Thank You LaikaSpoetnik Grand Rounds From The Netherlands

Thank you Jacqueline for hosting Grand Rounds Vol. 6 No. 2 this week on the LaikaSpoetnik MedLibLog and including my article Fast Fitness - Stretch For Menstrual Cramps - a quick stretching technique to ease symptoms of menstrual and other uterine cramps. On the web, Grand Rounds is a collection of the best on-line medical posts from the week. Who Is Laika?

Jacqueline is an information specialist in the Netherlands. She chose the blog name "LaikaSpoetnik" as a pseudonym because she thought of starting her blog as "a kind of an pioneering experiment." Laika is a Russian word for someone who howls or barks. The first dog to orbit the earth was renamed Laika (originally Kudryavka- "Little one with curly hair" and other names). Laika, pictured at right, flew in Spoetnik II (Dutch spelling of 'Sputnik'). Laika died soon after launch, in 1957.

Laika was not the first astro-dog. Several flew previous suborbital missions for the Soviet Union. In 1961, Nikita Khrushchev gave one of the puppies of Soviet space dog Strelka ("arrow") to Caroline Kennedy, young daughter of then U.S. President John F. Kennedy. That doggie had a cold war romance with a Kennedy dog. More puppies.

A different Grand Rounds host works hard each week to find and list the articles. This is different from the Grand Rounds in a hospital, which is a lecture for doctors about a patient or topic. Jacqueline went to much extra work for this Grand Rounds. I thank her. Here is her photo of the results:

Related:

• Space Walks
• Altitude Sickness on Flights
• Indiana Jones Rocket Sled

Labels: aerospace, Grand Rounds, military fitness

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Helium Speech - An Astronaut Calls the President of the United States

When you take a breath from a helium balloon and speak, your voice rises humorously. What happens when an astronaut does the equivalent and calls the President of the United States?

In 1965, Sealab II replaced Sealab I, 62 meters (200 feet) down on the ocean floor (photo at left). Sealab II was sometimes called the “Tiltin' Hilton" because of the slope of the site. Teams of "aquanauts" lived and slept inside, dry, breathing air pressurized to that depth. The Sealab project was under command of Dr. George Bond, Captain, U.S. Navy Medical Corps, affectionately called "Papa Topside."

NASA Astronaut Scott Carpenter (photo right) spent a record 30 days in Sealab II. After spending that much time at that depth, specific protocols of changing the breathing mixture and the pressure are needed to avoid problems from the dissolved gas that was absorbed while breathing the air at SeaLab pressure. Commander Carpenter did that inside a special decompression chamber, while breathing an air mixture containing helium. Yesterday's post How To Stay Underwater For A Month explains.

Helium changes heat transfer both inside and outside your body, and changes how fast sound can travel. Sound travels faster through helium than through air. That is the "Donald Duck" effect. People who inhale helium from a balloon and speak on the exhale have a distinctive humorous voice change. Funny voice is temporary, lasting only as long as helium is passing the vocal apparatus. (Helium can't support life. Don’t continuously breathe balloon or other helium source to get a few laughs talking funny.)

I had heard from my Navy friends that an old recording existed of Commander Carpenter trying to phone President Johnson for a formality of congratulations while still inside the recovery chamber breathing the helium mix.

Recently, my colleague Dr. Derrick Pitts, Director of the Fels Planetarium at the Franklin Institute in Philadelphia, and I were talking about space and underwater habitats. He told me that the recording of Commander Carpenter had been found, restored, and was available through NPR National Public Radio.


The description lists the event as 1964, but I think it would have been 1965. It doesn't matter. Enjoy the recording.


Over this summer, I hope to write you some interesting stories about decompression, scuba, space research, cool people involved, and my work living under the sea. Until then, here are related stories:

• Space Walks
• Indiana Jones Rocket Sled
• Exercise and Medicine Underwater and at High Pressure
• Exercise and Fitness in Decompression Sickness Risk
• How To Stay Underwater For A Month
• Collapsing Astronaut Gives Healthy Reminder
• Altitude Sickness, Viagra, and Bubbles on Flights
• Altitude Sickness on Flights
• Living Under The Sea

Labels: aerospace, altitude, breathing, hyperbaric, movie/media fitness, scuba

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How To Stay Underwater For A Month

Human beings have gotten all the way to the moon, but can't get far under the sea. In space we can wear special suits to decrease effects of pressure change and deliver air to breathe, but (in brief) the farther you go down underwater, the more these same conditions constantly change in difficult ways.

For ordinary scuba diving, divers wear a tank of regular air. A compressor squeezes ordinary filtered air into the tank, so that several times more air fits. For more time underwater than a tank allows, a diver can breathe from a special long hose from the surface. How far you can go depends on the length of the hose and the power to compress the air to the right pressure. With other specific training, you can wear a rebreather. A rebreather scrubs and reuses exhaled air instead of losing the exhale into the water (shortest description). In all these cases, the deeper and the longer you stay, the more nitrogen in the air you breathe dissolves all over your body.

When a diver starts back to the surface, pressure reduces all the way up, letting nitrogen back out. You need to come up slowly enough and not have stayed too long to be able to go directly to the surface without the nitrogen forming bubbles inside your body, part of the diving injury called decompression sickness or The Bends. Decompression sickness, and bubble formation, transit, and medical effects was a passion of my career work in physiology for many years. Still is.

On deeper dives, it works better to breathe less nitrogen. You can't substitute more oxygen at deep depths, because oxygen becomes increasingly toxic. You need a gas that doesn't make as much trouble during each depth and time. One choice is helium to replace some or all nitrogen, and part of the oxygen.

If you have lots of dissolved nitrogen or helium or other gases chosen for a long and/or deep dive, you need to stop on the way up, called a decompression stop. Where and when and for how long to stop is interesting, and the subject of research and arguments (discussions) among scientist and divers. Different Navies and commercial companies use different protocols, some known well, some closely guarded as company secrets.

For extreme depth diving for research, commercial work like oil drilling, mining, and communications, military surveillance, espionage, and "proprietary commercial interests," divers can spend time on "deco" stops, but for long dives, many stops are needed, some more than 10 hours. Doesn't work to do that, then go back to work the next day and repeat. One solution is to stay down inside the rig or habitat or other enclosure designed for that. I wrote a little of my work doing that in Living Under The Sea.

At each depth, you can only absorb a certain amount of gas. After that, no more fits. It doesn't matter how long you stay past a certain point, you have the same decompression obligation on the way up. Staying down until you are full of gas is called saturation diving. You can stay down a week or a month, then decompress once. Decompression can be done in the water, but there are problems of cold, darkness, bathroom needs, and gas supply. Another solution is inside a vehicle designed for that purpose. The decompression vehicle can be raised and removed from the water, and the divers inside slowly decompress safely. It was also experimented, to drag divers straight to the surface and throw them as fast as possible into a surface chamber to quickly compress them back to pressures at depth, then slowly release according to algorithms people back then decided were right. Tragically, some regular scuba divers heard about these two kinds of "surface decompression" and thinking it meant the water surface, managed to publish articles in diving magazines, and give lectures at dive shows, with that misinformation being widely repeated, that one could come straight to the surface after deep dives and float around in an inner tube and read dirty magazines, as the guys in the special recompression chambers did to pass the couple days they'd spend.

You wouldn't turn inside out from the huge pressure differential produced, as depicted in some science fiction movies, but it might kill you as effectively. That is a sample of what happens when reporters don't read what scientists write in their research articles, just repeat some sentences taken out of context, conclusions in the abstracts, or what someone else wrote.

Tomorrow - a fun story about NASA Astronaut Scott Carpenter in 1965. He lived 30 days underwater in SEALAB II, in the US Navy’s Man-in the-Sea Project off the coast of California. Commander Carpenter was breathing a helium mix during his surface decompression in a chamber. In tomorrow's post, hear a recording of what happens when he makes a pre-arranged phone call while breathing helium in the chamber to President Lyndon Johnson - Helium Speech - An Astronaut Calls the President of the United States.

Related stories:

• Space Walks
• Indiana Jones Rocket Sled
• Exercise and Medicine Underwater and at High Pressure
• Exercise and Fitness in Decompression Sickness Risk
• Living Under The Sea

Labels: aerospace, breathing, hyperbaric, injury, myths, scuba

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Extending The Envelope - Military and Civilian

When I worked as a military research scientist, strong brave men got hazardous duty pay to spend a day with me.

I measured what humans can do, physically and mentally, and how to make them better at it. I tested pilots undergoing acceleration to see what determined susceptibility or resilience to blackouts and other g-force effects. I tested combat swimmers to see what makes them swim faster, farther. I worked on modalities to prevent astronauts' bones from de-mineralizing, because without the pull of gravity, muscles do not make the bones retain calcium. After weeks in space, astronauts return with the equivalent of years of bone loss. I worked on countermeasures. I tested ground troops to see how much they could carry and why.

My work trains the person, making him self-contained and able to withstand harsh conditions without special clothing, tools, or pills. Another department works with garments that help resistance against temperature, weaponry, and other effects. Another group are the 'gadget guys' making yet more things I have to make the guys able to carry around. Another department is pharma-chemicals - what drugs they could develop and administer to block need for sleep and food, heighten focus, or increase strength or speed. Some heart drugs are long-known and used for steadying the marksman's hand by decreasing the contractile pulse of the heart.

Click the labels under this article for more Fitness Fixer on each topic. I have written several posts, with more to come, on my work to "extend the human envelope."

Look for tomorrow's post for one of the things the pharmaceutical groups work on - Neutropeptide Y Generation for Healthier Stress Response.

Labels: aerospace, drugs, g-force, military fitness, performance enhancing modality, stress, swimming, tests of fitness/health

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Do You Lose Most Of Your Heat Through Your Head?

Losing most of your heat through your head is a popular myth. Head heat loss is not the majority of body heat lost. Not even close.

Years of my career in research have been to study how the human body performs in extremes - exercise, injury states and how to prevent them, working and exercising in heat and cold, changes in air and pressure on mountain tops, and the related but different problems in space and underwater. I have lived in laboratories underwater and done experiments aboard aircraft. I have studied combat swimmers and done extreme swims with them for fun. For military research, I put men in vats of freezing water to see how we can keep pilots alive after bail-outs and how to get covert swimmers to their objective and, I found out, an entire separate topic to get them back again. Strong brave men got hazardous duty pay just to have a day with me. My life is scientific research and finding out why things are the way they are and how to make us better at surviving them. After finding out all these interesting things, I found out another thing - people still like myths more than fact. Here are some interesting facts (cool facts on cold):

Head heat loss is usually less than one-third to one-fifth of total heat loss. That means it is not the majority, which would be more than 50%. Head heat loss is usually less than 20-30 percent or so of total heat loss.

Head heat loss changes with how cold it is. The lower the temperature, the higher percentage head heat loss. Head heat loss is linear with temperature. At 0 degrees Centigrade, up to about 30 to 35% of heat could be lost through your head at rest.

Head heat loss changes with how much you exercise. When exercising at about a work rate of 50% of aerobic capacity, head heat loss falls to less than half of heat loss at rest.

Head heat loss changes if you are in water compared to air.

The heat you lose from your head is small compared to the rest of your body. Some people have bigger heads than others in proportion to their stature, so maybe they can lose a percentage more heat. To reduce heat loss, wear a hat.

All about cold, cold immersion, and scuba, try my book Diving Physiology in Plain English www.DrBookspan.com/books.
Post about body heat and cooling after death - Time of Death From Body Temperature?
All posts on myths - click the label 'myths' under this post.
All posts on aviation and aerospace - click the label 'aerospace' under this post.
All posts on cold or heat - click the corresponding label under this post.

Labels: aerospace, cold, heat, myths

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Hyperbaric and Aquatic Medicine On Travel

For the next 2 weeks we will be away attending the annual meeting of the Undersea and Hyperbaric Medical Society (UHMS). The post Exercise and Medicine Underwater and at High Pressure tells about the UHMS, the fun people, and the meeting. My friends and colleagues who attend are scientists and flight surgeons, SEAL team captains and commercial divers, submarine and aircraft personnel from navies of many countries. As we like to say, the rest have paying jobs.

I won't have computer access to see comments. Healthline will be changing format for answering reader comments and requests. Before you write with questions, check the hundreds of Fitness Fixer posts already here and all the replies already given to comments. If you still want more, click this post which gives a list of labels. Clicking a label will give all posts on that topic.

I will be posting as always, even on the road. Posts to come while I am away will cover swimming and other topics. Here are posts that cover some of the subjects we study at the meeting:

• Does Hyperbaric Treatment Help Muscle Injuries?
• Does Hyperbaric Treatment Heal Sprains?
• Does Hyperbaric Oxygen Help Exercise Ability?
• Exercise and Fitness in Decompression Sickness Risk
• Hyperbarics for Diabetic Foot Injury
• Respiratory Muscle Training for Swimming, Diving, and Running
• Collapsing Astronaut Gives Healthy Reminder
  
• Altitude Sickness on Flights
• Altitude Sickness, Viagra, and Bubbles on Flights

I am a career researcher in human performance in extremes of environment. That means extremes of heat, cold, altitude, exercise, injury, submersion, crimes (forensics) breathing different gases at different pressures (hyperbarics, see above), different g-forces, sometimes all at once. Many years of my work was spent on immersion physiology. If you are interested in scuba, diving medicine, clinical hyperbarics, wound healing in a hyperbaric environment, check my books page and scroll down toward the bottom for three books on these topics.

Labels: aerospace, altitude, education, military fitness, scuba

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Indiana Jones Rocket Sled

The new Indiana Jones movie came out this past weekend, the Kingdom of the Crystal Skull. It is set in 1957 with fun fitness and iconry of the era, for future blog posts. Today - the Rocket Sled.

In the early part of the movie, Indiana Jones and the Soviet Russians brawl through a US military testing base in Nevada. Jones and a Russian officer wind up on a rocket sled, which blasts them on a speed track into the desert.

Rocket sleds are one of several devices that create and test the effects of high acceleration on equipment and the people who use them. High acceleration forces occur when jets take off quickly, when launching a space flight, to eject from a hit (compromised) fighter jet, on roller coasters and spin and fall rides, when you fall from a height, and any time you change speed and/or direction quickly. Interesting changes occur in the body under acceleration. Acceleration is one of the areas of my study as a research physiologist and was my work for a time at two facilities testing air vehicle and human systems.

G-force is a measure of acceleration, not force, but the term g-force is also used for the reaction force that results from acceleration. More on meaning, spelling, and math of g and G in another post. Too much g-force can result in g-LOC (Loss of Consciousness), pronounced "jee-lock"in English, but just as meaningful when using the Cyrillic pronunciation of "loss." When piloting a multi-billion dollar property (the fighter jet) G-LOC is not a good thing for anyone. The pilot may convulse, called "doing an Elvis" because the flailing looks like playing an air guitar - a real air guitar. Then the pilot may "ding" (lose consciousness) and the vehicle may "descend below the level of the terrain" (crash) and "disperse energetically" (explode) and "value unfavorably" (be destroyed), and the crew and anyone they land on may "achieve a negative health status" (die).

So we test.

A rocket sled is a small platform. Rockets propel it on the ground on rails. It creates high onset g-forces for a time limited to the length of the track. When personnel or equipment riding it sit as in a car or plane, they experience acceleration pressing them from front to back (on an x-axis).

To measure the higher g-forces with short onset experienced in jet bail-out procedures, a vertical ejection tower can be used. A small seat is propelled quickly upward by a contained blast force under it (like lighting a bomb). If they are positioned to sit upright, the acceleration acts on them from head to foot, on their y-axis.

To experiment with varying accelerations over different amounts of time and onsets, one device used is a centrifuge. A long support arm swings around and around a center anchoring point -like swinging a ball on a string around your head. A container, often ball shaped, at the end of the support arm holds the equipment or personnel being tested. The ball can rotate to position the people inside at any angle to simulate the changing positioning of a cockpit during maneuvers, for example.

What happens to the people in these testing devices? Often they throw up all over my nice equipment. Some of my test subject pilots used to have contests who could eat the worst thing to redisplay on testing day. One ate plastic bugs just for the fun he was sure to cause - then he didn't throw up, no matter what we did to him. In vertical (y-axis) ejections, there is high impact and acceleration forces on the discs and spine. Back injury is a concern for ejection scenarios. Vibration, both during acceleration and non-acceleration situations, such as for helicopter and jack hammer operators seems to be a high contributor to back pain. It is not known if the various vibration devices sold as fitness devices are of the kind (vibration frequency or amplitude) that contribute to joint pain. G-LOC is another consideration. Why do we test it? To see how to prevent it, if we can screen for who is more likely to get it, if we can train those prone to it to be more resistant, and so on, in g-force tolerance improvement programs (g-TIP).

The set of photos at right is a well-known one of USAF Colonel John Paul Stapp, M.D., Ph.D., riding the rocket sled. He was a pioneer of acceleration study and is also known as the originator of the expression "Murphy's Law" for things that can go wrong. The effect on his face along the x-axis is not from his high speed, but the acceleration which is increasing in photos ii and iii, and decreasing in v and vi. Even though his speed is greatest in photo iv, speed is not increasing or decreasing much, so there is little effect.

More on the interesting effects of acceleration and environmental testing from roller coasters to jets to movies in posts to come.

Related Fitness Fixer:

• Space Walks
• Helium Speech - An Astronaut Calls the President of the United States
• Altitude Sickness on Flights
• A Reader Asks About Osteoporosis and Walking Lightly
  
• Collapsing Astronaut Gives Healthy Reminder
• Click labels under this post for more Fitness Fixer on each topic. For example, for all posts on fitness issues portrayed in the movies or other media, click movie/media fitness.
  

Labels: aerospace, circulation, disc, g-force, injury, lower back, military fitness, movie/media fitness, performance enhancing modality

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Equinox - An Exercise in Treating People With Equality

Today is the equinox. As the earth continues on its yearly path around the Sun, the center of the disk of the Sun passed over the Earth's equator at 1:48 A.M. Eastern Daylight Time this morning (March 20, 05:48 Universal Time). At the date of the equinox, night and day are approximately equal length all over the world (small variations for refractive effects). The Northern Hemisphere begins Spring, while the Southern Hemisphere begins the shorter days of Fall. Each day, for the next three months, days will become a few minutes longer and nights shorter in the Northern hemisphere. Our Southern Hemisphere friends will have longer nights each night until the Solstice in June.

Japan celebrates six days of the Spring equinox (shunbun no hi). Graves are visited during the week to reflect on looking forward and back. The six days are based on the six perfections: giving, observance of virtuous teachings, perseverance, effort, contemplation, and wisdom. Nowruz, in various spellings, is a major Spring observance among many Eastern religions. Nowruz comes from Persian words meaning "new daylight." Observances may date to at least 15,000 years ago. Diverse Indo-European cultures celebrated the Spring Goddess-mother and source of returning life. In the West, many observe the return of Spring and life with symbols of eggs, birth, passing, and rebirth.

The equinox is a fitting time to reflect on equality. That does not mean that everyone must get the same shoe size, but that you consider someone of higher or lower social rank with the same respect.

There is a story that at the end of the final exam of the finest MBA program in the country, was one question, "What is the name of the person who cleans the floors of this building?" Anyone not able to answer this did not get a degree that semester.

Do you say hello to the people who work so hard to make a beautiful place for you to learn and work? Do you care who they are? They are a special human being like you are. Learn their name. Say hello. See the difference it makes to them and to your world outlook.

Happy equinox.

Related Fitness Fixer:

• Fall Equinox
• Better Stretches for Swimming - Cook Strait Update
• Is Bad Martial Arts Good Exercise?
• Healthier Heart

Book:

Labels: aerospace, holiday, spirit

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A Reader Asks About Osteoporosis and Walking Lightly

One good question launched many answers. The post Walk Lightly - Shock Absorption for Happier Joints explained a light step prevents joint, soft tissue, and plantar fasciitis pain. In the comments, Carol asked if there were, "a connection between walking lightly and oesteopenia?" This is interesting, since osteopenia is lower than normal bone density, lack of enough pulling or tension on the bones reduces bone density, and a certain amount of vibration may help bones. The simple answer seems to be, that walking lightly should not be enough to reduce bone density, by itself.

Walking, running, and jumping lightly is good exercise to load the bones, while being better for your ankles, knees, hips, and spine than jarring with each step. The post Why So Many Aerobics Injuries? cited news accounts attributing joint pain and injury to high impact activities, with examples of popular aerobics personalities of the 1980s who now say they are too crippled to exercise. Their injuries were avoidable, but not by avoiding impact exercises. Impact activities can be done safely by not stomping down hard. Even repeated jumps from a height can be done with soft landings. Good athletes run, jump, and box with far less impact than most people walk, and have good strong bones. Exercise, done right, is crucial for your bones - Exercise is More Important Than Calcium Supplements for Bones.

When muscles pull your bones during walking, running, and other exercise, the pulling increases bone density. Adding external weight loads bones further. That is a major way weight-bearing and weight lifting exercise increases bone density. The effect of muscles contracting to provide good shock absorption when moving also pulls on the bones,which should be good. The post Forensic Anthropology and Bone Density looked at influencing the shape of our bones by how we move.

The reader went on to comment, "I have always been very light on my feet, and now in my 50s I have found out I have low bone density. I have a cousin who shakes the house when she walks who has been told that she doesn't ever have to worry about her bone mass." Walking lightly alone should not have caused the osteopenia. Questions would be, what other exercise the reader does, and what things might be decreasing her bone density? For the cousin, "shaking the house" by itself may not be enough bone stimulus that anyone could tell her that she "doesn't ever have to worry." Has the cousin taken a bone density test and was found to be high (for whatever reason)? Then you can say there is lowered risk of fracture. Is this cousin is very heavy, which helps load bone? Does this cousin do regular exercise to increase her bone density? It is not likely to be a valid prediction that someone never has to worry about bone density just because they walk badly.

The reader went on to ask, "I went to a bones for life class and was taught to do heel bouncing to stimulate bone growth. i.e. dropping repeatedly from toes onto heels while standing in proper alignment. Do you agree with that exercise?" I did a few searches on the bones for life class and found that the class uses many exercises, not bouncing on the heels alone. Bouncing for a few minutes would not be enough to undo sedentary life style, and the various things people do that actively take away from bone density. You need to do all the other exercises. How much the shock wave of the impact may additionally load or stimulate the bone is still an open question.

There are studies looking at effects of vibration and tapping on bone building. Mechanisms have been studied from the effect on cat bones of their purring, to various machines that bang or vibrate. Some advertising for vibration machines goes as far as making claims that they will increase bone density. So far, none have been found to have as much bone building effect as muscular activity (exercise). Too much occupational vibration, like jack-hammer, helicopter and similar environments produces joint pain, injuries to the spine, eyes, ear, nervous, and other systems. That was one of the topics I was looking into when I did aviation medicine research, explained in Indiana Jones Rocket Sled. A news article that came out on last year's fitness fad of vibration plates promising weight loss and fitness building, mentioned a few of the problems with too much vibration, and, ironically had an accompanying photograph showing severely hyperlordotic (overarched) lower spine positioning by a person listed as the trainer. Hyperlordotic spine posture, by itself, damages the facet joints of the spine over time. It seems safe to say that the jolting of the vertebral joints against each other in this overly arched position would only be worsened by vibration. The post Prevent Back Surgery shows examples of overarched lower spine and why it causes so many injuries in fitness.

It would be interesting to know if low levels of vibration, through tap dancing, Flamenco dancing, pogo stick jumping, and similar activities, would change bone compared to the same amount of exercise without the impact. Some studies claim that swimmers or cyclists do not have as high bone density as runners, while others do not find that when they control for the direct muscle work applied to the area. There are even studies showing that Tai Chi, a most mild form movement with almost no foot-falls at all, can increase bone density in older people, just from the movement.

Along with walking or running, and weight lifting to build bone density, and using your muscles to stop stomping which can hurt the joints, you can prevent bone loss by avoiding things that reduce bone density:

• Smoking
• Drugs that are known to greatly increase risk of bone fracture: stomach acid drugs and steroid anti-inflammatory drugs, regular use of SSRI antidepressants such as Prozac and Paxil. Numerous medications used to treat different cancers may produce osteopenia (bone shortage) and osteoporosis in long-term cancer survivors. See Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Lack of sunlight. Calcium cannot be absorbed or do its job without enough sunlight
  
• High consumption of meat and dairy products
• Drinking alcohol too often
  
• Lack of fruit and vegetables, and vegetable calcium sources
• Eating wheat and related grains by people with celiac
  

Osteoporosis and osteopenia cause major problems for men, not only women. More on this to come. Move, walk, lift weights, stand on your hands, and jump for fun, exercise, and bone building. You do not need to ooze around on tiptoe to avoid impact injuries. Jump and dance and stamp your feet for fun, without jarring your joints and retinas loose. Have fun.

Carol ended her comment to me with, "Thanks for your site - I've learned a lot about alignment, which has helped in many ways." Thank you Carol for writing so many helpful questions for our benefit.

Labels: aerospace, biking, facet joints, fibromyalgia, fix pain, impact, injury, osteoporosis, plantar fasciitis, sunlight, swimming

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Can We Teach Young Doctors to Be Healthy?

We have been traveling for the past 2 months in Asia and are on the way to the chilly Smokey Mountains of Tennessee USA to teach medical students for a week during their rotation elective in Wilderness Medicine. This is the third year I will teach there.

I will teach the entire curriculum of diving medicine and physiology, plus a workshop on why commonly prescribed stretches are not healthful, and what to do instead. Several members of the Knox County Sheriff's Office from Knoxville TN have requested to attend my lectures, and several readers made the effort to find the class information on my web site and make arrangements to travel to the camp to attend.

As a physiologist, I design the techniques that physicians use. I spent many years as a military and university researcher in environmental physiology, which is how the body functions in the heat and cold, at altitude and underwater, breathing different mixtures of gases, doing different forms and intensities of exercise. It's important to understand why things work. If you don't understand, then you can't think for yourself, and all you can do is repeat the mistakes of the generation before you, who also were just repeating what they learned in a book from teachers who just were repeating what they had heard.

This problem occurs with some of the exercises and stretches given as physical therapy. An introduction to the problem is in the post What Does Stretching Do? In the past two years teaching at the camp, we encountered young students who were not interested to change bad stretches, and made a point of showing me after my lectures that they will keep doing their rounded bent forward toe touches, since "everyone knows" that is how it is done. However, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch.

The problem occurs with nutrition. The medical school food at the wilderness camp is not healthy, and students have defended eating candy and junk food as reasonable, even saying that what they eat is not unhealthful - What Medical Students Told Me About Nutrition and When Did Health Become Thinking Out Of The Box?

The problem can occur with medical treatments that are in the books, even though wrong. In my diving physiology lectures, I try to show that if you understand the physiology, you will know why certain treatments do not work or are not needed. Immersion in water, for example, creates many interesting effects such as distributing blood volume more out of the limbs to the body. This is similar to the effect that occurs in space, described in Collapsing Astronaut Gives Healthy Reminder. Recently, during our travels, Paul wound up in the hospital with a swollen leg. The doctor who was Chief of Medicine of the hospital, announced that the treatment was bed rest. Paul was told he must lie flat in bed for at least three to fours days with the leg elevated to drain the fluid. We understand that bed rest is often listed in books as a treatment for this, but it is wrong. I asked the doctor if going in the water could help. The doctor said that standing in the water meant the leg would be "hanging down" and the leg needed to be elevated to drain. If you understand immersion, then you know why immersion can more effectively treat limb edema and water retention than medicines and lying in bed. Extended bed rest is unhealthy, and reduces muscle and bone health so much that it is used to study the damage to the body from floating around during space travel. We escaped the medical care and went into the water. I will post more on immersion, edema, and health soon.

I will not have Internet access for the next week to read or reply to comments. Enjoy the posts. Start taking and sending in fun photos of your successes using all the fun techniques.

Labels: aerospace, altitude, children, cold, education, fix pain, green fitness, hamstring, heat, hyperbaric, injury, nutrition, practice of medicine, scuba, sitting, stretch, swimming

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Space Walks

The space shuttle Endeavour landed yesterday at Kennedy Space Center in Florida.

Endeavour's two-week assignment to the International Space Station was shortened for safety arrangements concerning Hurricane Dean.


The Endeavour name uses British spelling because it was named for the HMB Endeavour, a sailing ship commanded by 18th century explorer James Cook. Before launching the space shuttle Endeavour, NASA hung a humorous, quickly replaced "GO Endeavor" banner. The formal name is STS - Space Transportation System. This mission was STS-118.


During STS-118, crewmembers went outside the vehicle for assorted tasks. Going out is called extravehicular activity (EVA). Space doesn't support human life. Crew going on EVA wear pressurized suits to protect against radiation, space debris, temperature extremes, and low air pressure. The suits aren't just called suits, they are Extravehicular Mobility Units (EMUs). EVAs get interesting because EMUs are pressurized higher than the near vacuum of space, but aren't pressurized as much as inside the shuttle. Because of the lower air pressure inside EMUs, risk increases for problems like gas embolism, but chiefly, decompression sickness, also called the bends.

Air pressure around us keeps nitrogen gas dissolved all over in our body all the time. When you go up a mountain, in a high airflight, or on an EVA, there is less surrounding pressure. Nitrogen becomes undissolved. If you reduce pressure slowly enough, nitrogen comes out peaceably and you can breathe it out. If you come up from a scuba dive or jump out for your EVA too fast, nitrogen offgases too fast, making bubbles, which are believed to be the basis of decompression sickness. Beside the role of exercise in countermeasures for space health and after returning, exercise is one of several factors affecting risk of decompression sickness. The post Exercise and Fitness in Decompression Sickness Risk explains.

If you could start an EVA with less nitrogen in your body, you could reduce your risk of decompression sickness. Crew preparing for an EVA do lengthy de-nitrogenation procedures. They breathe oxygen instead of air, and do physical exercise to "wash-out" nitrogen in several stages taking many hours. One goal of aviation scientists is to develop faster protocols for denitrogenation without increasing risk of decompression sickness during EVA.

American and Russian space programs use different denitrogenation protocols and different EVA suits. Russians use EMUs with higher suit pressure. The American suit design uses lower pressure, making it more flexible and maneuverable. The lower pressure suit is considered riskier for decompression sickness, and needs longer prebreathing and denitrogenation exercise. The Russian suit, higher pressure inside, is stiffer, needing more muscle to move. My Russian scientist friends say it is like the AK-47 - tough but good. My American scientist colleagues state that the Russian egress suit is a bull, lacking dexterity. My Russians reply they don't need it, as their vehicles, suits (and cosmonauts) are built strong and austerely, not needing fussy fine-tuning. Da.

My crew surgeon friends from both agencies are all submerged in triplicate paper forms for permissions to send me mission stories and photos to post for you. Nice that everyone can feel universally understood.

Related:

• Indiana Jones Rocket Sled
• Exercise and Medicine Underwater and at High Pressure
• Exercise and Fitness in Decompression Sickness Risk
• How To Stay Underwater For A Month
• Collapsing Astronaut Gives Healthy Reminder
• Altitude Sickness, Viagra, and Bubbles on Flights
• Altitude Sickness on Flights
• Living Under The Sea
• Helium Speech - An Astronaut Calls the President of the United States

Labels: aerospace, altitude, scuba

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Gaze Perseid Meteors Without Neck Pain

This weekend in the Northern Hemisphere, the moon will be new, and the night dark, and the skies filled with the shooting stars of the Perseid Meteor shower.

Every 130 years or so, the Swift-Tuttle comet circles the Sun, streaming icy, dusty debris the size of sand and peas. Every mid-August, the Earth passes the orbit of Swift-Tuttle, raining fiery remains through the atmosphere. Igniting against the air's intense friction, they "shoot" across the sky. Books by people who study these things say they fly about 37 miles per second (60 kps), most burning away far above the ground.

The Perseid showers are seen in the sky around the constellation of Perseus the Hero, giving the name. Early Greeks explained that the god Zeus, father of Perseus, visited Perseus' mortal mother Danae in a shower of brightness. Later the event was renamed (or reborn) as "The Tears of St. Lawrence" for their appearance during the August festival of Saint Laurentius. Chinese, Japanese, and Korean writings of Perseid showers date from the 8th century. I grew up on Russian childhood social-utopian folk bedtime stories of comets, mixed with my Grandmother's whispers of fiery conflagration, later determined from an unknown comet or part bursting over Tunguska Krasnoyarsk Siberia around 1908, devastating the forest (later politically reinvented as a nuclear event, and editorially as UFOs for Russian science fiction writing and American television).

What about your neck?
When watching meteor showers standing or sitting, don't martyr your neck. If you crane your neck and push the chin forward when looking upward, you put destructive force on the neck, shown in three examples that follow:

• Three images above show craning the neck and jutting the chin. Injurious compression builds in vertebrae, discs, and surrounding soft tissue.
• The left and middle images show leaning the upper body backward. Thoracic lean overly arches the lower back (hyperlordosis), adding weighted compression to the joints called facets and soft tissue of the lower spine.
• The right photo shows unhealthy craning with the chin forward, common in some yoga and exercise classes. It adds sizeable compressive loading on the back of neck vertebrae plus shearing force on the discs. When raising arms upward, it contributes to rotator cuff compression and injury. Click Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury.
  

I understand that jutting the chin far forward is often taught as proper form. I have taken yoga classes in India with major names and those unknown to the outside world. One teacher told me pushing the neck and chin forward protects the discs. It unfortunately doesn't. Shearing force on the discs is severe when you jut the chin forward then raise it. Shear is a structural strain when one layer shifts sideways (or front to back) in relation to the other. Damage may take years to accrue until visible on x-ray. Don't jut your chin forward, especially not when looking upward.

Photo 3 above shows tilting the neck forward when looking through binoculars (left figure with yellow arrow). The chin is not forward, but the forward head still creates painful forces on the upper back contributing to upper crossed syndrome, disc trouble, and muscle strain in the classic diamond and hangar shape across the upper back. The pain is easily stopped. Keep neck vertical and chin in (right green arrow).

You can look directly upward for all you need in healthful position. Here are ways:

• Keep your chin in, loosely and relaxed.
• Shoulders back.
  
• The back of your head lifts loosely upward without strain.
  
• Straighten the rounded-forward curve of the upper spine - get more upward gaze range from your upper back.
  
• Don't yank or force the head and chin back, or the corners of your neck will ache.
• Don't lean back by arching your lower back.

Healthy upward gazing is a nice good-feeling stretch and exercise for the upper back and neck without injury. Use it for all overhead needs, photo 4 of Amsterdam policeman at right.

The time where we pass through the Perseid shower is long, from about July 15 through August 25. The highest activity is predicted over the Northern Hemisphere this coming weekend. Look up on Saturday, 11 August before dawn, Sunday morning the 12th, late Sunday night through Monday early dawn.

Because of the tilt to Swift-Tuttle's orbit, its fiery dust falls almost entirely on Earth's northern hemisphere. Southern hemisphere friends see few Perseids. The next good Southern hemisphere meteor shower is hoped to be the Geminid showers in December.

The constellation where meteors appear to come from is called the radiant. The Perseid meteor shower radiant is the constellation Perseus. The Leonid shower is hoped to peak this 18 November. Look toward the constellation Leo. The Geminid shower radiant is the Gemini constellation. Watch in mid-December with the evening crescent of the moon.

In photo 5 at left of looking up through the telescope, the neck is a bit more forward than needs to be.

Experiment on your own. Use a mirror and send in your photos of remaking healthful fun overhead gazing activities.

Labels: aerospace, disc, facet joints, fix pain, holiday, lordosis, lower back, neck, upper back, yoga

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Altitude Sickness, Viagra, and Bubbles on Flights

The previous post Altitude Sickness During Flights told how certain symptoms occurring during air travel are from exposure to altitude.

If a craft were not pressurized, air pressure inside would be equivalent to air pressure outside. At high altitude, there would not be enough air pressure inside the craft for crew to be functional enough to fly. Crew in unpressurized craft wear oxygen-delivery equipment. This was one of my areas of study with the Navy.

Passenger planes are pressurized. The inside is kept at higher pressure than actual flight altitude (equivalent to lower altitude). The pressure inside is still not as much as at sea level. Keeping that much air pressure inside would create extreme metal fatigue on the craft and huge fuel costs. Regular passenger aircraft keep interior pressure equivalent to mild altitude exposure.

In the last few years, Viagra (sildenafil citrate) has been tested by various groups, including the military, as intervention against altitude sickness. Recently, it was also found that the drug reduced symptoms, thought to be jet lag, after flights. My guess is that it was effective for symptoms from flights because of the same properties that may help reduce symptoms, in some, of altitude sickness.

Another component that I discovered many years ago in my work in altitude sickness, was a bubble component - an altogether new dimension to the altitude sickness puzzle. Decompression sickness bubbles can form in the body when coming up after a scuba dive. I found the same kind of bubbles can form in your body when going to elevations encountered in aircraft and mountain travel, with no prior scuba diving. More of this in future posts.

Decompression sickness is also an issue when going into space during extra-vehicular activities. Click Space Walks.

Altitude sickness in flight is different from (or in addition to) the motion sickness of flight motion, or being stiff after not moving enough during long flights. The post Exercise and Stretch for Long Travel Sitting covers some exercises and stretches to relieve those problems.

Altitude exposure is not always a bad thing - certain athletes use altitude training to expose their body to conditions that make it work harder and develop greater oxygen carrying capacity. Future posts will cover different kinds of athletic training at altitude, and training to perform better physically at altitude. Click the labels under this post for more on each topic.

Labels: aerospace, altitude, drugs, injury, military fitness, scuba

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Exercise and Fitness in Decompression Sickness Risk

In the post Train Exercise is Exercise Training I mentioned the ongoing question in diving physiology research of how exercise can affect the risk of decompression sickness (the bends).

It seems that exercise done during a scuba dive at the bottom increases the amount of nitrogen gas you absorb from the air you breathe from your tanks. This makes more gas which could contribute to decompression sickness on the way up. Mild exercise on a "decompression hang" (waiting at specific shallower depths for a few minutes on the way up) seems to help let more gas dissolve out while you breathe, and may lower risk. Exercise soon after surfacing may increase gas coming out and increase risk according to other work. Some interesting studies look into whether exercise done days before a dive can reduce risk by "using up" specific components that decompression sickness bubbles need to be able to form. The kind of exercise and timing seems important. I will post more on this another time.

Some work looks at physical fitness, and whether that affects risk of decompression sickness (DCS). Would someone in better physical shape have lowered risk? What constitutes being in better shape? Is it body fat? Is it the amount of oxygen you can use to exercise? How might any one of those components affect DCS risk?

I am writing this from the UHMS scientific meeting, explained in Exercise and Medicine Underwater and at High Pressure. One of the studies presented by French naval researchers is, "Does the VO2 max value predict the formation of intravascular circulating bubbles during decompression of healthy divers?" VO2 max (pronounced vee-oh-too-max) is the most oxygen you can use when doing the most exercise you can do. It is usually higher in people who can do more aerobic exercise (other factors also contribute). The maximum amount of exercise an average person can do is about ten times their resting level of oxygen use. Marathoners usually max at around 20 times better than resting levels. A top aerobic athlete can use about 30 times resting level (a horse - more than twice the top human max). Someone badly out of shape, or with heart disease or other problems that limit ability to get oxygen to cells, generally has a low VO2 max. You can raise your level with regular exercise at any age. It is not set.

In the French study, divers were tested for VO2 max a week before their experimental dive. They avoided any physical exercise 48 hours before the dive. Then half completed a dive in a dry hyperbaric chamber and the other half in the open sea with the same dive profile and decompression stop according to French military decompression table MN90. After the dive they were all tested for presence of small decompression bubbles in the bloodstream.

Bubbles can form in the body painlessly after a dive without creating decompression sickness. It is not the case that bubbles always form after every dive, as often thought. Certain bubbles can be detected audibly (they sound like pops and squeeks) using Doppler ultrasound, and other kinds of instruments being developed. I will post more another time about these bubbles and what ultrasound can and can't determine about bubbles and decompression sickness.

The French researchers found that bubble formation in both types of dive was related to the age and body mass index of the divers, but not to VO2max.

Being in good shape makes many aspects of diving safer, even if it doesn't affect risk of decompression sickness. Being in better aerobic shape helps you swim more easily against currents that may take you away from your dive site or boat. Strengthening your body through weightlifting with good body mechanics helps you lift and haul gear with less chance of injury, and practicing all your physical skills helps you be more able to rescue someone or yourself.

• What about physical fitness and risk of decompression sickness in space? Several studies here at the meeting address that. Astronauts who go outside the space vehicle go to lower pressures, similar to divers coming up from a dive. Many considerations, including exercise, go into their preparation for that. The interesting story is posted in Space Walks.


• Next post from this meeting: Does Hyperbaric Treatment Heal Sprains?
  

Labels: aerobic, aerospace, hyperbaric, scuba

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Exercise and Medicine Underwater and at High Pressure

For the next week, I will be at scientific meeting of the Undersea and Hyperbaric Medical Society (UHMS). My colleagues attending are flight surgeons, SEAL team captains, commercial divers, submersible and submarine craft personnel from navies of many countries, and scientists from all over the world who study the science of what happens to the body when working under different pressures, temperatures, and breathing gases - at altitude, underwater, and in the specialized dry compartments to build bridges and structures deep underwater. There are also physicians, technicians, nurses, and aerospace scientists and astronauts who use hyperbaric chamber technology to prevent or treat specific non-diving conditions. Allied health workers, divers, and non-divers also attend.

Originally, we were the Undersea Medical Society (UMS). As use of high-pressure oxygen chambers to treat illnesses other than diving climbed, more sessions on how hyperbaric oxygen works (and doesn't work) were added. Wound healing increased in focus. In 1986, we became the Undersea and Hyperbaric Medical Society (UHMS). Forums, sometimes strangely heated for brainy, cool-headed scientists, are held about which conditions legitimately respond to hyperbaric oxygen treatment and which are felt not to have evidence (no matter how much we wish it would work and alleviate the suffering of the patients).

Some of the established benefits of hyperbaric oxygen and some uses that are not shown to be effective are explained in the post and comments of Does Hyperbaric Oxygen Help Exercise Ability?

The meeting will cover many interesting topics in decompression bubbles that are thought to cause (or be part of) decompression sickness, or "the bends," and mathematical and empirical models of decompression. Decompression theory and bubbles were my research area for many years along with the effects of too much oxygen on the body during exercise underwater and in dry habitats underwater. The meeting will have many sessions in clinical hyperbaric oxygen therapy for several specific conditions (abbreviated HBO, HBOT, HB02 and other), chamber equipment, and wound treatment. There will be a session of The Veterinary Hyperbaric Medicine Society. Animals get problem wounds that need help healing, too.

The national board exam for hyperbaric chamber nurse and technician will be administered. There is also a board exam for physicians in hyperbaric medicine held each fall through the American Board of Preventive Medicine & Emergency Medicine. I wrote the study guides for both exams. I tried to make them fun, user-friendly, and packed with understanding, not just lists of facts and equations to memorize. The guides cover the entire contents of both areas and are a nice review or compendium for anyone interested I the field. Info is on my web site books page.

I won't be staying at the fancy conference hotel but at a backpacker's hostel. Over the next week, I will try to get to Internet cafes to post on some of the interesting topics and research at the meeting - and swim and go underwater for real. That is good for a researcher in underwater exercise and medicine to do.


Here is the next post from the conference Hyperbarics for Diabetic Foot Injury.

Labels: aerospace, education, hyperbaric, injury, military fitness, scuba

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Forensic Anthropology and Bone Density

A few weeks ago, I attended a lecture on forensic anthropology. In general, this is the study of things you can tell from human bones in a crime setting. How old was the person? Were they male or female? How big were they? What was their probable race or ancestry?

Why was I there when my work is with the living? Two main reasons. I am the science officer for the Vidocq Society, an international forensic society. I might evaluate data, for example in an aviation disaster, whether someone might have been conscious at each point when undergoing G-forces or different temperatures and amounts of oxygen after a depressurization at various altitudes. In a scuba death, I might advise on physical changes that occur with different situations. The second reason was to learn more about bones. Bones are remarkable. Your bones know a lot about you. What was your health like? Were you active? What kind of activity did you do? When I was small, I read about an archaeological dig in ancient Rome. The bones of a girl were recovered. The account stated they could tell she carried loads too heavy for her, and was therefore (in conjunction with other evidence) probably a servant or slave. I was riveted. How could they know that? I spent years after that learning more about telling how someone moved from looking at their bones.

Throughout your entire life, when you exercise you stimulate growth of new bone cells. The physical pull of muscles thickens your bones where the muscles attach. Using your arm muscles thickens arm bones. Using your legs strengthens leg bones, and so on. This is a main mechanism of how exercise prevents osteoporosis. Without exercise, you don't stimulate enough new cells to counter the normal loss as old ones break down. Your bones thin no matter how much calcium you eat. The post Exercise is More Important Than Calcium Supplements for Bones tells more about this. Bone demineralization is rapid and serious in astronauts in microgravity (Collapsing Astronaut Gives Healthy Reminder).

How you use your muscles causes them to pull differently, giving evidence about the kind of habitual motion. More interesting is that when you are active, your bones grow and shape themselves to facilitate your motion. An example of interest to readers following the posts on squatting is that people who habitually sit for normal daily life in full squat grow "squatting facets" on their lower leg bones. These are small areas on the bone that quickly grow to make squatting more comfortable. At one point, it was a debate in anthropology that squatting facets were a marker of someone of Asian ancestry, until it was found that others who squat also grow them, and that squatting facets disappear when the person adopts a Western sitting habit of chairs and no longer squats. Babies of all races can have them.

Someone who habitually slouches can change the shape of their bones, eventually deforming them. This can occur in the spine, knees, hips, ankles, shoulders, feet, toes - everywhere you pressure your bones. Changing positioning habits to healthier ones can, in many cases, reshape the bones back to healthier shape. Think of braces on your teeth. It's human bonsai. In cases of extreme dystrophies of the muscles, someone who sits without function of their trunk muscles to hold the spine upright, can eventually deform their spine until their ribs sit on their hip bones. How are you sitting right now? The recent post What Does Stretching Do? explained a bit of why stretching isn't reducing injuries. People are stretching, then exercising and going about daily life in bent over positions that rub and grind the joints and soft tissue.

You literally shape your own health. Use the articles throughout this Fitness Fixer blog to do healthy exercise in healthful positioning so that your bones will only tell good tales about you.

Labels: achilles stretch, aerospace, ankle, arm, feet, forensic, injury, leg stretch, osteoporosis, posture, scuba, sitting, squat, toes

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Collapsing Astronaut Gives Healthy Reminder

On Friday, a day after the shuttle Atlantis returned after 12 days at reduced gravity, one of the astronauts collapsed twice during the welcome home ceremony. The reasons are the same as what happens here on Earth.

When you stand and sit on Earth, some of your blood pools in the veins of your legs because of the pull of gravity. In space, the pull of gravity is weak so blood does not pool. Blood floats upward. Astronauts and mission control scientists refer to the upward shift of blood during space flight in a technical manner. They call it the "Fat-Face-Chicken-Legs-Effect."

Upon return to the gravity of Earth, blood is again pulled downward. More pooling than usual occurs and not enough blood may be able to get to the brain. It is not uncommon for astronauts to feel weak and dizzy.

You may notice the same venous pooling on land in several situations: Sometimes when you stand suddenly, the rush of pooling in legs briefly lowers blood supply and blood pressure to your head. You may feel light headed. When this happens you just need to bend over and get your head down. Lowering your head allows gravity to restore blood, relieving dizziness. Extreme pooling has caused occasional cases of fainting when standing suddenly, when standing long periods at attention, and when climbing out of the water, especially hot water in spas and hot tubs. Pooling has been fatal to beached whales.

In space, the human body quickly gets badly out of shape without the pull of gravity. Muscles do not have to work to pull bones and quickly weaken. Bones do not have the muscular pull they need to stay dense and lose much calcium and bone mineral. Astronauts lose bone in space no matter how much calcium they eat. The cardiovascular system does not have to work as much to pump blood. This is why astronauts must exercise so much during missions.

Here on Earth you need regular activity that contracts leg and other muscles to squeeze the vessels to keep blood moving. After sitting for long periods at work and on a plane, your feet may swell with pooling fluids. Contracting your leg muscles while sitting, and by getting up and moving around pumps blood upward, reducing pooling and your risk of clots. For daily life, you need activity to keep muscles and bones from weakening. Even if you are sick it is crucial to get up and out of bed every day to stop the huge health losses that occur. Being sedentary is so devastating to health that bed rest is used as a model in scientific studies for loss of many health benchmarks in the microgravity of space. Stand to exercise, get outside, and enjoy some fun activity every day. Smile - another way to exercise against gravity.

Gravity and activity are important for health. Thank the astronaut, Heidemarie Stefanyshyn-Piper, for reminding us.

Related Fitness Fixer:

• A Reader Asks About Osteoporosis and Walking Lightly
• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Healthy Mother's Day
• Forensic Anthropology and Bone Density
• Getting Stronger is for Everyone
• Exercise is More Important Than Calcium Supplements for Bones
• Space Walks
• Click the labels under this post for more Fitness Fixer on each topic.

Labels: aerospace, circulation, osteoporosis, strength

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