Move to Improve Function and Quality of Life
The term “movement” has become so trendy these days. Media reports have covered how everyone from celebrities to athletes are using “movement” approaches to get in shape. However, I truly think that the term has become misused in the media and popular press to describe a narrow range of activities. These types of activities include various types of crawling movements (I am, admittedly, a huge fan of these) and other “organic” movements. While this is good stuff, it misses the much more holistic definition of the term.
The most holistic definition of movement that I give to most of my patients is “anything you do or don’t do with your body over the course of a day.” This can be exercises that a person does as part of a training schedule, but it is also walking, sleep, sitting, lying down, bending, lifting and carrying. I like using the term “movement” with patients because other terms like “exercise” can have negative connotations for some people, and although exercise is important, it also matters what positions your body is in for the rest of the 23 hours of the day that you aren’t exercising. This means that we must have a plan that takes into account what exercise we should do and what lifestyle changes we can adapt when not exercising.
I prescribe a movement regimen for all of my patients because it is so critical to overall health, lifespan and healthspan. However, what this plan looks like varies a great deal based on the patient’s stated goals and aspirations. Almost all of my patients are asked to perform certain movements that are considered “basic human movements”. These movements do almost always fall under “functional movements,” but I think they are much more than that. They are movements that that all healthy people should be able to perform without pain or difficulty. Walking is the simplest example of this, but I also have people spend time hanging, squatting, pushing and pulling.
The next layer of prescribed movements involves optimizing metabolism. We choose exercises that help regulate blood sugar because this will also regulate insulin. This is important due to the effects of insulin signaling on both longevity and degenerative diseases. Keeping insulin levels low will, all things being equal, lead to a longer, healthier life. The opposite also holds true, with elevated insulin levels driving the metabolic, degenerative diseases that so many people are afflicted by (diabetes, elevated blood pressure, cancer, cardiovascular disease etc.). Although this sounds complicated, the exercises that do this are well known to most and fall under two basic categories. The first category is resistance training, which involves the concentric contraction of muscles against an external force (lifting weights, bodyweight calisthenics, exercise bands, etc.). The second category is high intensity interval training, which involves exercising very hard for 30-120 sec with periods of rest in between. Both of these groups will improve the body’s ability to handle glucose and are an important piece of the puzzle for overall health.
After that, things become much more focused towards a person’s goals. Everyone will need certain basic skills that make life easier (lifting something off the ground, pressing objects overhead, squatting down, etc.), but once those basics are taken care of then we can focus on what someone wants to do with their body. For some people this might be running a marathon and for others it might be aspiring to deadlift a certain amount. This layer then becomes about specializing a person's training towards these goals. Not everyone will have a specific goal they want to work towards, and I have many patients who just want to live without pain and be functional in their daily life. If that is the goal, then that can be specialized as well. At this point it becomes about strengthening and improving what will allow the person to function better in their physical pursuit of choice (be it marathons or just daily life). This is rather intuitive and involves tailoring the training to meet the goal. However, all activities have positive and negative inputs on the body, and the negative inputs will also have to be identified and managed.
Let's take running as a simple example. It's common sense that the runner will need to run more and at varying intensities and distances to improve, and I don't think it's useful to go into detail on this at this time. The flip side is that running is hard on the hips, knees and ankles due to the repetitive impact. This will have to be managed with prehab work that strengthens or stretches areas that running itself is weakening or tightening. However, what do we do for the person that doesn't have this physical goal and just wants to be healthy, functional and pain free? The same process will apply. First this involves identifying the positive inputs provided by both daily life and the basic movements already discussed. These are attributes that are improved by these individual aspects (ie, hanging improving shoulder mobility). The next step then becomes identifying the negative inputs. This takes more time because it involves going through an average day or week for a person and picking out what physical activities and positions they spend their time in. This is usually the most lengthy and detailed part of my evaluation of a person’s movement. Although I won't bore you with all the details, some important points are: 1) total amount of hours a person sits daily, 2) their posture when sitting and 3) how long they must sit during the day before being able to take a break to stand or walk. Knowing these 3 questions will guide us towards exercises geared towards rehabbing any dysfunctional patterns. Also, this may involve recommendations that can be integrated into a person's day (like standing or walking for 5 minutes for every hour we spend sitting).
I hope this offers some insight into the process that I go through to determine a person's movement recommendations. I'm sure each practioner has their own process to evaluate movement, and I've only presented one approach that I have developed over years of working with people. However, whatever approach is used to optimize the physical structure of the body, it is critical to have a process that looks at the basic human movements that we all should be able to perform, short term goals and long term goals. This will allow a person to continue to move towards their goals and stay at that level for as long as possible.