Your Home Gym- from COVID-19 and Beyond

As we emerge from the days of stay-at-home orders and the reality that the fitness industry may be changed for the long-term, how we stay fit going forward is looking very different. Limitations on group fitness keep us from our fitness friends who motivate us and provide accountability to show up when we need that extra push. We find ourselves with little to no equipment and it is more difficult to eat healthy now that planning a meal requires 5 extra steps, a delivery service and trips to 3 grocery stores in full PPE to try to find a fresh head of broccoli.

But the fitness industry is nimble, moving live workouts online or via ZOOM, providing creative workout programming utilizing little to no equipment (or the use of various household objects) and some facilities rent their equipment to members for little to no cost.

So we adapt. We set aside space in our homes, gather some dumbbells and odd weighted objects, set up our mobile devices to access an online class, tee up a playlist on Spotify and off we go. It suffices for the short term but it is just not the same.

But there is a light the end of the tunnel. We will soon begin the return to our beloved fitness facilities and someday, COVID-19 will be behind us.

However, it will likely take time and we may have health issues that make getting back to normal riskier than we would like. If we take a step back, we will find that during this time, we have developed the ability to adapt our fitness to efforts outside the gym.  We now know how to get a good workout at home when life issues prevent us from getting to the gym and we have since developed the creativity to access or even create for ourselves, workouts that require minimal to no equipment. These new skills will serve us well. For example, how many times have we found ourselves staying at a hotel with mismatched dumbbells and a space the size of a large closet? But now, we have the creativity and the skills to work with that!

So what does the home gym and “fitness-on-the-go” look like post-COVID-19? Here are some tips to create a home fitness area that is practical, affordable and quite possibly even portable!

  1. Dumbbells are a staple. They are widely available, take up little space and most hotels / resorts have them; and there are endless exercises that can be designed with them.
  2. Pull-up rig. These are affordable, easy to install and take up negligible space.
  3. Jump rope. It’s small, portable, inexpensive and requires little space for use.
  4. A rigid box/ottoman for step ups or jump/step-overs. Very inexpensive, takes up little space and a variety of exercises can be designed with it.

So with just some basic equipment, a little floor space, and a device to access workout programming (or an online trainer, such as Yours, Truly) you can add variety, convenience and flexibility to your fitness routine in the new world beyond COVID- 19.■

Workout #1 – COVID CRUSHER

You will need: some floor space, an object weighing 10-15#

  • 5 min warm-up: Alternate 25 jumping jacks and 30 high knee run in place x 1 min/rest 20 sec. Repeat for a total of 5 min.
  • AMRAP (As Many Rounds As Possible) in 15:00 min
  • 15 squats holding your weighted object
  • 15 Burpees (options: substitute 20 jumping jacks or 20 sec of high knee runs)
  • 15 push-ups (options: from the floor, against a wall, elevated on a sturdy chair, ottoman, sturdy box)
  • 15 alternating forward lunges holding the weighted object (step forward, front knee behind toe, back knee touches the floor – return to standing position and switch sides.)
  • 15 Burpees (see options above)
  • ** Repeat this sequence of exercises as many times as you can in 15 min. Goal is to keep moving for the entire 15 min. Adjust speed to manage heart rate.
  • 5 min stretch/cool-down – take 5 min to do some of your favorite stretches, meditation and mindfulness exercises.

Score: number of times you repeated the sequence in the 15 min time frame and the weighted object you used.

Workout #2 – Crossfit “CINDY”

You will need: some floor space, doorway pull- up rig.

  • 5 min warm-up: Alternate 25 jumping jacks and 30 high knee run in place x 1 min/rest 20 sec.
  • Repeat for a total of 5 min. AMRAP 20:00 min
  • 5 pull ups (can modify and sub jumping pull ups or heavy dumbbell curls)
  • 10 push-ups (options: from the floor, against a wall, elevated on a sturdy chair, ottoman, sturdy box).
  • 15 air squats
  • ** Repeat this sequence of exercises as many times as you can in 15 min. Goal is to keep moving for the entire 15 min. Adjust speed to manage heart rate.
  • 5 min stretch/cool-down – take 5 min to do some of your favorite stretches, meditation and mindfulness exercise.

Score: number of times you repeated the sequence in the 20 min time frame.

Aging is not a Decline – It’s a Detour

Aging is not a Decline – It’s a Detour

This was a tough week. I have been running a mile to warm up before my workouts and I’ve been so slow. Why am I slow? Is age catching up with me? I am turning 50 next month, after all. Maybe this is it. Maybe it’s downhill from here – my biggest fear – or maybe it’s something else and I’m just using my age as an excuse. My Coach, Erika, thought this would be a good opportunity for me to acknowledge this “decline” as a possibility – because it is not biologically possible to keep what you have forever. So I should be proud of my accomplishments and live in the moment – not looking at the next goal, for now, and become more comfortable with this biological reality.

In some ways it sounds like surrender. But it’s true! At 50, I don’t have the VO2 max (a measure of cardiovascular capacity and aerobic endurance) that I had when I was 30. But wait – neither does Roger Federer – and he’s arguably still the greatest tennis player of all time. Tom Brady – another athlete who is still the GOAT at age 41, could not possibly be running circles around his 25 year-old teammates. So, if they don’t have the same athletic capacity as they did 10 years ago, how can they still be on top?

Because “Fitness” is more than just a measure of “capacity”. The founding principles of Crossfit methodology have emerged from a debate about the definition of fitness. We have 3 energy systems (Figure 1) and 10 physical skills (Figure 2). Fitness, as defined by this methodology, is the ability to function well in all of these areas.

As we age, our bodies change and awaken us to other fitness domains that we may have never focused on before. For example, I have a lot more aches and stiffness these days compared to my younger self. So I started doing yoga. Through yoga, I not only improved my mobility dramatically, but I also gained greater body and mind control. Lizard Pose and headstands were not even on the radar 20 years ago – and neither were handstand push-ups. But they are accomplished skills for me now. Age 40 and a bodyweight 30 lbs heavier than I am today motivated me to raise the bar for my fitness- after residency, fellowship and childbearing took its toll on my health. Age 45 awakened me to Crossfit as I knew nature was going to bring a decline in muscle mass and bone density with menopause. So here I am, 1 month away from 50 with a cache of skills and capacities that I have accumulated over the last decade in more energy and skill domains than I have ever had! Maybe I don’t run as fast, but I am a much more well-rounded athlete than I was 10, even 20 years ago. The lesson here is listen to your body – embrace the changes – and let these changes awaken you to learning new skills and abilities that you have never explored before. Fitness is a journey that does not inevitably result in “decline” – if you can embrace the athlete that you are, accept the natural course of time, and truly listen to what your body tells you, the journey instead can take you on a detour into new, exciting and uncharted fitness territories; and what emerges is quite possibly the healthiest, fittest version of yourself that you have ever achieved!

Thank you, Coach Erika for your inspiration and your wisdom.

“Coach Erika” is Erika Snyder, CFL3 and Founder of ThoughtWOD specializing in fitness and mindset coaching.

Fertility, Fitness and Reproductive Health – Debunking the Myths

So many times I hear patients say “Should I be on bedrest while I’m trying to get pregnant?”…… “I read something online that said I shouldn’t exercise if I’m having trouble getting pregnant…”. Well, the myths are debunked here.
According to the American Congress of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 650:

  • “Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength conditioning exercises before, during and after pregnancy.”
  • “Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women and enhances psychologic well-being. ”Exercise during pregnancy poses minimal risk, although modification may be needed due to the anatomic and physical changes that occur during pregnancy.” Also, in pregnancies where there are complications, your obstetrician will be the best resource for providing modifications to physical activity if needed.
  • There are few studies with recommendations pertaining to physical activity in patients struggling with conception, however, there are some that focus on patients with specific fertility issues. Some examples are below.
  • According to the Recommendations from the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovarian Syndrome (PCOS), health professionals should be recommending that adult patients age 18-64 with PCOS should engage in a minimum of 150min per week of moderate activity or 75 min/week of vigorous activity to include muscle conditioning on 2 consecutive days per week. (Fertility and Sterility 110 (3); 2018).
  • Competitive athletes face the challenge of the impact of very intense training and rigorous training schedules and how their training/nutritional balance impacts menstrual cycles and body composition. (The Female Athlete Triad; Pediatrics 138; 2016)

The benefits of physical activity in all stages of life are well-documented. Regular exercise maintains and improves cardiorespiratory fitness, reduces the risk of obesity and associated comorbidities and promotes greater longevity. The fitness industry has evolved immensely in the last 30 years to be more inclusive of all people – not just athletes – as the benefit of regular exercise for all individuals continues to be realized.

I am fortunate to have two passions in my professional life – building families and fitness and wellness. Here is where I hope to bring them together and share them with you. Future articles will focus on specific areas of fitness and nutrition and how they relate to reproductive health.

About the Author:
Dr. DiGirolamo is a Board Certified Reproductive Endocrinologist at Boston IVF. She is also a Crossfit L1 trainer, Les Mills certified group fitness instructor and a member of Crossfit Health – an organization of physicians who CrossFit founded by Crossfit Founder, Greg Glassman in the quest to cure the world of chronic disease. In addition to building families, Dr DiGirolamo has a special interest in the unique challenges of female athletes.

Keto and Conception – Is It Safe?

The science of fitness and nutrition is advancing at a rapid pace. Fad diets and supplements are flooding the mainstream and fertility specialists are increasingly asked “Is there a special diet that will increase my chances of getting pregnant?” or “Is there anything else I can do to improve my chances of conceiving?” One dietary strategy that is gaining popularity is the “Keto Diet.”

What is the Keto Diet?

The Ketogenic (“Keto”) Diet has been used to treat intractable epilepsy since the 1920s. This nutrition plan is extremely low in carbohydrates, moderate in protein and high in fat. Once a very low carbohydrate status is achieved, the body switches from using glucose for fuel to metabolizing fatty acids into ketone bodies, which replace glucose as the energy source for cells and tissues. Carbohydrate levels are generally <10% of total daily energy (TDE) or, for most individuals, between 20-50g of carbohydrate per day. For perspective, one piece of wheat toast contains ~ 16g of carbohydrate. Calories not consumed as carbohydrate are instead consumed as fat. As a result, insulin levels decrease and serum glucose levels remain stable due to the metabolism of amino acids and glycerol into glucose.

A review of the evidence by Kirkpatrick et. al in a scientific statement from the National Lipid Association (NLA)1 suggests that although the Ketogenic Diet is an effective way to achieve weight loss, there is no significant advantage over other dietary plans that incorporate moderate carbohydrate and lower-fat alternatives. What is important for successful weight loss, however, is adherence to a dietary plan. Achieving a state of ketosis with the Keto Diet can result in the “keto flu” with symptoms of light-headedness, dizziness and fatigue as well as constipation, abdominal pain and nausea in the first 2-3 weeks2, thus making it difficult to stay engaged in the dietary plan.

The Ketogenic Diet should be considered only for a limited duration of 2-6 months to achieve weight loss, followed by reintroduction of healthy carbohydrates and reduction of dietary fat to achieve a steady, more sustainable state of dietary equilibrium. Long term use of ketogenic diets has been associated with an increase in all-cause mortality (death from all causes)3 and may have unfavorable effects on serum lipid levels. For patients with high cholesterol, high blood pressure, diabetes, pancreatitis and kidney disease, this type of dietary plan should only be considered under close medical supervision1.

Does it Have to be Keto to Work?

The Ketogenic Diet represents the far end of a spectrum of dietary strategies to achieve weight loss and a healthier lifestyle. Although the Ketogenic Diet can be an effective choice in healthy individuals seeking weight loss over the short term, modified lower carbohydrate diet alternatives may also achieve favorable results and may promote better adherence and sustainability as a lifestyle.

Is Keto Safe while I’m Trying to Conceive?

The Ketogenic Diet can be an effective strategy to achieve short term weight loss to improve conception success and reduce obesity-related pregnancy complications such as gestational diabetes, gestational hypertension (high blood pressure) and fetal macrosomia (large fetus). In patients with clinical obesity (Body mass index >30), ketogenic and low carbohydrate (<45% of total calories) nutrition plans may reduce circulating insulin levels, improve ovulatory function and improve pregnancy rates compared to no dietary intervention4. These plans can be safely used in otherwise healthy individuals for a limited duration before conception with a measured reintroduction of healthy carbohydrates and fat for longer-term weight loss and weight maintenance. Metabolic ketosis should be avoided once pregnant as the safety of the ketotic state in pregnancy has not been well-studied and may be detrimental. Consultation with a nutritionist in early pregnancy is always recommended. As with any lifestyle change, it is helpful to consult with your primary care and general obstetric and gynecology providers for helpful suggestions and any needed precautions. Every patient has unique health issues and life circumstances and no single nutrition program works for everyone. However the critical element – whether it is a fitness or a nutritional program – is finding a plan that can be adhered to for the long term with the goal of making the “diet” a lifestyle.

References

  1. Kirkpatrick CF et al., Journal of Clinical Lipidology (2019) ePUB. Accepted for publication Aug 13, 2019.
  2. Kossoff, EH; Epilepsia Open. 2018;3(2):175–192.
  3. Noto H., et al. PLoS One. 2013;8(1):e55030 Erratum: PLoS One 2019 Feb 7;14(2):e0212203.
  4. McGrice M and Porter J; Nutrients 2017, 9, 204; doi:10.3390/nu9030204

About the author:
Carla M. DiGirolamo, M.D., Ph.D. is a Reproductive Endocrinologist taking new patients at Boston IVF, Waltham, Massachusetts. She is Board Certified in Reproductive Endocrinology and Infertility as well as general Obstetrics and Gynecology. Dr. DiGirolamo is credentialed as a Level 1 CrossFit Trainer, Les  Mills certified group fitness instructor and is a  member of  CrossFit Health, a worldwide organization of physicians who CrossFit created by CrossFit  Founder,  Greg  Glassman  in his  quest to cure the world of chronic disease. In addition to helping patients build their families,  Dr. DiGirolamo’s special interest is in managing the unique reproductive/endocrine challenges of female athletes.

The article was published on LinkedIn

The Female Athlete Triad – What Every Woman Should Know about Exercise, Nutrition and her Body

Every woman’s body – inside and out – is as unique as her fingerprint. Some of us are good at squats (that would NOT be me) and some of us live for box jumps. Have you ever looked at the athlete next to you and think “Yeah, I’m in good shape -I’ve got this” only to realize that that athlete next to you, who is old enough to be your mom, just rowed circles around you; but you think to yourself, “Well, at least I’m good at pull-ups!”

I have been doing CrossFit for only 2 years, but one thing I have learned to appreciate is that each and every athlete has an “athletic cache” which includes her unique strengths and weaknesses as well as her unique response to physical and nutritional challenges. Finding that magical combination of exercise, nutrition and emotional and mental well-being that takes us off our plateaus into that better version of ourselves is the Holy Grail of our personal fitness goals.

Sometimes that journey is a bumpy one. We have all felt defeated after a tough WOD and felt crappy doing a nutritional challenge. However, other times when we ARE successfully seeing change in our performance and body composition, some unexpected – and sometimes concerning – changes are happening inside of our bodies. Here, we begin to talk about these changes and raise awareness of them so they can be managed.

The Female Athlete Triad1

The Female Athlete Triad was originally defined in an American College of Sports Medicine position statement published in 19972 and has since evolved to be recognized as 3 components that each exist on a spectrum from optimal health to disease: menstrual function, bone mineral density (BMD) and energy availability (EA). An athlete may experience one, two or all three of these components. Younger athletes (< age 32), especially adolescents, are particularly vulnerable because these early years are when peak bone mineral density is being established. Interference with this process can put an athlete at risk of osteoporosis and stress fractures. Menstrual cycle irregularity can also affect child bearing because ovulation is directly related to a regular menstrual cycle. When cycles become irregular, ovulation occurs less frequently and conception can become more difficult.

When the components of the triad occur on the “disease” end of the spectrum and persist for long periods of time, there is evidence that the risk of cardiovascular disease is increased. Imagine all the work that goes into your best 2K row time could actually be putting your heart at risk if done to excess! In more extreme cases where menstrual cycles are absent for an extended timeframe, the risk of pre-cancerous changes in the uterus is also increased. Fortunately, with awareness and health care providers knowledgeable in the unique challenges of female athletes, the female athlete triad can be very effectively managed.

Energy availability (EA) is defined as daily dietary energy intake minus daily exercise expenditure corrected for lean body mass; or more simply put, “energy in” minus “energy out”. When dietary intake is insufficient to keep up with energy expenditure, the body may reach a threshold where one or more components of the female athlete triad become apparent. This imbalance can occur from overt eating disorders like anorexia nervosa or bulimia, however very commonly can occur simply with insufficient caloric intake or an imbalance of macronutrients (“macros”) in one’s diet. What is challenging is that there is no “one size fits all”. Two gymnasts could train the same way, be on the same nutritional program with the same body mass index with dramatically different effects on their individual physiologies. The “nutritional prescription” to balance “energy in” and “energy out” for a specific athlete and her training program is often achieved with educated trial and error by the athlete herself or with the help of a sports nutritionist, CrossFit Coach and/or health care providers specializing in the special needs of athletes. Achieving this balance is critically important for staying on the “optimal health” end of the spectrum.

The physiologic changes associated with the female athlete triad can affect any athlete from the beginner to the elite level. A formerly obese woman who has become healthier and fitter losing body fat and gaining muscle mass can experience these changes the same way as an elite athlete trying to take her performance to the next level. But with increased awareness about the unique challenges that female athletes of all levels face, the better we can navigate the bumps that we may encounter in our fitness journey.

About the author:
Carla M. DiGirolamo, MD, PhD is a Board Certified Reproductive Endocrinologist taking new patients at Boston IVF, Waltham, MA and is credentialed as a Level 1 CrossFit Trainer, Les Mills certified group fitness instructor and is a member of CrossFit Health – a worldwide organization of physicians who CrossFit created by CrossFit Founder, Greg Glassman in his quest to cure the world of chronic disease. In addition to helping patients build their families, Dr. DiGirolamo’s special interest is managing the unique reproductive/endocrine challenges of female athletes.
References:

  1. Weiss Kelly, AK et al.; Pediatrics 2016; 138(2) e-pub
  2. Otis, CL et al.; Med Sci Sports Exerc. 1997;29(5):i-ix