Exercise Comes in Three Flavors

Physical exercise can take three different forms:


1. anaerobic or strength training exercise

2. flexibility training

3. aerobic or cardiovascular exercise


Strength training, is important for maintaining overall well-being and for supporting the body’s weight-bearing joints, especially the spine.  Weight lifting is the primary example of this form of exercise, but there are other ways to build strength as well.  Strength training does not rely primarily upon the ability of the body to utilize oxygen and hence is sometimes referred to as anaerobic exercise.  It involves an increase in heart rate for short intervals as a person performs each set of an exercise.  The heart rate gradually comes down during the rest period between each set, then elevates again during performance of the next set, or the next exercise.  In so doing, the heart and lungs undergo a small amount of training, mostly in the form of recovery training (this will be discussed a bit later when I talk about cardiovascular exercise).  A small amount of calories are burned as well (typically about the same as during walking) which is an additional benefit.


While most experts maintain the importance of strength training in overall health, the medical understanding of its role is somewhat controversial, since studies do not bear out a strong disease-preventive benefit from this form of exercise.  In the past, it was commonly held to be true that increasing muscle mass–the main physiological effect of strength training–results in faster, more efficient fat burning.  However scientific investigation has not supported this link between weight lifting or other forms of strength training and body fat reduction.  


In the last two decades, the focus of musculoskeletal clinicians has been shifting away from ‘bulk-building’ to something called ‘core strengthening.’  The concept of core strengthening is that there are muscles in and around the mid and lower trunk (abdomen, lower back, and buttocks) which are essential for stabilization and support of the spine.  These muscles, taken as a group, are referred to as the ‘core.’  Disuse of these muscles cause instability of and excessive load bearing by the lower spine, resulting in various forms of disease and dysfunction.  Chronic lower back pain affects approximately one fifth of adult Americans, and failure to maintain good core muscular strength is undoubtedly one of the principle causes.  To the extent that strength training is essential to good health, it is becoming more and more clear that core strengthening is the centerpiece of this form of exercise.  I will say more about core strengthening and about a new device, the Kore Power Trainer, at the end of this paper, under the section ‘Putting it All Together.


For now, what is important to understand is that if you have experienced lower back problems, are planning to become pregnant, or if you are over 30 years of age, you have a simple choice to make: begin to take care of your core or suffer degeneration of your back.  By now you will not be surprised to learn that back health is measured along a continuum, and long before you have a break down, poor habits can lead to weakening, fibrosis, and degeneration of joint, bone, and muscle tissue, or ‘pre-disease.’  I have developed a basic back routine which can be expanded upon or edited back to fit the needs and abilities of every patient.  Regardless of the reason you came to see me as a patient, learning the healthy back routine is an important a part of your well-being and you are encouraged to request this training at any time.  Learning the back routine usually requires two office visits.  


The ‘core’ is a term widely used to refer to the group of muscles in the lower back, abdomen, and pelvis which, when used properly, support and relieve pressure from the weight-bearing elements of the spine.  A strong, well-coordinated core means better overall body strength and less chance of injury, especially during activities which require lifting, pushing, pulling, and twisting.  For decades, chiropractic doctors, physical therapists, and other musculoskeletal practitioners have promoted the idea of strong abdominal muscles as the key to a healthy lower back.  But until recently, a strong core meant lying on your back and doing sit-ups which only work a very limited part of the Core.  Working the rectus abdominus (the ‘six pack’ muscle) has its benefits, but doing so in isolation does not result in a strong core as it does little to defray compressive loads carried by the spine and offers little support for movements such as pushing, pulling, lifting, and twisting.  Ask Dr. Berkoff about the Kore Power Trainer, a device which can be used on any standard bed to train ALL of the muscles comprising the Core, including the rectus, the obliques, and the muscles of the lower back and buttocks.

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