tacklinghearsay-blog

[tacklinghearsay-blog]

Hearsay Seven: People who suffer from anxiety are weak and difficult to handle.

@breakingicesg

instagram & facebook

For those of you who didn’t already know, I have been working on this since last year —  Breaking Ice is a mental health movement that aims to empower individuals to speak up, encourage social assistance and inspire healthy living. And whilst I have never been a fan of talking about my past, or “imperfections”, I felt that it was only appropriate that I shared a little back story of why, and what sparked off the need for this movement in the first place, as well as how it eventually led to this brainchild. Perhaps getting the ball rolling would inspire more like-minded individuals to feel empowered to speak up.

I was diagnosed with mild Anxiety Disorder at twenty six. At twenty three, I decided that I was capable enough to start my own business. Having completed my internship in Melbourne, Australia, after my Bachelor’s Degree in  in the States, I felt fully ready and proficient to start something of my own in Melbourne — a place I fell in love with whilst I was working there.

When I first sprung the entrepreneurial proposal on my parents, I was surprised that, despite the inevitable distress and incessant worrying from them, both my mum and dad were coherently supportive of my aspirations. I mean, why wouldn’t they? Having been living abroad for close to three years, my parents did not have to worry about me much. I was an easy kid. What helped was also the fact that my dad, owns a business of his own, so you could say he was proud to have his daughter “follow in his footsteps.”

The first year of my business was inevitably the toughest. Murphy’s Law was on point for almost three hundred and sixty four days of launching Yogurddiction. Everything that could go wrong, went wrong. It was almost impossible to keep my head up.

However, amongst the chaos, I was fortunate to find some light - nothing made me more thankful for being a Mass Communications Major — for without the expertise and knowledge attained from my further studies, my business would never have made it. Undeniably, too, giving up was never my forte, so you can say I worked my butt off every single day of the year.

As most happy endings would conclude in fairy tales, I am grateful that everything worked out the way it should have. It’s been five years in, and Yogurddiction still continues to run; albeit having to do so remotely.

Of course it was not all rainbows and butterflies. Being alone in a foreign country, simultaneously handling business toil, financial stress and physical grind caused a lot more anxiety and pressure on a young adult than one should handle. Being an athletic person who loved doing sports, time was spread thinly so I stopped working out completely, so you could say that was no possible outlet for stress as well.

The exertion from multitude sources led me to a dark place, one of which even I was unaware of at that point of time. It was only after two years of constant struggle did I realise that I needed to seek help.

My anxiety had a brain of its own — I had persistent anxious thoughts on most days for prolonged periods of time, which truly interfered with my daily life. You could say my irrational fears were off the roof. I was panicky at the slightest matter. My finicky and obsessive mind-set went hand in hand with my anxiety. So aside from all the anxious thoughts and scenarios in my head, I was also constantly judging myself, having massive amounts of anticipatory anxiety about making mistakes or falling short of my standards. This naturally led to persistent self-doubt and more second guessing, which eventually brought to my demise. I figured that support was what I needed at that point of time so I moved back to Singapore to be with my family.

While I am not proud of the hurt I have caused to a couple of past relationships and friendships due to this condition, my ordeal taught me a great deal — Firstly, I must emphasise that refusing to acknowledge that I had a problem never made things better, in fact, it made things tragically worse. Secondly, if I refused to acknowledge my problem, how would I ever think I needed help? Being an individual of a headstrong and self-willed character led me to thinking that I never wanted help and that I never needed it anyway. It was only after several agonising panic attacks that I realised that reaching out was the only way I could save myself.

I am not saying that I live in a perfect world now. Some days I still find myself brooding over a mistake that I have made, which does not warrant that much of thought, much less the self blame.

I remind myself to be tolerant of uncertainty, so that the question does not turn into an obsession. I think of the progress I have made in my recovery, my loved ones whom I am accountable to, and the kind of life I want to lead, and innately, things become less complicated and more manageable. I am thankful for the solid support system I have now - consisting of my supportive family, loving partner and nurturing close friends. I am a much happier person right now.

As of late, with the incline in usage of social media and networking, I am exposed to the myriad cases and stories of victims or sufferers of mental illness, and nothing breaks my heart more than to hear them say that they are alone in this. “Although social media relationships can have a positive effect on us emotionally, numerous studies have been conducted linking social networking to depression and social isolation while also eliciting feelings of envy, insecurity and poor self-esteem.” (1)

What I am driving at is simply that social media often paints a picture of a perfect life for many, but no one really knows what happens behind the lenses.

This is a message to those of you who, perhaps, felt a little tugging at your heartstrings whilst reading this, or teared a slight bit because you can relate to this account of mine — I am not saying it is going to be easy, because it is not. There will be days you find yourself wanting to give up, seeing no hope, or refusing to try anymore. Or maybe you think you are alone in this, and that no one understands. I urge you to reach out, stand up and speak up. This is the first step to recovery. This is the only way you will find your voice and set yourself free.  

@breakingicesg

instagram & facebook

References:

Durlofsky, P. (2014). Can Too Much Social Media Cause Depression? [online] [Accessed 6 April. 2018].

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Hearsay Six: Let’s do the Crossfit Open for Fun!

Photo Credits: @aiksooon 

Every February of the year is a time when The CrossFit Open happens. The Open is the first stage of the CrossFit Games season and the largest community event of the year. This is the time when hundreds and thousands of athletes come together to compete in the worldwide, online competition.

Everyone can join this competition, as long as you are aged 14 or older, you can compete. All you have to do is sign up and log your scores in each week.The workouts are determined by Dave Castro, the Director of The Crossfit Games, and because this competition offers two different version for each workout, scaled and RX’d, it makes the event all-inclusive.

A workout is announced each week over five weeks. At the end of five weeks, the fittest move on to the next stages of competition: the Regionals and the Online Qualifier.

Why does The Open interest CrossFit athletes? The Open encourages great community spirit in the Crossfit gyms, or “boxes”- as they call it. All athletes in the box attempt the announced workouts at the specific facility of their choice (usually their own), adjudicated by registered judges from the CrossFit facility or box.

When attempting the workouts, these athletes are supported by applause and hurrahs from their fellow CrossFitters, most of which have grown to be best training buddies from all their training sessions together. The cheering of the crowd makes the atmosphere thrilling, and being in such an exciting setting makes the Opens something all athletes look forward to every year.

What makes the CrossFit Open so remarkable is that many athletes have trained weeks, months, and even years just for this. As the standards of the workouts are high, strenuous, and gruelling, this is the time the athletes are required to push their personal limits, both physically and mentally.

As a competitive CrossFit athlete, this is also the time to benchmark your performance. It is during these workouts when you test your grit, determination and strength of will from all the weeks of training and hard work- day in and day out of the box for the entire year.

However, you can’t make an omelette without breaking some eggs. With the boon of The Open comes the bane.

Firstly, there is bound to be human error when judging athletes. What we are talking about here is not just the unfairness of scores resulting from inconsistent judging when it comes to movement standards but also the judging standards which may differ and vary across all the boxes worldwide. And while this may seem trivial, it is hardly considered petty towards individuals gunning for a top spot on the leaderboard - every rep counts, and every score matters in their circumstance.

Additionally, it is inevitable that people rarely accept the hard reality behind their goals. As the talent pool for people competing in CrossFit has grown immensely, it is increasingly more difficult to secure a spot in the next levels of The Games. The truth is, most of us are probably not going to make it to The Regionals, much less The Games.

Given the aforementioned, some have resorted to “buying” athletes from all over the world in face of competition. Akin to the English Premier League, there appears to be a “transfer window” for athletes to change their box representation as long as it happens before a stipulated date prior to Opens (as stated in the 2018 CrossFit Games Rulebook). Hence, it hints at the potential of the Crossfit games becoming a game for the “rich”, albeit not too explicit yet currently. Well, there is nothing wrong with buying athletes; it’s not against the rules (unless you breach the aforementioned). However we think - in our own opinion - that it is way more respectable if boxes train and groom their own athletes from ground zero.

Lastly, it is only natural for all, if not, most athletes to be competitive. Why else would anyone want to do this for? CrossFit athletes are naturally self-motivated, committed individuals, that inherently leads to competitiveness. And whilst a little competition amongst friends is healthy, what happens when the rivalry goes a little too far? What I have seen resulting from such competition is not pretty, and friendships take a hit from all the vying.

To conclude, I would say that joining The Open will give you some significant and interesting data on your performance, which can be a guide for setting realistic goals for the following year. This is relevant to both competitive athletes or those who just do CrossFit for leisure, or to keep in shape. Having said that, setting some personal goals in your fitness journey is a step in the right direction.

At the end of the day, competition is almost like a game. Win or lose, competing in CrossFit does not define you as person. Your effort does.

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Hearsay Five: Having a back pain? Consult the chiropractor.

Most of us would have experienced some form of bone, joint or muscle pain, particularly for those of us who exercise. Low back pain (LBP), for instance, is one of the leading causes of functional disability globally(1). Many of us would consult our primary physician, or an orthopedic specialist in hope of finding the magical “cure”. However, most of us tend to walk away disappointed knowing that treatment options are limited to: 1) surgery; 2) pain control medications; 3) rest, especially when none of the aforementioned provide immediate relief. Hence, some turn to alternative medicine in times of desperation. In the context of musculoskeletal (MSK) disease, the term “chiropractic” rings familiar bells amongst many as evident from growing prevalence across different countries(2). For instance, about 2.3 million children in the United States utilized chiropractic care, typically amongst those aged between 12 and 18 years old primarily for back and neck pain(3).

What is chiropractic? In brief, it is a branch of alternative medicine seeking to treat an array of MSK conditions through manual and physical procedures, including but not limited to, osteopathic manipulation (OMT), massage, exercise and nutrition(4). On a molecular level, the mechanistic basis of chiropractic manipulation is orchestrated by fibroblasts, which are cells found in your muscles, fascia and other soft tissues. It primarily functions to produce collagen, an integral part of the connective tissue structure. Chiropractic pioneers argue that manual forces applied during OMT stretches these connective tissues in multiple ways to “injure” the fibroblasts. In response to this unfriendly stimulus, fibroblasts secrete anti-inflammatory molecules and growth factors to initiate wound healing and muscle repair(5). These explains the “therapeutic benefits” reported by the chiropractic community. However, the caveat with the aforementioned is that these were only demonstrated in experimental 3D models, not actual human beings. Hence, one cannot simply “copy and paste” these experimental results to real-life human beings.

Importantly though, what does the evidence say? Several things may sound completely logical and appealing in theory; but real-world evidence may vary or even contradict. It appears that there is a lack of evidence supporting chiropractic manipulations. To illustrate, a systematic review of 11 studies reported some evidence suggesting that chiropractic treatment may confer some benefits in injury prevention of the lower limb muscles, bunion, and tennis elbow. However, evidence was lacking for treatment of neck pain. Importantly, significant inconsistencies exist amongst all the studies, impeding the establishment of any firm conclusion(2). Similar findings on neck pain were observed in another study by Ernst, who demonstrated the lack of superiority of chiropractic treatment over exercise therapy(6). Aside from neck pain, an earlier study published in the British Medical Journal reviewed 35 randomized controlled trials comparing spinal manipulation (SM) against other treatments. The authors concluded that most trials were of poor quality; and of the 4 trials with moderate quality only one trial showed that SM was superior. Hence the efficacy of SM cannot be convincingly established(7). In the same vein, a Cochrane review investigating spinal manipulative therapy (SMT) for acute low-back pain(8) reviewed a total of 20 randomized controlled trials including 2,674 patients. The authors concluded that SMT conferred no additional benefit when compared to inert interventions and sham SMT. Only one trial reported beneficial pain relief and improvement in functional status from SMT, albeit quality of evidence was assessed to be low(8). In the context of chronic back pain, another Cochrane review reported a similar conclusion that SMT failed to confer any clinically relevant improvement in pain and functional status(9). Collectively, these data do not support the use of chiropractic maneuvers in the treatment of MSK conditions.

One major pitfall of chiropractic manipulations is the risk of stroke, as a result of neck manipulation and consequent trauma to the cervical artery – an important blood supply to the brain. Fortunately, or unfortunately, the association is appreciable but nonetheless still small(10). Further research is warranted in this particular aspect, as it is important to discern the adverse effects (stroke, headache, vertebral artery trauma) commonly associated with chiropractic manipulation(11).

Other important aspect to consider is whether such therapies are cost effective. Unfortunately, there is a dearth in the current pool of literature to establish any firm conclusion(1, 12). However, an intriguing article published in the Forbes reported that Medicare paid $494 million for chiropractic treatments across 50 states in the USA. Nonetheless, this phenomenon is unlikely to occur in Singapore, even in the distant future, unless the government decides to subsidize non-evident based treatments. This is evident from the lack of chiropractic clinics in Singapore’s government hospitals.

The evidence has spoken for itself – there is little to no evidence supporting the use of chiropractic therapy for management of MSK conditions in both the acute and chronic settings. Safe to say, you might be better off sticking to exercise interventions prescribed by your physiotherapist; or medical and surgical interventions prescribed by your doctor. However, it is ultimately up to the individual’s preferences, beliefs, past experiences, and to a small extent – his/her financial capacity.

References

1. Blanchette MA, Stochkendahl MJ, Borges Da Silva R, Boruff J, Harrison P, Bussieres A. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. PloS one. 2016;11(8):e0160037.

2. Salehi A, Hashemi N, Imanieh MH, Saber M. Chiropractic: Is it Efficient in Treatment of Diseases? Review of Systematic Reviews. International journal of community based nursing and midwifery. 2015;3(4):244-54.

3. Ndetan H, Evans MW, Jr., Hawk C, Walker C. Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey. Journal of alternative and complementary medicine (New York, NY). 2012;18(4):347-53.

4. Dagenais S, Haldeman S. Chiropractic. Primary care. 2002;29(2):419-37.

5. Patterson MM. Basic Mechanisms of Osteopathic Manipulative Treatment: A Must Read. The Journal of the American Osteopathic Association. 2015;115(9):534-5.

6. Ernst E. Chiropractic spinal manipulation for neck pain: a systematic review. The journal of pain : official journal of the American Pain Society. 2003;4(8):417-21.

7. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM, Knipschild PG. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ (Clinical research ed). 1991;303(6813):1298-303.

8. Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. The Cochrane database of systematic reviews. 2012(9):Cd008880.

9. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. The Cochrane database of systematic reviews. 2011(2):Cd008112.

10. Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016;8(2):e498.

11. Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Systematic reviews. 2017;6(1):64.

12. Dagenais S, Brady O, Haldeman S, Manga P. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC health services research. 2015;15:474.

[tacklinghearsay-blog]

Hearsay Four: A lot of Singaporeans are depressed

We hear a lot about people feeling depressed these days. Many of us would say that they know of at least one family member or friend who suffers from some form of depression, but how exactly does depression affect one’s life? Is depression something people take upon too lightly these days?

Depression is one of the most common mental health illnesses known - It is not just sadness, frustration or loneliness. While these emotions surely are powerful, it is not a mental illness. This vocabulary has somehow found its way into common usage, and the only way to challenge it is to educate the people around us- because mental illness victims are at risk of more dangers than we can imagine.

According to the World Health Organization (WHO), it can affect 6.9 per cent of the population. A local study in 2010 showed that about six people out of a 100 in Singapore will develop this illness over their lifetimes. (1) Depression is a serious medical condition, and anyone diagnosed with this should seek professional help

Depression in youths & adolescents in Singapore

Depression is common in children and adolescents, and has a propensity for persisting into adulthood if not adequately treated. A study has shown that Depression affects between 2 to 8% of youths, and vary between 2.5 to 18%. (2)

The symptoms of depression in children and adolescents may vary across different developmental stages and diverse ethnic groups. Children may show more anxiety, somatic complaints and auditory hallucinations. Children verbalise feelings less but develop behavioural problems, e.g. temper tantrums,

IMH treated 600 people youths between 20 to 29-years-old last year alone. Another local survey (3) reported that one out of four youths aged 18 to 25 admitted to suffering from multiple symptoms of depression.

With such statistics, it is natural to blame the academic demands of schools. Youths and adolescents spend a great amount of time in school and are constantly bogged down with tests and examinations; ultimately struggling to stay afloat in the “Bell curve” system; but what many fail to understand is that the stress youth today experience stems from multiple sources beyond the school environment.

For instance, we see young students have trouble making friends in school, and some face problems at home - personal relationships with parents and siblings. Additionally, some of these youths may not be getting adequate attention and support from their parents - most times, both their parents are busy at work.

Evidently, Singapore is known for its pressure-cooker education system, but social issues also play a big stressor for teens. In a recent article in the Straits Times, Associate Professor Wong, the head of National University Hospital’s psychological medicine department, states that another often-overlooked factor is that each child has his own expectations. “A child will want to achieve something that his parents want or he may form his own expectations based on the incentives or how his siblings have performed. As a result, stress occurs. It's not the fault of the school or the curriculum.”

As children and youths are still under their parent’s care and provision, it is important for parents to validate and recognise their child’s efforts from time to time so as to alleviate any form of stress he or she may be under.

Depression in working adults in Singapore

You would imagine adults to be more capable in coping with their feelings and emotions because they are more matured, but this may not be the case when it comes to mental matters.

When you are sick, you see a doctor, hoping to get a cure; hoping to feel better. Unfortunately, this is different when it comes to anything other than physical pain or discomfort - Working adults who suffer from depression suffer in silence. They are not able to speak up, and therefore are less likely to get help. Moreover, they may feel that it is expected of them to be able to deal with such life matters given their age and maturity.

More young professionals are plagued with a myriad of medical problems, including insomnia, depression and hypertension because of extra long working hours. And though longer working hours may seem mainstream and common in the 21st Century, such burn-out can progress to full-blown depressive or anxiety disorder with accompaniment of severe symptoms such as feelings of hopelessness and suicidal thoughts.

I have had some friends admit that they stay in the office till the wee hours of the night because they feel bad about leaving early; everyone is putting in long hours and it does not look good if they left the office first.

It is therefore important for companies and firms to adopt a smarter working system – emphasizing result-driven work, which increases employees’ productivity, rather than focusing on “face time”.

Depression in the elderly in Singapore

While the elderly may not be pressured with school curriculum, social pressure or long working hours, the kind of misery they feel is of a different sort. The golden years lose their lustre for a rising number of elderly in Singapore as they turn to suicide to end their pain and struggles.

Ms Christine Wong, executive director of suicide prevention agency Samaritans of Singapore, said suicides among the elderly are "a disturbing indicator of the level of distress they were experiencing in what should be the golden years of their lives". "The majority of the elderly clients who called our 24-hour hotline expressed concerns such as physical and mental ill health, financial and relationship issues, and loneliness," said Ms Wong (4).

Social isolation and loneliness is perhaps one of the biggest reasons for their demise.

Sadly, these elderly generally take longer to recover from depression and therefore, it is important that we let our elderly know that they are not alone; what old people need is simply friendship.

At the end of the day, whilst the statistics seem to suggest a rising trend of Singaporeans in danger of Mental illness as the years go by, the word “depression” should not be thrown around too casually. Within the mental health community, this term has tremendous power. Having these words casually thrown around will eventually make them meaningless to everyone. Depression is severe and is not to be taken lightly. If you see anyone who may portray symptoms of this mental illness, reach out and talk to them, you could very well be saving a life.

It is paramount to understand these people are not intrinsically weak mentally hence they develop depression; neither it is something they ask or want for in life – it is a legitimate medical diagnosis that should be treated with weight. Let’s stop labeling people as “depressive” so loosely. If we identify our friends and family members who display red flags of mental illness, approach them to see how you can support them, and refer them appropriately for medical help when necessary.

References

1. Channel NewsAsia. (2018). Commentary: Let's talk about depression. [online] [Accessed 6 Feb. 2018].

2. Moh.gov.sg. (2011). MOH Clinical Practice Guidelines 6/2011. [online] [Accessed 7 Feb. 2018].

3. Rashith, R. and Rashith, R. (2018). NTU Students' Survey Reveals 1 In 4 Singaporeans Suffer From Depression - Must Share News. [online] [Accessed 8 Feb. 2018]

4. AI, J. (2018). More seniors in Singapore taking own lives. [online] The Straits Times. [Accessed 8 Feb. 2018].

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Hearsay Three: It is dangerous to exercise if you have Cancer

The word “cancer” continues to strike fear in many. Unsurprisingly so given that approximately one in three will be affected by cancer before the age of 75 years. Epidemiological trends suggest that cancer is one of the most prevalent global health problems, with approximately 25 million people worldwide living with cancer. It is a debilitating disease, with far-ranging impacts on one’s physical, mental and social health.

Hitherto, the impacts of exercise on cancer remain contentious. Cancer patients often stop exercising as it may aggravate the fatigue associated with the disease and side effects of treatment (chemotherapy). However, there is accumulating evidence supporting the positive effects of exercise on cancer along the cancer continuum including prevention, pre-treatment, and post-treatment.

Prevention

Exercise and physical activity are protective against overall cancer risk, with average risk reductions ranging from 20-30%(1).  Particularly in breast and colon cancers, there is a dose-response relationship between moderate physical activity and cancer risk, meaning to say that the type of activity you perform changes the amount of risk for cancer development(2). Particularly in breast cancer, examples of physical activity that rendered the largest risk reduction were recreational (21%), household (21%), and work-related activities (18%). In terms of intensity, both moderate (15%) and vigorous levels (18%) provided significant risk reduction. However, risk of cancer development was not dependent on the volume of activity(3, 4). The benefits of exercise are aplenty. In the context of cancer prevention, it has been postulated that exercise reduces obesity, sexual and metabolic hormones, insulin resistance, inflammation, and boost in immune function(1). The mechanisms are complicated, and it will not be the focus of this article. Evidently, despite the genetic influences of cancer lifestyle factors are pivotal hallmarks in the development of cancer. Obesity and physical inactivity in particular increases the risk of cancer, contributing approximately 26% of total risk of developing colon cancer. Furthermore, 35% of all cancer deaths globally are caused by preventable life-style factors(5).

During treatment

What if you have already been diagnosed with cancer – is exercise harmful for you? Some fear that exercise aggravates the fatigue associated with treatment or the disease itself, given the overwhelming state of affairs. Although exercise may not be a useful adjunct to all cancer patients, there is encouraging evidence suggesting that it may improve the symptoms and side effects associated with treatment(6). Aerobic exercise yields significant cardiorespiratory benefits, which often deconditions during cancer treatment(7-10). These benefits also extend to cancer patients with heart failure, as aerobic exercise has been shown to improve heart functions. However, combined strength and aerobic training failed to show similar improvements in cardiac function.(10). Cancer patients may suffer from heart toxicity during chemotherapy however evidence is scant regarding the benefits of exercise for this select subgroup of patients(11). Strength training still has its place, as a meta-analysis of 82 studies conclusively showed that both upper and lower body strength improve after strength training during cancer treatment(9). Evidence is particularly strong for patients with prostate or breast cancer(6). However, there is unfortunately no evidence till date supporting the use of resistance training for late-stage cancer patients who are suffering from cachexia, which is characterized by significant loss of body mass, fat and muscle tissue(12). In terms of bone loss, exercise may only preserve bone integrity during cancer treatment, but probably still limited over and above pharmacological treatment(13).

The benefits of exercise are not limited to just one’s physical health; but mental health as well. It appears that supervised aerobic exercise reduced cancer-related fatigue in breast cancer patients however this was not apparent for unsupervised home-based aerobic exercise(14). These findings were limited to breast cancer; findings were mixed for other cancers. Exercise may also attenuate anxiety that is commonly experienced during cancer treatment(6, 9). Quality of life may improve, as demonstrated in one study where women who performed at least one session of strenuous exercise per week experienced improved levels of quality of life post-treatment(15). A Cochrane review(16) established a similar conclusion, showing that exercise during active treatment may benefit one’s quality of life (body image, self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, pain) However, further research is warranted to establish these findings, particularly for other cancer types.

Post-treatment

Exercise is now in routine clinical practice to help rehabilitate patients recovering from chronic illness, and its benefits are multitudinous – side effect and symptom management; limiting disease progression and mortality (death). Can exercise potentially alter the chronic condition consequences of cancer? Aerobic capacity and fitness levels increase post-treatment with exercise. Lung function has been shown to improve amongst female patients after exercise, which is important in the context of chest radiotherapy or chemotherapy, both of which are toxic to the lungs. These findings were not apparent in males, although stable values were reported over treatment possibly signifying a protective effect of exercise (17, 18). Although evidence for musculoskeletal benefits remains mixed, exercise may reverse the bone-damaging effects of cancer and improve overall flexibility, the latter of which is important for patients with poor joint mobility post-radiation or surgery. An interesting study demonstrated that dynamic exercise involving whole-body range of motion (e.g Tai Chi) improved upper and lower body flexibility amongst breast cancer patients(19). From a metabolic stand-point, post-treatment exercise improves lipid (fat) profile and cholesterol levels, with accompaniment of weight-loss. However, it is recommended to perform exercise at moderate to vigorous intensity, as light-intensity exercise has failed to improve waist circumference amongst cancer patients(20). Patients often experience neurological symptoms such as numbness in the hands. However, there is minimal recommendation on whether exercise can improve these symptoms. Nonetheless, improvements in muscular strength from exercise could result in better balance and stability. Lastly, exercise is a double-edged sword for the immune system – it can either boost or compromise depending on the type and volume of exercise(21). On the activity intensity spectrum, the two extremes – inactivity and extreme activity – can compromise the immune function and increase inflammation(22), whereas moderate intensity exercise may improve immune capacity and combat the inflammatory state. However, there is no clear evidence to suggest any benefits associated with exercise post-treatment. Lastly, cancer survivors may benefit from exercise in terms of their quality of life(23)

Personal anecdote

Interestingly, in addition to post-treatment exercise discussions, I was fortunate to witness a real life encounter with a friend, Jane, name has been changed to protect the privacy of the individual, who was scouting around for somebody to help her with her physical health.

Jane had battled with cancer for the last 13 years. She was diagnosed with Hodgkin Lymphoma in 2005. Hodgkin lymphoma (HL), a B cell–derived cancer, is one of the most common lymphomas. In HL, the tumor cells — Hodgkin and Reed-Sternberg (HRS) cells — are usually very rare in the tissue. Hodgkin lymphoma (HL) is one of the most frequent lymphomas in the Western world, with an annual incidence of about 3 cases per 100,000 persons. This lymphoid malignancy involves peripheral lymph nodes and can also affect organs such as liver, lung, and bone marrow(24)

In 2005, she was in remission from cancer and was still undergoing treatment. She then commenced a 30-day radiotherapy at the head, neck, entire torso and pelvis. She had lost a significant amount of weight during this ordeal; but gained the 30kgs back after the chemotherapy treatment.

As she had wanted to lose some of the weight, she started heavy steady state cardio on a regular basis for a long period of time – 4 years, until she was diagnosed with a hormonal disorder, where she was prescribed a hormone pill. This medication caused her to gain weight yet again.

The fluctuations in Jane’s weight caused her to be exceedingly religious with her workouts - Her exercise regime started to include very high cardio-based activities like HIIT, long-distance cycling. She also started having a cleaner diet and was very careful about what she consumed.

However, it was only until the beginning of this year did Jane felt that it was necessary to gain some strength.

She wanted to focus more on strength training as her doctor had advised that it would help increase metabolism - by speeding up the Resting Metabolic Rate (RMR). She explained, “I hope that by gaining strength, it will also help to increase the strength and endurance of my muscles, as well as the strength of my bones. I have become notably weaker after all the cancer treatments that I had to undergo these many years. I don’t wish to feel that, all I hope is to feel stronger.”

Conclusion

Evidence to date overwhelmingly demonstrates the positive profile of physical activity and exercise along the cancer continuum, albeit majority of evidence is in favor of moderate intensity exercise. However, research has yet to establish the “optimum dose” of exercise to prevent cancer, or improve its outcomes. Furthermore, it has to be prescribed in the context of known side effects that the individual patient is experiencing. Ultimately, exercise prescription should be tailored to the individual, along with adequate supervision. As there is a disproportionate focus of research studies on breast cancer patients, further research is still needed to substantiate these findings, particularly for other cancer types. For now, it is best for you to keep moving, sweat it out, and reap the multitude of benefits that exercise brings for your general well-being and health.

References

1. Kruk J, Czerniak U. Physical activity and its relation to cancer risk: updating the evidence. Asian Pacific journal of cancer prevention : APJCP. 2013;14(7):3993-4003.

2. Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and site-specific. Medicine and science in sports and exercise. 2001;33(6 Suppl):S530-50; discussion S609-10.

3. Friedenreich CM. Physical activity and breast cancer: review of the epidemiologic evidence and biologic mechanisms. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer. 2011;188:125-39.

4. Friedenreich CM. The role of physical activity in breast cancer etiology. Seminars in oncology. 2010;37(3):297-302.

5. Brown JC, Winters-Stone K, Lee A, Schmitz KH. Cancer, physical activity, and exercise. Comprehensive Physiology. 2012;2(4):2775-809.

6. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and science in sports and exercise. 2010;42(7):1409-26.

7. Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. The oncologist. 2011;16(1):112-20.

8. Jones LW, Eves ND, Kraus WE, Potti A, Crawford J, Blumenthal JA, et al. The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design. BMC cancer. 2010;10:155.

9. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of cancer survivorship : research and practice. 2010;4(2):87-100.

10. Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. Journal of the American College of Cardiology. 2007;49(24):2329-36.

11. Scott JM, Khakoo A, Mackey JR, Haykowsky MJ, Douglas PS, Jones LW. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Circulation. 2011;124(5):642-50.

12. Bossola M, Pacelli F, Tortorelli A, Doglietto GB. Cancer cachexia: it’s time for more clinical trials. Annals of surgical oncology. 2007;14(2):276-85.

13. Schwartz AL, Winters-Stone K. Effects of a 12-month randomized controlled trial of aerobic or resistance exercise during and following cancer treatment in women. The Physician and sportsmedicine. 2009;37(3):62-7.

14. Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clinical oncology (Royal College of Radiologists (Great Britain)). 2010;22(3):208-21.

15. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007;25(28):4396-404.

16. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. The Cochrane database of systematic reviews. 2012(8):Cd008465.

17. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer. 2007;110(4):918-25.

18. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integrative cancer therapies. 2007;6(3):235-41.

19. Mustian KM, Palesh OG, Flecksteiner SA. Tai Chi Chuan for breast cancer survivors. Medicine and sport science. 2008;52:209-17.

20. Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N. Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003-2006). Cancer causes & control : CCC. 2010;21(2):283-8.

21. Moreira A, Delgado L, Moreira P, Haahtela T. Does exercise increase the risk of upper respiratory tract infections? British medical bulletin. 2009;90:111-31.

22. McTiernan A. Mechanisms linking physical activity with cancer. Nature reviews Cancer. 2008;8(3):205-11.

23. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. The Cochrane database of systematic reviews. 2012(8):Cd007566.

24. Kuppers R, Engert A, Hansmann ML. Hodgkin lymphoma. The Journal of clinical investigation. 2012;122(10):3439-47.

[tacklinghearsay-blog]

Hearsay 2: Skinny girls look better

When it comes to personal achievements and goals, weight loss remains to be one of the top choices that people hanker after these days. “Looking good equates to feeling good.” This notion is definitely familiar to many.

The question is - How much weight loss is enough?  How many inches off your waistline would make you feel good enough?

I wonder how many people actually feel truly confident and contented with their bodies - You would imagine only girls to have body image issues, however,  males have been known to have their fair share of insecurities too, and sometimes, overcoming self-doubt stems from more than just numbers on the weighing scale.

As a female myself, I too, was a victim to such body image issues in my younger days.

Exercising was mandatory to me - My workouts consisted of very high cardio-based activities regularly - I was a runner, clocking a distance of up to fifteen to twenty kilometers daily.

This amounted to at least 1200 – 1500 of calorie output per day. My runs would minimally take an hour and a half to two hours, and all of that aimless running would then be followed by some more conditioning exercises like the usual sit-ups, plank holds and/or push-ups, which would take another thirty more minutes. Day in and day out, I would spend almost three hours working out before I could go about my day. That was clearly excessive exercising, but I was not going to stop.

Flipping to the back of food packets to check for food labels, converting Kilojoules (Kjs) to Calories (kcal) - that was a crucial routine when buying food products - it was almost a customary habit.

The entire weight loss concept was a complete obsession; something I was clearly oblivious to at that point of time - The basic idea was to ensure that my daily calorie output remains higher than the input, only then would I get to sleep in peace at night.

I was also playing field hockey amidst the vigorous cardio sessions, so I spent an additional two hours sprinting about a five-thousand square meters field six times a week in the evenings. Yes - more cardio.

Of course I was a lean machine – “Fit” was my middle name and nothing could tire me out - not until I decided to try out a new sport one day.

A good friend who gave me a quick gist of this sport invited me for a session at the gym she was training at. I remembered her words to me, “It’s a functional fitness kind of gym where you do various movements for the Workout Of The Day (WOD). I’m sure it’ll be a piece of cake for you.”

Boy, was it not. I attended the introduction class and was given an eight minutes workout involving “Burpees”, “Airdynes” and “Box Jumps”. I expected myself to make it through the entire session, but let’s just say I felt so uncomfortable after the eight minutes that I wanted to puke and collapse onto the ground. Strangely, that got me instantly hooked.

Besides falling in love with a brand new sport I had zero experience in, my perception of body image changed from that day forward.

CrossFit is constantly varied functional movements performed at high intensity. (1) This sport required strength – to lift heavy weights, and you could never do so with a tiny body frame. This scrawny physique of mine was not going to help me to move a heavy load - something that years of running did not prime me for.

I wanted to be strong because the lack of could be dangerous -  I would get injured easily. Strength is like body armour because it strengthens the muscles and tendons in the body. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissues that supports and binds tissues and organs together. (2) When you have a lot of tightly wound and neuro-muscularly active fibers like strong muscles, your joints and connective tissues are literally harder to pull apart.

Needless to say, It was necessary to eat well if I wanted to gain strength – Exercise has a profound effect on muscle growth, which can occur only if muscle protein synthesis exceeds muscle protein breakdown; there must be a positive muscle protein balance. Resistance exercise improves muscle protein balance, but, in the absence of food intake, the balance remains negative (i.e., catabolic).(3) I was no longer skipping meals or counting calories.

Naturally, my increase in muscle mass also equated to weight gain, but this increase in muscle mass also greatly increased my strength and performance in the sport. With that, my once my greatest fear of gaining weight tormented me no more. 

Sure, you could choose to lift weights to lose weight - to look and feel better, but lifting weights is very much more what you can do, and not how you look when you do it. Numbers on the weighing scale did not matter, weights on the barbell did.

I guess you can say that I am now no longer interested in calorie counting and clocking senseless mileage by aimless running. I have a different physical pursuit and perspective of “a beautiful body”, but one thing remains the same - my determination and sense of purpose when working out.

I am not advocating for you to stop running, but rather to change your purpose of doing so. If you enjoy clocking mileage, carry on; but try to keep the concept of “burning calories” off your mind whilst exercising. Enjoy the process; it’s not always a game of quantity and numbers. 

It’s not about the pursuit of being “skinny”; but rather “healthy” both mentally and physically. Strong could perhaps be your new beautiful.

References

1.  Crossfit, Inc. What is Crossfit? 2018. Web. 23 January 2018.

2.    National Library of Medicine - PubMed Health, Musculoskeletal System. Web. 23 January 2018.

3. Tipton KD, Wolfe RR, Exercise, Protein Metabolism, and Muscle Growth, Int J Sport Nutr Exerc Metab. 2001 Mar; 11(1):109-32

[tacklinghearsay-blog]

Hearsay 1: The Ketogenic diet is the best way to lose weight

Diet remains a cornerstone of any weight-loss intervention program. It is now established that for weight loss to occur there must be a reduction in energy/calorie intake and increase in energy output (exercise). However the methods of achieving the aforementioned remains controversial, as several different strategies have been advocated for weight loss. Although initial weight loss results are often encouraging, there is pessimism about how dieters sustain in the long run(1). Furthermore, some may even suffer from weight regain due to physiological changes in the body, including reduction in energy expenditure and certain appetite-regulating hormones(2). Your hunger consequently increases; metabolic rate decreases; likelihood of storing fat increases.

Amongst the armamentarium of weight loss strategies including low carbohydrate/high fat and low fat/high carbohydrate diets, the ketogenic diet has emerging evidence suggesting that it may be different. The ketogenic diet is a very-low-carbohydrate diet, which requires one to consume approximately 50g of carbohydrates a day or 10% of your daily caloric intake(3). Some even advocate as low as below 20g of carbohydrates per day. Protein has to be limited to an amount sufficient to maintain lean body mass, because it too can be converted to glucose kicking the body out of ketosis. As specific as you want the numbers to be, you need to be in a state of ketosis in order for the effects of the “keto diet” to kick in irregardless of how low your carb consumption is. In a nutshell, once your body is deprived of carbohydrates, sugar level becomes insufficient for the brain to function hence triggering the body to generate an alternative energy source. The process of ketosis kicks in, producing so-called ketone bodies that can be used by your brain and other organs for energy. Many have the misconception that the keto-diet simply means an extremely fatty diet with minimal to no carbohydrates. This is false - you are only truly ketogenic after testing for elevated levels of ketones either in the blood or urine(4). This would mean that you probably need to test your urine on a regular basis to see if you are still in a state of ketosis. Troublesome much? But anything for weight loss, right?

Most importantly, does this diet work? A meta-analysis of 13 studies involving 1,577 individuals(5) showed that people on the ketogenic diet lost more weight in the long term compared to those on a low fat diet. However the mechanisms underlying these weight loss effects is still a subject of discourse. One group propound that the use of ketones as an energy sources is itself very “expensive”, leading to a “waste of calories” and increased weight loss. Others have postulated that the diet suppresses one’s appetite due to the effects of protein, appetite control hormones, reduced insulin or even ketones(4, 6). Additionally, the ketogenic diet does not slow your body’s metabolism unlike other diets(7). As a result people tend to feel less hungry on a ketogenic diet hence reducing their overall food intake, which could further improve their weight loss.

Additionally, it appears that the benefits of this diet can be extrapolated to obesity-related cognitive impairment(8), improved mood and energy(9), individuals with diabetes(10), and overall heart health(11). Some doctors and dieticians even prescribe the ketogenic diet for diabetic patients (Virta Health). Given the multitude of benefits as described above, it seems that this could be a game changer for those looking to shed some excess weight. However this comes with some caveats. Although it is generally safe, one might experience lightheadedness, fatigue, poor sleep, constipation, and poor exercise and strength function. Particularly for diabetic patients, it is best for you to consult your doctor first because you can experience severely low sugar levels on this diet when combined with your own diabetic medications. Nonetheless for every weight loss program, the most crucial barrier is sustainability. A diet with minimal to no carbs can be a challenge to many, especially for those with a strong sweet tooth. What typically happens for most on a diet is the “Yo-Yo” effect, where people’s weight loss tend to swing back and forth over the long run. Unsurprisingly, critiques would opine that any beneficial effects of the ketogenic diet are only transient, and that success of any weight loss diet is defined by the amount of weight regain.

Here are a few suggestions that you might want to consider. First, the ketogenic diet may not need to be permanent. Once you have reached your goal weight, you can attempt to add back a small amount of carbohydrates, and reduce fat intake as long as you are still in a calorie deficit. One example of a successful weight loss protocol is the combination of two short periods of ketogenic diet (20 days) separated by longer periods of maintenance with the Mediterranean diet (4 months)(12). In your decision-making, also consider other practical aspects such as cost of food, accessibility and convenience.

It is important to acknowledge that almost every diet out there probably works as long as you are in a calorie deficit. There is no “best diet” - what’s best for someone else may not be best for you. Pick one that you can stick with in the long run; do not be tempted by hearsays or simply what you read on the internet that is trendy (including this post). Everyone is unique – we all have different levels of tolerance, discipline, preferences for a diet. If you have a very strong sweet tooth, the ketogenic diet may not be suitable for you; instead stick to a high carb/low fat diet that still puts you in a calorie deficit (unless you have a medical condition e.g diabetes). Until nutrition becomes our highest scientific priorities to invest in so we can answer these questions that constantly befuddle us, there is no harm in trying different diets in order to experiment what works best for you and your lifestyle. From there, pick one and stick with it for a substantial amount of time before going on a maintenance. Ultimately, it is not the wisest and healthiest thing to go on a life-long diet/calorie restriction.

References

1. Wing RR, Hill JO. Successful weight loss maintenance. Annual review of nutrition. 2001;21:323-41.

2. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. The New England journal of medicine. 2011;365(17):1597-604.

3. Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutrition & metabolism. 2008;5:9.

4. Paoli A. Ketogenic diet for obesity: friend or foe? International journal of environmental research and public health. 2014;11(2):2092-107.

5. Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. The British journal of nutrition. 2013;110(7):1178-87.

6. Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. The American journal of clinical nutrition. 2008;87(1):44-55.

7. Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E, et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. Jama. 2012;307(24):2627-34.

8. Davidson TL, Hargrave SL, Swithers SE, Sample CH, Fu X, Kinzig KP, et al. Inter-relationships among diet, obesity and hippocampal-dependent cognitive function. Neuroscience. 2013;253:110-22.

9. Brinkworth GD, Noakes M, Clifton PM, Buckley JD. Effects of a low carbohydrate weight loss diet on exercise capacity and tolerance in obese subjects. Obesity (Silver Spring, Md). 2009;17(10):1916-23.

10. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of internal medicine. 2005;142(6):403-11.

11. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition. 2013;67(8):789-96.

12. Paoli A, Bianco A, Grimaldi KA, Lodi A, Bosco G. Long term successful weight loss with a combination biphasic ketogenic Mediterranean diet and Mediterranean diet maintenance protocol. Nutrients. 2013;5(12):5205-17.