A life in balance is the healthiest life, but what does balance mean, and how can you attain it?
In the movie Karate Kid, the martial arts master Mr. Miyagi tells his student Daniel “Got to learn balance. Balance is key. Balance good, karate good. Everything good.” It cannot be denied that in athletics and in all of health and fitness, balance is a fundamental goal. Webster’s New World Dictionary defines balance as “a state of equilibrium or equipoise; equality in amount, weight, value, or importance, as between two things or the parts of a thing: mental, emotional, or bodily stability.”
I have many patients who want to hear directly from their doctor on health and fitness topics, and so I dedicate these articles to you. Thank you for letting me partner in taking care of you. In this article we will focus on balance as it relates to health and fitness.
Calcium is necessary for strong bones and is found in dairy products. Women and others at risk for osteoporosis often take supplements of 1,500 mg/day. Hazardous levels are more than 2,500 mg/day, and can result in kidney damage, constipation, and impaired absorption of iron and zinc.
As early as 300 BC, the Chinese observer Lu-pu-wei described people with crooked legs and hunched backs, and by the 7th century AD Chinese physicians were describing children with delayed walking, body wasting, enlarged heads and pigeon breast. These are all signs and symptoms of rickets, which is caused by a lack of vitamin D. With the addition of vitamin D to bread and dairy products, rickets has been declining as a cause of disease in children.
Rickets, however, is merely the name for the pediatric version of osteomalacia, “softening of the bones”, and osteomalacia can occur in adults as well. Poor diet and lack of skin exposure to sunshine are common causes of osteomalacia in adults, especially the elderly. Drinking milk, eating vitamin D fortified foods, and getting at least 30 minutes of sun exposure per day to the arms and face can prevent osteomalacia. Even once the disease begins, early lifestyle changes should allow for healing within six months.
There is also danger in getting too much. Prolonged sun exposure won’t result in vitamin D overdose, but may result in sunburn or skin cancer. It is also very hard to eat too much of it. However taking too much vitamin D can result in elevated levels of blood calcium, weakness, poor appetite, nausea, vomiting, and kidney problems. The Food and Drug Administration recommends 600-800 international units (IU) per day.
One of the most common nutritional deficiencies in women is iron deficiency. Menstruation causes chronic iron loss and many women, especially those on vegetarian diets, do not replace these losses. Iron deficiency and iron deficiency anemia, characterized by fatigue, pale skin, fast heart rate, shortness of breath, headache, and poor performance, often result.
Calorie and Fluid Balance
The human body was created to preserve itself. As such it acquires and conserves chemical energy in the form of food and has been conditioned over millennia past to compensate for food scarcity. As a result our bodies are very good at converting nearly everything we put into our mouths into energy. This energy is stored as glycogen in our muscles and liver, and as fat elsewhere in our bodies. Ancient Pacific Islanders had large amounts of body fat to sustain them through long outrigger voyages just as bears build up body fat to hibernate in the winter. Modern people, however, often accumulate far more energy, stored as fat, than they need.
The bottom line is that if we take in more energy than we use, we gain weight. If we exercise while gaining weight, we will gain less fat and more muscle. If we use more energy than we ingest, we lose weight, including about 50% fat and about 50% muscle. If we exercise while losing weight, we will lose more fat and less muscle. The only way to combat starvation is with diet and exercise, and the only way to combat obesity is with diet and exercise. Medicines and surgeries may suppress our appetites and decrease our intestinal absorption, but even these are secondary to diet and exercise.
Failure to maintain energy in balance has powerful health effects. Negative energy balance (energy expenditure exceeding intake) results in menstrual disturbances, bone and muscle loss, fatigue, and higher risk of injury and illness. Positive energy balance (energy intake exceeding expenditure) results in overweight, obesity, higher risk of diabetes, heart disease, injury, and illness.
Carbohydrates should comprise about 65% of total energy intake, fats about 20% and protein about 15%. For a person consuming a balanced diet including fruits, vegetables, and whole grains, vitamin supplements are generally unnecessary. Protein and amino acid supplementation are rarely needed. Fluid intake should be geared to thirst, and moist mucous membranes and light yellow urine suggest adequate hydration.
Most people in Western culture are sedentary, implying that they spend a lot of time sitting and are not routinely physically active. Unfortunately, being sedentary puts people at higher risk for many diseases including obesity, diabetes and heart disease.
For optimum health people should have 30-60 minutes of moderate intensity exercise at least five or six days per week. At least three of the days should be for aerobic training and at least two should be for strength training. People who are badly deconditioned, pregnant women, or the frail and elderly can benefit from multiple sessions of exercise, each ten minutes long, per day. Varying exercises can help maintain interest and decrease the risk of overuse injury.
Exercise sessions should begin with 5-10 minutes of light activity to warm up muscles. This is followed by 20-40 minutes of exercises and 5-10 minutes to cool down. In general, weekly caloric expenditure for regular exercise should be at least 1,000 calories. For example, a 170 lb person running six miles in one hour (10 minute per mile pace) will burn about 1000 calories. A 130 lb person doing the same will burn about 780 calories.
Before beginning an exercise program it is vital for each person to identify their personal fitness goals. Please read the article How to Pick Your Fitness Goals at mdharrismd.com for guidance. The journey from initiating the fitness plan to improving and finally to reaching fitness goals typically takes six months.
Yoga and Tai chi are also good ways to improve aerobic fitness, balance and flexibility. Most exercises also improve relaxation. The improvements conferred by exercise typically are lost after 4-8 weeks of inactivity.
A good rule of thumb is that a person’s maximum heart rate is 220 minus their age, so a 40 year old man would have a maximal heart rate of 180. Athletes gauge their exercise intensity by what percentage of their maximum heart rate they maintain while exercising, with 70-85% being vigorous intensity and 50-70% being moderate intensity. For our 40 year old man, vigorous exercise would be activities that kept his heart rate between 126 and 153, and moderate exercise would maintain his heart rate between 90 and 126. Relative perceived exertion (RPE) is another good way to measure intensity of exercise. The most commonly used scale is 6/20 (no exertion) to 20/20 (maximal exertion). Exercising to an RPE level of 12-16 (“somewhat hard to hard”) is usually adequate to improve health.
Rhythmic aerobic activities involving large muscle groups are best for cardiorespiratory fitness. Walking, jogging, running, cycling, aerobic dance, and swimming are excellent examples. People starting an exercise program should begin near the lower end of their heart rate window and gradually increase their intensity until they reach their personal fitness goals.
Resistance exercise strengthens major muscle groups, and lifting weights is the classic example. Regimens should include 8-10 separate exercises that target major muscle groups.
- Arms – Biceps curls and triceps extensions, wrist curls and extensions
- Shoulders – Back presses, prone lateral raises
- Neck – Shrugs, range of motion exercises against resistance
- Chest – Bench press, pushups, parallel bar dips
- Abdomen – Core exercises including side and back bridges, crunches, sit ups
- Back – Chin ups, lateral pull downs (front and back), rows, back extensions
- Hips – Squats, hip abductions and adductions, lunges
- Legs – Quadriceps extensions, hamstring curls, calf raises,
Perform one to two sets of 8-12 repetitions per set two to three days per week with one day of rest in between. This allows damaged muscle fibers to heal and get larger. Children should avoid heavy weights and maximal strength lifting because it impairs growth plate development.
Static stretching refers to slowly stretching a muscle to the point of mild discomfort and then holding that position for 10-30 seconds. A newer watch phrase in flexibility training is proprioceptive neuromuscular facilitation (PNF). It involves alternating contraction and relaxation in opposing muscles (such as the quadriceps and the hamstrings). Stretches should be repeated 3-4 times on at least three days per week to start. Eventually stretching should be 5-6 days per week, 3-4 times per day, and lasting 60-90 seconds each time.
The first and simplest exercise to promote balance is to stand barefooted with your feet together and your eyes closed; holding the position for at least 60 seconds, twice per day. Easy for normal patients, this task is much harder for those with excessive weakness or other balance-related disease. The second exercise is to do the same while standing on one foot and not holding on to any other objects. Closing the eyes makes it much harder.
The third exercise is to stand with both feet and eyes closed on a wobble or balance board. This board is usually circular with a rounded bottom which allows the board to tip in any direction. You stand on the top, preferably without shoes, and avoid falling off the sides. Eyes can be open or closed. Most beginners need to hold on to a fixed object. Stay on the board for at least 60 seconds, twice per day. Work your way up, ultimately doing it on one foot and with your eyes closed.
People who have great trouble with balance should do these exercises in a pool of water. Strengthening the core is also vital to having good balance.
Sleep Balance – Age and Daily Sleep Needs (hours)
- Newborn (0-2 months) – 12-18
- Infants (3-11 months) – 14-15
- Toddlers (1-3 years) – 12-14
- Preschoolers (3-5 years) – 11-13
- School age children (5-12 years) – 10-11
- Teens (13-17 years) – 8.5-9.25
- Adults – 7-9
There are exceptions to these numbers, but not many. Most people get, and think that they need far less sleep than they should. Some compare how little sleep they get as a way to “one up” each other. However it is impossible to be at maximal health and fitness without enough sleep.
To improve sleep, the first step is to establish consistent sleep and wake schedules and stick to them, including on the weekends. The second step is to develop a consistent bedtime routine, one which does not involve television or other screen time for 60 minutes before going to bed. Third, it is important to have a dark, quiet and comfortable sleeping area. Fourth, avoid food, caffeine, alcohol and smoking prior to bedtime. Exercising regularly contributes to good sleep. Most importantly, make sleep a priority.
Mental and Psychological Balance
In my practice I often encounter patients who are unable to relax. While children are good at relaxing adults, especially those in high pressure work, are not. Improving nutritional balance, activity balance and sleep balance will help with relaxation and mental and psychological health. Having a reliable and supportive social network, keeping regular spiritual observances, and allowing time for recreation and renewal are also important.
Books and articles by the thousands have been written on the topics of health and fitness, and this article has barely scratched the surface. However, I hope that my patients, and others who may read these words, will get a little healthier because of what they learn here.