The 6 Best Exercises for Preventing Falls in Older Adults

Building strength, balance and cognitive function can keep nasty slips at bay.






Falls happen, no matter your age. But the truth is, the higher your age, the more susceptible you are to falling. In fact, the Centers for Disease Control and Prevention has pegged falling the leading cause of injury and death among adults age 65 and older.

But don’t think that having a forest of candles on your birthday cake automatically means you’re doomed to fall. If there’s one thing health professionals know for sure, it’s that it’s never too late to start protecting yourself against the pesky, age-related changes that make you more susceptible to tumbles than your teenage grandkids, says physical therapist Michael Silverman, director of rehabilitation and wellness at Northern Westchester Hospital in New York.

You know, changes like declines in muscle mass. According to one Age and Ageing review, 1 in 3 adults age 60 and older suffer from severe muscle loss, called sarcopenia. You know that shuffle, shuffle, shuffle sound many older adults make when they walk? That’s the sound of sarcopenia.

"Sarcopenia drastically affects the strength of the legs, hips, and core, all of which are critical to mobility and maintaining independence," Silverman says. "The loss of muscle mass and strength in the arms can make it difficult to catch yourself if you do trip. And since the muscles of the body act as a sort of protection for the bones, if you fall because of inadequate muscle mass, you may be more likely to suffer a bone break."

Meanwhile, your proprioception – or your ability to sense where your body is relative to other things and control your body’s positioning – can naturally decline through the decades, explains Chris Ochner, director of research for the Hospital Corporation of America. As a result, balance and stability suffer.

Common health conditions such as heart disease and Type 2 diabetes can also impact your risk of falling by contributing to nerve damage in the legs and feet. And, when your legs and feet go numb, staying upright is next to impossible, Silverman says.

Yeah, that’s a lot of factors teaming up to try to take you down. And while a diet rich in vitamin D, calcium and protein can boost fall prevention, as can staying mentally engaged with brain games, exercise is key in preventing fall-related hazards, too. Simply adding the right exercises to your regular routine can make an enormous impact on your safety by strengthening the body, boosting blood flow to the lower extremities, improving neurological function and even helping to enhance your body’s proprioceptive powers, Silverman says.

In fact, a 2016 comprehensive British Journal of Sports Medicine meta-analysis found that exercise alone reduces the risk of falls in older adults by an average of 21 percent. What's more, working out for more than three hours per week was linked to a 39 percent reduction in falls. Pretty impressive, right? "It's best to focus on your body's largest, most powerful muscle groups, such as your glutes, quads and triceps, while also performing single-leg and balancing exercises," Ochner says.


Not sure where to start? Here are six exercises that can help keep you strong and stable through the years:

1. Alternating Lunges

Stand tall with your feet hip-width apart. Place a sturdy chair to one side to hold for balance. (As you gain strength, you can perform this exercise without holding onto a chair.) Keeping your back straight, step forward with one foot. Bend your front knee until your back knee is almost touching the ground. Make sure your front knee doesn’t extend past your front toes. Then, push through your front foot to return to standing. Repeat with the opposite leg. Start with five reps per leg before increasing to 10 reps per leg. Once 10 reps feel easy, add 2kg weights.

2. Single-Leg Stands

Stand tall with your feet hip-width apart. If needed, hold onto the wall or a sturdy piece of furniture for balance. (As you progress at this exercise, you can perform it without holding onto anything.) From here, lift one foot an inch off of the floor while keeping your torso straight and without leaning toward your planted foot. Hold for 10 to 15 seconds, then slowly return it to the floor. Repeat on the opposite leg. Perform five repetitions on each leg.

3. Sit-to-Stands

Begin seated in a chair with arms. Then, brace yourself on the arms and push your butt up in the air using as little help from your lower body as possible. Once you’ve lifted your body out of the chair, slowly lower yourself back into a seated position. Perform 10 repetitions.

4. Triceps Kickbacks

Begin standing to one side of a sturdy chair or bench, holding a 1kg weight down by your opposite side in one hand. With your back straight, hinge forward at the waist to place your free hand on the chair or bench. Then, bend your opposite arm at the waist. Keeping your elbow planted at your waist, extend only your forearm behind you. Pull the weight back to your waist. Perform 10 repetitions per arm, and work your way up to a 2kg weight.

5. Chair Leg Raises

Begin seated in a sturdy chair. Then, holding on to the bottom of the chair with both hands, extend one leg straight out and bring your knee in toward your chest without moving your upper body to meet it. Extend your leg back out and lower your foot to the ground. Repeat with the opposite side. Start with five reps per leg, and work up to 10. Eventually, you’ll want to be able to extend both legs at the same time.

6. Slow Toe Touches

Stand tall with feet together. Then, slowly roll your upper body down to reach your fingers toward your toes, only going as far as your current level of flexibility allows. Try to keep your legs straight the entire time. Slowly roll back up to stand. Perform 10 repetitions.

How Physio Can Help Muscle Sprains


A physio can help you recover from a muscle sprain or tear. The earlier you get help, the faster your injury is likely to heal.


About muscle sprains

Muscle strains are common. They can occur when you stretch or reach out past your normal range while running, playing sport or gardening etc. A muscle tear is more serious as some of the muscle fibres will be broken.


Preventing muscle sprains

The best way to prevent muscle strains and tears is to include a warm-up program before starting any exercise, and then cool down and stretch when you have finished the activity. Advice on warm-up programs and cool-down activities can be obtained from your local physiotherapist or from the ACC website. You can also see some handy injury prevention tips here.


Early treatment

The sooner you get help, the faster you injury is likely to heal.

For an initial treatment of your muscle sprain follow the R.I.C.E.D method

  • Rest - stop the activity you are doing to avoid further damage
  • Ice - place crushed ice wrapped in a damp towel on the injured area for 20 minutes every 2 hours for the first 48 hours.
  • Compression - firm bandaging helps reduce swelling and bleeding
  • Elevation - keep the affected area raised as much as possible
  • Diagnosis - it is very important to see your doctor or physiotherapist if the pain and swelling gets worse or you have not improved after a couple of days.


And avoid H.A.R.M. for the first 72 hours:

  • Heat
  • Alcohol
  • Running (or any exercise)
  • Massage


How can physiotherapy help?

Following an injury, your physiotherapist can help restore you to full movement and also teach you how to prevent injuries reoccurring. Treatment will include an exercise program , possibly with the use of some gym equipment to increase your strength and co-ordination and restore any movement lost in the joint.

Come and see us at Rolleston Central Physio for your muscle sprains.

The Dangers of Sitting All Day and How to Protect Your Health


We are at a crisis point in our society and individually. Our lifestyles have changed so much in the past 50 years that our bodies are not able to keep up with our economic evolution.

We need to think seriously about chairs……

The Evolution of Sitting

Chairs have evolved to be more comfortable and ergonomic to allow us to sit for long periods of time, however, our bodies have not evolved to sit for prolonged periods.

As technology has become integral to many of modern society, our sitting time has dramatically increased compared to that of our parents and grandparents.

The research is mounting and the statistics prove that our health is suffering from being bound to a chair.

Sometimes sitting becomes second nature and we may not even realise that we are being glued down by our seats.

Consider a typical office worker and how much of their waking hours involve sitting from the moment they wake up and until they are in bed.

Here is an example of such a pie chart with someone who works a typical 40 hour week at the office.


With our example pie chart, it demonstrates approximately 70% of the waking day sitting, but some of us may need to commute longer, work longer hours, or spend a bit more extra time winding down in the evening.

What is all the Hype about the Dangers of Sitting?

There has been a lot of discussion in the media lately about the benefits of standing more during the day, with the potential health risks associated with sitting for 6-8 hours each day deemed to be the “new smoking”.

If you sit for 7 hours a day or more, you are are twice as likely to develop type 2 diabetes and cardiovascular disease, and are 13% more likely to develop cancer.

Recent research has even likened the dangers of sitting to that of smoking.

Even after you have adjusted the data for additional moderate-to-vigorous physical activity, you still have an increased risk of these adverse health outcomes.

These are the grim facts of sitting and we need to focus on developing strategies to reduce our sitting time to improve our health.

These benefits extend beyond the musculoskeletal goals of reducing stiffness and load through the lower back and neck in particular, including increased energy metabolism, increased productivity, and benefits for cardiovascular health, all of which can help to reduce the obesity epidemic that Australia is facing.

A recent study published in the UK recommends that office workers spend at least two hours a day on their feet, building up to four hours.

Individuals who sit for the majority of their day (often 65-75% of working hours) are twice as likely to develop type 2 diabetes and cardiovascular disease, and are 13% more likely to develop cancer.

Although some tasks such as handwriting or drawing may be easier whilst sitting, tasks such as reading and responding to emails, reading reference material and having face to face meetings can be efficiently performed in standing.

What are 4 Easy Things I Can Do About It?


1. Get your steps up in your everyday life.

Just the process of moving your muscles increases blood flow and gets endorphins flowing.

There is so much available to read about the “best forms of exercise to lose weight” or the “best form of exercise to cross train” but if we change our attitude from our workout being something that has to be inserted into a weekly timetable towards incorporating incidental movement or exercise into our day, health becomes an overall state of mind rather than something that emotes the image of lugging a gym bag in the dark at 6am.

The attitude permeates your overall lifestyle and your body will feel fitter, stronger and lighter.

Park the car one station earlier and walk the extra 15 minutes, pick your kids up from school on foot or start to ride your bike to work. Not only will your physical-self appreciate these small changes, your mental health will improve too.

2. Think about how your job can involve movement.

Look at your weekly schedule in your current role and think about how more movement can be built in as part of it.

Could you schedule your weekly team meeting at a cafe 1-2 blocks away?

Could you purposefully book a meeting room on another floor so that you have to take the stairs?

Or could you don your runners and have meetings with certain colleagues while walking?

Even the most sedentary job can be shaken up with a few strategic changes.

More and more people are adopting the idea of “active coffee meetings” where rather than sit for 30min over coffee discussing their “corporate takeover”, they are opting to walk a few blocks of the city with a take-away coffee whilst discussing the strategies for this latest business venture.

Not only will your organs thank you for it, but you will be more likely to tap into your creative side by being upright and moving.

3. Get a Stand Up Desk

OK, so not all of us can throw in the towel and become a yoga instructor but if a career change is not on the agenda, consider a standing desk.

Many companies are funding standing desks now for their employees, but I would even urge you to consider taking on the $500-$600 investment yourself for one of the varieties that sits on top of an existing desk.

You might even start a trend in your office as an early adopter.

4. Learn how to sit actively

OK, it doesn’t bring you into a weight-bearing position, but there are lots of things you can do to learn how to sit actively.

Book a consultation with one of our physios and we’ll show you how to sit using your core muscles in a way that will reduce your chance of back or neck pain from the time you do need to sit.

How do I use a stand up desk?

A work set-up that is adjustable between sitting and standing is optimal, especially in the early days as it takes time to build the endurance to stand for longer periods.

However, just because you’re standing doesn’t mean you might not feel back pain – posture is just as important when standing for prolonged periods.

If you wear high heels, take them off while using your standing desk, as this will likely tilt the pelvis forwards, increasing the curve (lordosis) of your lower back, as well as shortening your calf muscles and placing unnecessary stress on the forefoot.

For men and women, it is important to have the weight even under both feet, knees soft (not locked back) and maintain the “S” shape curve of the spine with shoulders over the hips, not swaying backwards.

If you want advice on how to stand in a way that is best for your spine, we can show you how.

Are there other risks to sitting too much?

From a medical perspective research has shown sitting to increase the rate of cancer and other chronic diseases but from a physio perspective, the results are much more instant.

Do you know if we see a client who has had a heavy desk-based week, we can often see a noticeable decrease in the range of rotation of their neck and upper back?

Hip flexors are really commonly affected by sitting as you can imagine the shortened position they adopt in sitting can stiffen them up considerably. This then poses a problem if the “sitter” then wants to run or do other upright activity that requires lengthened or loose hip flexors.

We can do retraining work with you to teach you how to sit in a good position, using your core muscles, but we wouldn’t expect any muscle in the body to hold a static position for 8 hours per day. So therefore, try not to sit so much!

Avoid serious damage to your health and start sitting at your desk better.

We hope you’re standing now 

Walking to work or doing the vacuuming can extend your life


One in 12 deaths could be prevented with 30 minutes of physical activity five days a week. That’s the conclusion from the world’s largest study of physical activity, which analysed data from more than 130,000 people across 17 countries.

At the start of the study, participants provided information on their socioeconomic status, lifestyle behaviours and medical history. They also answered a questionnaire about the physical activity they complete over a typical week. Participants were followed-up at least every three years to record information about cardiovascular disease and death for almost seven years.

Over the period studied, Scott Lear, from McMaster University in Canada and his colleagues found that 150 minutes of activity per week reduced the risk of death from any cause by 28 per cent and rates of heart disease by a fifth.


Being highly active was associated with even greater benefits: people who spent more than 750 minutes walking briskly each week reduced their risk of premature death by 36 per cent.

Results showed that it was not necessary to run, swim or work out at the gym. Household chores such as vacuuming or scrubbing the floor, or merely walking to work provided enough exercise to protect the heart and extend life.

“Going to the gym is great, but we only have so much time we can spend there. If we can walk to work, or at lunch time, that will help too,” says Lear.

The World Health Organisation recommend that adults aged 18 to 64 do at least 150 minutes of moderate physical activity throughout the week, as well as muscle strengthening exercises at least two days a week.

The study found that if the world’s population met these guidelines, 8 per cent of global deaths over seven years would be prevented.

“The clear-cut results reinforce the message that exercise truly is the best medicine at our disposal for reducing the odds of an early death,” says James Rudd, senior lecturer in cardiovascular medicine, at the University of Cambridge. “If a drug company came up with a medicine as effective as exercise, they would have a billion-dollar blockbuster on their hands and a Nobel prize in the post.”


Can trying to meet specific exercise goals put us off being active altogether


Encouraging people to meet specific fitness goals when they are new to exercising can be ineffective. In fact, it may even make it harder to become active, according to an editorial published in the British Journal of Sports Medicine.

Does this sound familiar?

Every time I join a gym, I get pressured into writing down a goal, when I just want to exercise a few times a week. And I often feel like a failure if I’m no closer to my goal after a few months, so I stop going altogether.

This is the experience a friend shared with me after I told her about our latest paper. And it makes sense. Exercise practitioners and personal trainers are taught to help us set goals, and often we try setting our own exercise goals - such as New Years’ resolutions.

But what if the way we set these goals isn’t actually that helpful, or worse, makes it harder for us to become more active?


Why do we set specific goals?

Specific, challenging goals are widely accepted and recommended as being most effective for increasing performance, based on over 50 years of research. This is why a personal trainer may encourage us to set a goal like losing 5kg over the next 12 weeks by committing to a program including at least three visits to the gym per week.

Indeed, peak exercise bodies, such as the American College of Sports Medicine, advise practitioners that in order to be effective, goals need to follow the SMART principle. This means they should be Specific, Measurable, Achievable, Realistic, and Time-bound.

Even the World Health Organisation guidelines include specific targets for physical activity, such as participating in at least 150 minutes of moderate intensity physical activity throughout the week.

However, important aspects of the theory around goal setting seem to have been oversimplified, overlooked, or misunderstood. Specific goals are often used in a one-size-fits-all manner, where it is assumed they are equally effective for people of different skill levels.

If we’re already skilled, or in this case physically active, then specific goals are great for getting more out of ourselves. Alternatively, if the task isn’t complex - like simply trying to increase a daily step count - then specific goals can work well.

Yet increasing and maintaining physical activity long term is a complex process, so this issue is very relevant for our attempts to exercise and get fit. The theory also states that when we’re in the early stages of learning new, complex tasks, specific goals aren’t as effective as goals such as to do your best – and could even be harmful to our attempts. Just imagine being set a specific goal to cycle 100 metres the very first time you get on a bike.

There is good evidence of this too. For example, a large review of studies looked at interventions which used goal setting to increase physical activity. It found specific goals were no more effective at increasing physical activity than vague goals such as to simply “be more active”.


See how active you can be

Problems with the current approach of setting goals include focusing on immediate or short-term outcomes (like losing 1kg this week), diverting attention away from strategy development (aiming to get through a 20 minute run rather than understanding how to pace yourself), and inhibiting learning (achieving less knowledge of how to exercise appropriately).

Specific goals may be off-putting if we believe they’re unrealistic, hence the Achievable and Realistic in SMART. So we might even think “I won’t be able to achieve 150 minutes of physical activity this week - why bother trying?”

Specific goals also introduce the possibility of failure, which is a negative feeling and can be extremely demotivating. For example, you could think:

I wanted to run for half an hour but only managed 15 minutes – I’m so bad at this!

In this way, specific goals can distract you from your achievements:

I ran for 15 minutes today even though I was busy – that’s not bad.

Instead of automatically relying on specific, challenging targets when we’re trying to become more active, we need to re-think how we set goals, and look at other options. According to the theory and based on promising results from initial studies, open goals like “see how active you can be” seem to be a great way to start.

After that, you could focus on beating what you achieved last time, and on incremental improvements rather than lofty goals planned in advance.

You can also focus on developing strategies for becoming more active, like trying out different times and days when you can make it to the gym, or different pieces of gym equipment. And you can focus on the process of learning how to be active, like learning how to pace yourself if you go for a run.

By simply changing how your goals are phrased, it might become easier to get active, and stay active for longer.

Should You Drink Coffee Before You Work Out?


Coffee lovers everywhere joke that they run on coffee. But should you literally run – or lift or cycle or play sport – on coffee, too?

Research on caffeine has shown that the stimulant increases exercise performance when taken all by itself, but exactly how caffeine boosts workout power and endurance isn’t definitive. And likely, various mechanisms are at play, says board-certified sports dietitian George Fear with One by One Nutrition in Canada.

For example, caffeine is known to thwart adenosine’s effects on the body. A byproduct of your body breaking down food for energy, adenosine contributes to brain fog and fatigue when it binds to specialized receptors in your body, Fear says. Caffeine blocks those receptors, so, theoretically, caffeine could also block that “I can’t run any farther!” feeling.

Caffeine might also help dull pain since many of the adenosine receptors that caffeine blocks are found in areas of the brain and spinal cord that are also heavily involved in pain perception. In one University of Illinois study, taking a caffeine tablet before exercising significantly reduced how painful cyclists rated their workouts to be.

Caffeine also triggers the body’s release of the feel-good neurotransmitter dopamine as well as beta-endorphins, natural painkillers that can help you push harder with less discomfort, Fear says. In one Journal of Pain study, drinking coffee 24 to 48 hours after exercise cut symptoms of delayed onset muscle soreness – that tight, achy feeling you get a couple days after a super-tough workout – in half.


Speaking of post-workout brews, caffeine may also increase the body’s ability to refill its energy stores following exercise. In one small study, exercisers who consumed carbs and caffeine after a tough workout packed away 66 percent more glycogen – a form of carbohydrate that hangs out in your liver and muscles to fuel intense activity – than those who only ate carbs. Stockpiling your reserves allows you to work out that much harder the next time you hit the gym, but more research is needed to confirm caffeine’s potential effects on recovery.

All caffeine aside, however, coffee may promote exercise recovery through its wealth of antioxidant compounds, says sports dietitian Kelly Pritchett, assistant professor of nutrition and exercise science at Central Washington University and spokesperson for the Academy of Nutrition and Dietetics. While some level of inflammation post-exercise is required to cause your body to adapt and improve from your workouts, excess inflammation can hinder recovery and contribute to overtraining. The natural antioxidants in coffee help to keep those levels in check.

As wonderful as coffee is, however, you can’t drink as much you want whenever you want and expect to get results like those Popeye got from slamming spinach. Here's what to do instead:


1. Drink in moderation.

Research suggests that you need to consume 4.5 to 6 milligrams of caffeine per kilogram of body weight to maximize your exercise benefits. For a 140-pound woman, that’s roughly 285 to 380 milligrams, or roughly one 20-ounce to two 16-ounce cups of coffee, Fear says. (Every brand, roast, and shop offers slightly different amounts of caffeine.) And, in case you’re wondering, even if you’re a heavy coffee drinker and have a tolerance to caffeine, you don’t necessarily need extra coffee to get an exercise boost, according to University of Illinois findings.

If you have a sensitive stomach or aren’t used to drinking that much coffee, start with about half that and see how it goes, Pritchett says, noting that you will likely see a benefit from the smaller servings.


2. Time your order.

Power up one hour prior to hitting the gym, Pritchett says, noting that’s when the vast majority of studies time pre-workout caffeine. However, it’s possible that coffee can boost recovery when consumed following exercise, so go ahead and give it a shot – as long as that doesn’t mean drinking coffee too close to bedtime. Caffeine consumed within four hours of bedtime can significantly affect sleep quality in most people, Fear says.


3. Dress it up.

While it’s always best to minimize intake of added sugars and artificial sweeteners, you don’t have to order your coffee black. Milk doesn’t seem to blunt the athletic boost you’ll get from the coffee – and it may actually aid in performance and recovery through its combo of carbs and protein, Fear says. Pre-workout latte, anyone?

9 Health Benefits of Swimming



Summer is almost over and there is no better time to get back in the pool to create great habits for winter. In case you need some further motivation beyond relief from the heat, these are only some of the health benefits associated with swimming.



Swimming offers something no other aerobic exercise does: the ability to work your body without harsh impact to your skeletal system. When the human body is submerged in water, it automatically becomes lighter. When immersed to the waist, your body bears just 50 percent of its weight; dunk yourself to the chest and that number reduces to around 25 to 35 percent; with water all the way to the neck, you only have to bear 10 percent of your own weight. The other 90 percent is handled by the pool.

This means that the pool provides an ideal place to work stiff muscles and sore joints, especially if you’re overweight or suffer from arthritis.

In its recommendation for the right types of exercise for people with arthritis, the Arthritis Foundation suggests those that stretch muscles, those that strengthen muscles, and those that provide an aerobic workout. A few laps in the pool combine all three!
If the pool is heated, so much the better for arthritis sufferers, as the warm water can help loosen stiff joints. In fact, people with rheumatoid arthritis receive greater benefits to their health after participating in hydrotherapy than with other activities. It’s also been proven that water-based exercise improves the use of affected joints and decreases pain from osteoarthritis.



Ever see a flabby dolphin or a weak-looking competitive swimmer? We didn’t think so. That’s because swimming is a great way to increase muscular strength and muscle tone — especially compared to several other aerobic exercises.
Take running, for example. When a jogger takes few laps around the track, that jogger is only moving his or her body through air. A swimmer, on the other hand, is propelling himself through water — a substance about twelve times as dense as air. That means that every kick and every arm stroke becomes a resistance exercise — and it’s well known that resistance exercises are the best way to build muscle tone and strength.
There’s yet another bonus of a watery workout: Swimming has also been shown to improve bone strength — especially in post-menopausal women.



Unlike exercise machines in a gym that tend to isolate one body part at a time (like a bicep curl machine, for example), swimming puts the body through a broad range of motion that helps joints and ligaments stay loose and flexible. The arms move in wide arcs, the hips are engaged as the legs scissor through the water, and the head and spine twist from side to side. Plus, with every stroke, as you reach forward, you’re lengthening the body, which not only makes it more efficient in the water, it also helps give you a good stretch from head to toe.
To improve your flexibility beyond the natural gains you’ll make by swimming, you might also want to finish your pool workout with a series of gentle stretches. The support of the water should help you maintain positions involving tricky balance — such as a quadriceps stretch — for longer periods of time.



For some time, some people thought that because water is generally cooler than our body temperatures, it would be difficult to lose weight with a water workout. Like many old ideas about exercise, this has since been revised: Swimming is now recognised as one of the biggest calorie burners around, and it’s great for keeping weight under control.
The exact number of calories you burn, of course, depends on your own physiology and the intensity with which you exercise, but as a general rule, for every 10 minutes of swimming: the breast stroke will burn 60 calories; the backstroke torches 80; the freestyle lights up 100; and the butterfly stroke incinerates an impressive 150.



Being healthy is more about having the right ratio of cholesterol in your body than just having low amounts of the stuff in your blood. Specifically, it’s beneficial to have higher levels of “good” cholesterol (HDL) and lower levels of LDL, or “bad” cholesterol.
Swimming can get these levels in the right balance thanks to its aerobic power, which has been proven to raise HDL levels. And for every 1 percent increase in HDL cholesterol, the risk of dying from heart disease drops by 3.5 percent.

What’s more, studies have shown that aerobic exercises like swimming can also keep your endothelium in good shape. What’s your endothelium, you might wonder? It’s the thin layer of cells that lines your arteries, and it tends to lose flexibility as you age. In one study of people in their sixties who participated in aerobic exercise, however, endothelium function was found to be equal to those 30 to 40 years younger. The theory is that because aerobic exercise causes arteries to expand and contract, it keeps them fit.



When it comes to warding off diabetes, there are few prescriptions as powerful as aerobic exercise. In one study, men reduced their risk of diabetes by an average of 6 percent for every 500 calories a week they burned in aerobic exercise [source: Bobalik]. With just 30 minutes of breaststroke swimming three times per week, you could burn 900 calories — reducing your risk of contracting type 2 diabetes by over 10 percent. A study that focused on women also suggested the same benefits for the fairer sex: Vigorous exercise just once a week (like the kind derived from a robust swimming session) lowered their risk of contracting type 2 diabetes by 16 percent over inactive women.
And, if you already have type 1 diabetes, the aerobic benefits of swimming can be particularly helpful, as this type of exercise can increase insulin sensitivity.
According to the American Diabetes Association, diabetics should get 150 minutes per week, spread across at least three days per week, of moderate-intensity physical activity like swimming to aid glycemic control.



William Wilson wrote in the 1883 book, “The Swimming Instructor”: “The experienced swimmer, when in the water, may be classed among the happiest of mortals in the happiest of moods, and in the most complete enjoyment of the happiest of exercises.”
Wilson probably didn’t know this in the 19th century, but all that happiness was likely due to the release of feel-good chemicals known as endorphins — one of swimming’s most pleasant side effects. In addition to a natural high, swimming can also evoke the relaxation response the same way yoga works on the body. This is due in large part to the constant stretching and relaxing of your muscles combined with deep rhythmic breathing. Swimming is also a meditative exercise, with the sound of your own breathing and the splash of the water acting as a mantra of sorts that can help you “drown out” all other distractions.
Aside from the metaphysical benefits of swimming, research has shown that it can actually change the brain for the better through a process known as hippocampal neurogenesis, in which the brain replaces cells lost through stress.

Patellar Tendinosis


Patellar Tendinopathy strengthening techniques

Figures show that up to 40% of jumping athletes, and 14% of recreational athletes have experienced patellar tendinopathy at some point in their sporting career. The site of tenderness is usually just below the patella (kneecap): the bone-tendon junction where the patella tendon inserts onto the lower portion of the kneecap.

The word tendinopathy basically refers to a degenerative tendon. What happens is in the early stages the tendon becomes sensitive to load (jumping/sprinting), and if left untreated can progress into a chain reaction of changes to the collagen matrix (or makeup) of the tendon until it becomes degenerative. Some of you may have previously heard the term patella ‘tendinitis’ which is now obsolete as many studies show the absence of inflammatory cells within the tendon itself.

There are 3 stages of a tendinopathy (outlined below). It is important that your physiotherapist determines which stage the tendon is in, as this will determine the correct form of management (each stage needs to be managed differently). It will also give us an idea of healing timeframes & how long your rehab will take. It may be neccessary to get an ultrasound scan (doppler) to determine the exact stage your tendon is in.

Tendinopathy Stages:
Normal tendon -> Reactive tendon -> Tendon disrepair -> Degenerative Tendon.

It should be noted that pathological changes in the tendon are not easily reversible: once in the degenerative stage, very few get back to normal! This is because once in the degenerative stage the collagen matrix is so disrupted & unorganised; potentially leaving it prone to rupture. The ‘tipping point’ that turns the tendon into a degenerative state is when “neovascularisation” is seen on a doppler ultrasound scan, this is where there is small blood vessels growing into the tendon itself. A normal healthy tendon should be avascular (no blood vessels)!

In terms of management, a number of different studies have shown that strengthening exercises have a positive outcome on Patella Tendinopathy. There appears to be two current schools of thought in terms of strengthening, both are outlined below & take 12-weeks to complete.

Long periods of unloading are not good (the tendon likes load). Thus – just resting will not cure your tendon!! On average – a patient presenting with a painful persistent PT for the first time may take 3-6 months to fully recover. If it is a longstanding injury it will likely take a good 6-12 months to return to sport painfree without recurrence.

Below are the examples of a research-based strengthening programme for a patellar tendinopathy. It is advised that you have your knee assessed before beginning this strengthening as the stage of your tendinopathy needs to be determined first, plus also any faulty movement patterns & instability (that may have contributed to the injury) also need to be addressed!

Eccentric Exercise Programme on a 25-deg Decline Board: (Purdem et al 2004).
3x 15 reps of eccentric single legs squats on a 25-deg Decline board
Twice daily (morning & night) for 12 consecutive weeks.
Load should be increased incrementally using a loaded backpack or holding a dumbbell.
Spend approx. 3-seconds doing each repetition, 2-min rest period between sets.
Mild pain during exercises acceptable, but pain & discomfort was not to increase following cessation of training.
This YouTube clip shows Bede performing this exercise:

Heavy Slow Resistance Training: (Kongsgaard et al, 2009).
3 sessions per week only, ideally 1x session is supervised by physio.
Each session consists of 3 bilateral exercises: Squat, Leg Press, and Hack Squat.
Patients to complete 4 sets in each exercise with a 2-3min rest between sets.
All exercises performed to maximum 90-deg knee flexion.
Spend 3-secs completing each of the concentric + eccentric phases (ie. 6-secs per repetition).
Pain during exercise acceptable, but pain & discomfort not to increase following cessation of training.
The amount of repetitions/load varies throughout the 12-week programme:
Week 1: 15 rep maximum (RM).
Week 2-3: 12 RM.
Week 4-5: 10 RM.
Week 6-8: 8 RM.
Week 9-12: 6 RM.

If you have any queries (or think that you may have a patella tendinopathy) please feel free to contact us!