASCULAR DISEASE

1, 25-dihydroxy vitamin D (1, 25[OH]2 D) or calcitriol, has been implicated in many physiologic processes beyond calcium and phosphorus homeostasis, and likely plays a role in several chronic disease states, including cardiovascular disease.

Experimental data suggest that 1, 25(OH)2 D affects cardiac muscle directly, controls parathyroid hormone secretion, regulates the renin-angiotensin-aldosterone system, and modulates the immune system.

Treatment with vitamin D has been shown to lower blood pressure in patients with hypertension and modify the cytokine profile in patients with heart failure.

 

DEPRESSION

Some cross-sectional clinical and epidemiological studies have found that low levels of vitamin D are significantly associated with higher levels of depressive symptoms. While cross-sectional studies cannot establish causality, vitamin D supplementation for depression in those who are deficient warrants further investigation.

 

DEMENTIA AND COGNITION

A review of thirty-seven studies suggests that lower vitamin D concentrations are associated with lower cognitive function and a higher risk of Alzheimer’s disease. Further studies are required to determine the significance and potential public health effect of this association.

 

DIABETES

Vitamin D appears to play a role in the prevention of type 1 diabetes in genetically predisposed individuals, as well as type 2 diabetes, by affecting insulin secretion and glucose tolerance.

 

IMMUNE SYSTEM

Recent studies have shown that the hormonal form of calcitriol can act as a regulator of immune cell differentiation and proliferation, specifically in T cells and activated macrophages. Vitamin D may have a similar role to that of other immune regulatory molecules such as cytokines, by modulating the inflammatory process.

 

INFECTIOUS DISEASE

Vitamin D plays a role in the synthesis of antibacterial peptides (short chains of amino acids) and in autophagy (cell degradation of unnecessary or dysfunctional cellular components). Several studies have shown that low levels of vitamin D are associated with the susceptibility and the severity of acute infections and with an unfavorable outcome of some chronic infections including the HIV infection. Vitamin D supplementation improves response to treatment of some viral and bacterial infections.

 

AUTOIMMUNE DISEASE

Vitamin D is an important component in the interaction between the kidney, bone, parathyroid hormone, and the intestine, which maintains extracellular calcium levels within normal limits in order to maintain physiologic processes and skeletal integrity. Vitamin D is also associated with hypertension, muscular function, immunity, and one’s ability to deal with an infection, autoimmune disease (including multiple sclerosis), and cancer.

Vitamin D influences immunity via CD4 T cell differentiation as well as increasing the function of T suppressor cells. The active form of vitamin D produces and maintains self-immunologic tolerance. Some studies show that 1, 25(OH)2 D inhibits induction of disease such as thyroiditis, type 1 diabetes, inflammatory bowel disease, systemic lupus erythematosus, collagen-induced arthritis and Lyme disease.

 

PERFORMANCE

Vitamin D status has been hypothesized to play a role in musculoskeletal function. In a study by Houston et al, 2007, vitamin D status was inversely associated with poor physical performance. Given the high prevalence of vitamin D deficiency in older populations, additional studies examining the association between vitamin D status and physical function are warranted.

 

ADHD, BIPOLAR, SCHIZOPHRENIA, AND IMPULSIVE BEHAVIOR

Brain serotonin is synthesized from the amino acid tryptophan and is activated by vitamin D and omega 3 fatty acids. Inadequate levels of vitamin D (∼70% of the population) and omega-3 fatty acids can result in suboptimal brain serotonin synthesis, leading to a number of cognitive and behavioral disorders.

 

PAIN

Gloth et al, 1991, identified a pain syndrome associated with vitamin D depletion that is worsened by light, superficial pressure, as well as movement. This pain restricts mobility and function.

Faraj & Mutairi, 2003, evaluated 360 patients attending spinal and internal medicine clinics over a 6-year period who had experienced low back pain. They found that a vitamin D deficiency was a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic.

Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting. Measurement of serum 25-OH cholecalciferol is sensitive and specific for detection of vitamin D deficiency and could be a useful assessment in patients with chronic low back pain.

 

TOXICITY

Because vitamin D is fat soluble and can be stored in the body, excessive amounts can be toxic and cause a constellation of symptoms, including: Hypercalcemia, hypercalciuria, kidney stones, hyperphosphatemia, polyuria, polydipsia, ectopic calcification of soft tissues, nausea & vomiting, anorexia, constipation, headache and hypertension.

 

CONCLUSION

It is generally accepted that vitamin D deficiency is a worldwide health problem affecting a wide range of acute and chronic diseases. Individuals should try to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources, supplements, and sun exposure.

The effect of vitamin D on epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life. Increasing the vitamin D status of children and adults worldwide is an imperative strategy for improving musculoskeletal health and reducing the risk of chronic illnesses, such as cancer, autoimmune diseases, infectious diseases, diabetes (both type 1 and type 2), neurocognitive disorders, and mortality.

 

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