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Competitive Edge, Summer 2011

Trend Alert: Are these exercise trends really worth a try?

By Heather Nettle, MA
Exercise Physiologist

Most people recognize that exercise is a valuable part of their lifestyle, but it is not always easy to figure out what to do. So why not use new technology and programs to help guide you? Good question. Here is a review of some of the most popular trends in fitness merchandise today:

Wii Fit:

The Wii Fit™ is a breakout gaming system meant to get child and adult gamers up and moving. Research indicates that games such as the hula or step games, boxing or some of the dance games are actually beneficial fitness for the general population. That is not to say that if you are bowling while sitting on the couch and flicking your wrist that you are gaining any benefit at all. Whole body movement is the key to this game system. Cheating by minimizing your movements and allowing the remote to do all of the work will not help you on your way to a healthier lifestyle. The Wii Fit also is great because it tracks your progress, allows you to have fun family competitions, and keeps statistics like your weight, the most recent time you played, and testing results. Interestingly, the Wii is actually used clinically to help people with neuromuscular deficiencies (such as stroke patients) to recover because the balance portion of the system is excellent.

XBox 360 Kinect:

The Kinect™ also is a gaming system similar to the Wii that can help you get up and moving. It is more difficult to cheat with this system than with the Wii because your body is the remote. So, if you are not moving enough, your performance in the game or interactive fitness does not register. It, like the Wii Fit, promotes consistency and is great for family fun.

Shape-Up Shoes:

First off, there is little research outside of shoe company-funded studies to report that there is a significant change in muscle recruitment when wearing shoes that tout help in weight loss and muscle tone. Second, the more important question is whether that increased muscle recruitment, or change in body mechanics, is a good thing. Wearing high heels also changes the muscle demands on the legs, but that doesn’t mean it is a good idea to go out and walk five miles in them! Shoes such as these should be worn with caution, otherwise you may end up with some tendonitis or plantar fascitis that sidelines you for awhile.


Zumba® is an exercise class – a hybrid of aerobics and salsa dancing – that is rapidly becoming one of the hottest fitness trends Many people love it because the music and party-like vibe makes it easy to forget that you are actually doing exercise. It is great cardiovascular exercise, but very challenging. Also, some report knee and ankle pain when consistently doing Zumba several days per week. If this becomes a problem, it is best to switch to a tennis shoe with less tread, like Keds®, and see if the problem improves. If the pain persists, you may want to have the problem evaluated.

Belly Dancing:

Belly dancing also is becoming an increasingly popular pick. These classes are usually marketed to help decrease abdominal fat and increase abdominal tone. While it is a challenging core exercise, if other lifestyle modifications – such as nutrition and a well-rounded exercise program – aren’t met, than it is unrealistic to think this class will do it all for you. What this class does help with is balance, coordination and increased core muscle strength. It is much more challenging than it looks and can be fun, particularly for those who are looking for a class to do with friends.


P90X® is a home exercise system designed to combine all components of yoga, plyometrics, cardiovascular exercise and resistance training in one high-intensity workout. The program is easy to follow, required little equipment and has rest days built in. P90X is great for someone who is a regular exerciser in great shape who is looking to change it up. It isn’t appropriate for someone who is not already consistently exercising, who has joint problems, or any health restrictions.


Insanity®, a program similar to P90X, is a good option for an active person looking for a change. It is more cardio-based than P90X, and also is not appropriate for beginning exercisers or anyone with joint problems.

When sitting on the couch contemplating your options for improving your fitness level, take caution. When an activity promises something that sounds too good to be true, it likely is. Also, many of these trends may provide benefit, but it may not be the benefit the commercial suggests. When choosing from these new fitness options, be cautious and skeptical – and practice moderation. Don’t overdo it on any one thing. It’s great to go out and try more things, so long as you are realistic in your goals and listen to your body.

Heather Nettle, MA, is an exercise physiologist at Cleveland Clinic Sports Health. If you would like to make an appointment with Heather or any of our exercise physiologists, please call 877.440.TEAM.

Vitamin D – Human Photosynthesis?

By Richard Figler, MD

While Vitamin D supplementation has received a lot of press recently, questions abound about how much we should take and how we should obtain it. Understanding this essential vitamin is important not only for athletes who spend considerable time in the sun, but also for anyone concerned about optimum performance.

Study after study confirms that many of us (25 to 57 percent) are deficient in vitamin D. It’s not just in Cleveland. A recent study showed a surprisingly high incidence of vitamin D deficiency in Miami – and even Hawaii!

Evidence shows that vitamin D is more of a pro-hormone than “just a vitamin.” It plays an important role in cell regulation and, along with calcium, is imperative for bone health.

Deficiency in vitamin D has been linked to multiple cancers, auto-immune conditions, diabetes and cardiovascular disease. In the sports medicine world, those not deficient seem to have a leg up on the competition. In a recent study, teenage girls who were deficient in vitamin D did not do as well as their counterparts in jump height and muscle force. Other studies also suggest that vitamin D improves neuromuscular performance.

Vitamin D is obtained in the diet from fatty fish, such as salmon, and fortified foods including milk, cereals and breads. Vitamin D also is synthesized in our skin from the sun – similar to how a plant converts sun to energy – or in essence, our own “photosynthesis”. So in the evolution of the human being, vitamin D seems to be a pretty vital component to life.

So how should we take in vitamin D? The key is simple: moderation. Some propose vitamin D supplementation of 800 to 2000 units a day. Debate lingers on the correct dose as well as the correct form of vitamin D. Vitamin D2 (ergocalciferol) is from plant-based sources and vitamin D3 (cholecalciferol) is from animal sources. Vitamin D3 seems to be cheaper, fairly well tolerated, easy to find, and may be more effective at correcting low vitamin D levels.

The best way to know how much to take is to have a blood test done that will check your level, which can guide replacement. It is an easy blood test that can be performed by your primary care physician. Follow-up tests can assure appropriate levels. Although rare, over supplementing with vitamin D can cause toxicity. Symptoms include nausea, vomiting, and in some cases, kidney failure. What about the sun as a source? Once again, moderation here is key. No one knows the “exact” dose. Skin color, proximity to the equator, cloud cover, all can alter the absorption. Too much sun, as we know, can cause skin damage and possibly cancer. So if you are susceptible or concerned, check with your physician. Some experts suggest five to 30 minutes of sun exposure twice weekly on the arms and face, followed by applying sunscreen to avoid skin damage. Be smart – don’t burn!

Richard Figler, MD, is a primary care sports medicine physician. He is board-certified in family medicine with a Certificate of Added Qualification in Sports Medicine. He is the primary care sports medicine physician for John Carroll University and Solon High School. To make an appointment with Dr. Figler or any of our primary care sports medicine physicians, please call 877.440.TEAM.

Making an ImPACT: Protecting athletes through proper concussion care

By Bob Gray, MS, ATC

Because conventional imaging techniques don’t detect concussions, Cleveland Clinic Sports Health experts use leading-edge computer technology known as Immediate Post-concussion and Cognitive Testing (ImPACT) to make a more precise sports-related concussion diagnosis and help them get back to play safely.

Properly treating concussions is extremely important because the after-effects of these brain injuries can last a lifetime, if not treated promptly and properly.

ImPACT is the first and most widely used concussion evaluation tool and is used by both sports medicine physicians and athletic trainers. Cleveland Clinic Sports Health is one of only nine Credentialed ImPACT Consultants in Ohio.

Ideally, ImPACT testing starts before an athlete steps onto the playing field. We highly recommend baseline testing before the season begins for any collision/contact sports. The test can be repeated 24 to 72 hours after a concussion – along with a thorough medical evaluation – and before the athlete returns to play.

The half-hour test is administered online at home or at school to measure:

  • Any symptoms
  • Verbal and visual memory
  • Attention span
  • Processing speed and reaction time
  • Impulse control
  • Non-verbal problem solving

If the athlete then sustains a concussion, another ImPACT test is administered. Comparing these results with baseline, health care professionals can determine the severity of the concussion and design an appropriate treatment plan, which is shared with the parents, referring physician, athletic trainer and coach. If necessary, the athlete undergoes concussion rehabilitation. ImPACT testing may be repeated later to help in deciding when the athlete can safely return to play.

Although ImPACT is a great tool to monitor the recovery from a concussion, it does not replace the evaluation and treatment from a health care provider.

If you, your school, or youth organizations have questions regarding the implementation of ImPACT, please contact Bob Gray, MS, ATC, Coordinator of Athletic Training Community Affairs for Cleveland Clinic Sports Health, at 216.518.3615 or by email at

Tips for Coaching Youth Sports

By Gerard A. Banez, PhD

Coaching youth sports is enjoyable and rewarding, but can have its ups and downs. The more prepared you are, the better the experience for you, the kids you coach and their parents. Here are some tips to help make your coaching experience a positive one:

Making it Fun

Especially at first, kids sign up for sports to have fun. If it’s not fun, they lose interest and quit playing. As a youth coach, it is important that you keep fun front and center. Putting a priority on fun does not mean ignoring wins and losses. For those of you who are competitive – and all of us are – be aware that the more fun your players have, the more relaxed they are, and the better they play. Making it fun is pivotal.

Improving Skills

Another reason kids play sports is to improve their skills. As a coach, your role in your players’ skill development is critical. Being a good coach does not require a standout playing career. It does, however, require a willingness to learn about your sport and effective coaching strategies. Fortunately, there are countless books, DVDs, websites and courses available to assist in this process.

Wins, Losses & Effort

In youth sports, winning cannot be the be-all and end-all. The outcomes of games are influenced by multiple factors, many of which are beyond your control as a coach. Especially at the entry level, kids on your team will vary considerably in terms of ability level, maturity, motivation and interest. As such, a focus on effort, as opposed to wins and losses, may be most helpful. If your players are having fun and getting better, the outcomes will improve.

Practices = Learning Time

Good practices serve as the foundation for a successful season. Prior to each practice, think about your teaching objectives and make a plan to achieve them. Some combination of skills training and drills/activities to address problems observed in competition works best. As you make a practice plan, know that each session does not need to be different. Continuity between sessions, with gradual introduction of new activities, facilitates mastery as well as interest/engagement. When appropriate, a games-based approach is more enjoyable and generalizes better to competition. Make your instructions and explanations brief, demonstrate as much as possible (or find an adult or child who can), provide lots of constructive feedback and be flexible. Good practices are where kids really start to learn the game.

Games: A Chance to Shine

Game day should be first and foremost about the kids. Their hard work is done at practices, and games provide your players a chance to shine in front of family and friends. On game day, organization is again critical. Think about your lineups (such as who will play where, for how long), and be prepared for the myriad of game situations you may face. On the sideline, your comments should be instructional, praising, and/or reinforcing. There is no research that shows that yelling from the bench makes kids play better. So, for your kids’ sake, be a positive leader for your players and parents.

Positive Parent-Coach Relationships

While it is near impossible to make all of your parents happy, you will be more successful if you keep a few things in mind. First, although their words and actions may suggest otherwise, most parents just want their kids to do well and have a good experience. To establish a good relationship with players’ parents, give clear, specific instructions and expectations and treat your players with respect. Be prepared and organized at all times. Last, make sure you encourage open communication - and set clear guidelines on when and how coach-parent discussions are appropriate (such as if during practices or games are off limits, or if in-person conversations are preferable to phone calls or emails).

Gerard A. Banez, PhD, is a pediatric psychologist at Cleveland Clinic Children’s Hospital, where he serves as Program Director for the Pediatric Pain Rehabilitation Program. He has coached youth soccer in Strongsville, Ohio for more than 10 years.

Q&A: Inserts and Orthotics: Should You Try One?

Wondering whether shoe inserts or orthotics are right for you? Cleveland Clinic Sports Health experts William Murphy, CPed, and Monica Betchker, PT, DPT, ATC, shed some light on some commonly asked questions:

What is the difference between shoe inserts and orthotics?

It is important to distinguish the difference between the two.

Shoe inserts are any device purchased over-the-counter (OTC), available at a drug store or department store without a prescription – and not specifically molded for your feet. Custom orthotics, on the other hand, are individually molded from a weight-bearing foam impression or a nonweight-bearing plaster slipper cast of your feet. They are prescribed and designed by a member of your healthcare team, which includes you and your physician, podiatrist, pedorthist and physical therapist.

There are many types of inserts ranging from heel cups, arch cushions, gel cushions, wedges and arch supports. Custom orthotics may be rigid or semi-rigid and either ¾- to full-length, depending upon your athletic and biomechanical needs.

What are the possible benefits?

Inserts and/or orthotics may help reduce or prevent movement-related injuries. Other benefits might include:

  • Decreasing pain
  • Increasing comfort
  • Changing pressure
  • Improving biomechanics
  • Providing stability
  • Improving balance
  • Decreasing numbness or tingling
  • Improving athletic performance

They work by aligning the skeleton. Your skeleton has a preferred path of movement. So, if inserts or orthotics alter this path (either by counteracting it or supporting it), your muscle activity will be increased or reduced. Based on this concept, ideal inserts or orthotics would feel comfortable, help to optimize muscle activity, and possibly increase performance.

Who would actually benefit from their use?

Both shoe inserts and orthotics have been used over the years to help treat back, hip, knee and foot pain, as well as numbness and/or tingling of the lower extremity associated with many conditions, including Morton’s neuroma, plantar fasciitis, ankle tendonitis, shin splints, iliotibial band syndrome, mechanical low back pain, knee osteoarthritis and trochanteric bursitis.

Many studies have attempted to prove their usefulness and effectiveness of inserts and orthotics. The results are mixed. Some studies have found custom orthotics improved runners’ gait and overall running economy. While more research would be helpful, no study has found inserts or orthotics harmful. Therefore, many athletes seeking relief from pain or improved performance may choose to give them a try. This desire is understandable given no two feet are created alike, and it can often feel impossible to find a shoe that fits comfortably.

If you are living with discomfort due to foot, ankle, leg, hip or back pain, and over-the-counter inserts aren't working, the need for custom shoe insert is more likely. Athletes also may benefit from any improved biomechanics and increased performance that sports orthotics may provide. If you are uncertain of your needs, see a foot and ankle specialist who can refer you to a licensed pedorthist or physical therapist for help.

How do you decide between inserts and custom orthotics?

Your specific activity level is important in choosing the appropriate insert. Athletes, who typically place significantly more impact on their feet, require a specific style – ones typically sturdier and that adhere better to the shoe’s sole to withstand frequent use. Cost consideration often weighs heavily in this decision. Inserts range from about $10 to $50 a pair while custom orthotics run in the hundreds of dollars. Many people may first try over-the-counter inserts, largely due to cost. However, if you are experiencing pain that is not relieved by rest or changes in training methods, it is best to consult your healthcare team for a full biomechanical assessment that addresses your individual concerns and long-term goals.

How should I pick an over-the-counter (OTC) insert?

There are some very good OTC inserts on the market. But always remember that there are different kinds, depending on if you have a low, medium or high arches, as well as what type of shoe you will wear them with. It is best to consult your foot and ankle specialist before selecting an insert.

How do you know if you’re getting the best orthotics?

Don’t be afraid to ask what options are available. The best companies for custom insoles offer a wide-range of possibilities. Some things to consider include: level of physical activity, hours per day spent on your feet, body weight, shoe size, age, any medical issues, shoe type the custom orthotics will be for, and if it is important for the orthotics to be made from breathable performance materials.

Many of these details may seem trivial, but they are critical. For instance, material weight and breathability may be vital to a runner. Outdoor athletes may need waterproof custom shoe inserts.

The human foot is incredibly complex and lifestyles vary. The more you understand the options, the more likely you will get the best orthotics for you and avoid any need for re-examination.

Think an orthotic may be right for you? To schedule an evaluation with a physical therapist who can then give you a prescription to see an orthotist or pedorthist, please call 877.440.TEAM.

Q&A: Ask the Dietitian

Q: What is a CSSD and what can one do for me?

A: First and foremost, a CSSD (which stands for certified specialist in sports dietetics) is a Registered Dietitian who is also a board-certified specialist in sports dietetics. That means a CSSD has special knowledge and skills in sports nutrition. A CSSD will offer safe, evidence-based nutrition therapy to anyone interested in optimizing their health, fitness or athletic abilities.

The most common reason athletes go to see a CSSD is to improve their exercise or sports performance. A CSSD will calculate how many total calories and fluids they need, including how many calories and servings should come from carbohydrates, protein and fat to adequately fuel their sport.

Depending on each athlete’s particular goals, a CSSD will work with them to achieve them. Common goals include:

  • Gaining muscle strength and power
  • Building muscle mass or losing body fat
  • Increasing energy during endurance events

A CSSD also educates athletes on what type and how much food and fluids to eat and drink before, during and after exercise, practices, races or games. For those with food allergies, gastrointestinal issues – or even diabetes, heart disease, osteoporosis and anemia – a CSSD will assess their unique needs and develop a specific meal plan just for them. In fact, a CSSD can create a customized meal plan for anyone.

Or maybe you just need some pointers. Do you have questions about sports drinks, energy enhancing products or dietary supplements? A CSSD can help! Whether you are interested in changing your body composition, can’t seem to finish an endurance training session without bonking, or just need guidance with what to eat and when to eat it, an appointment with a CSSD will help you achieve even the smallest goals.

Katherine Mone, MEd, RD, CSSD, LD is a board-certified specialist in sports dietetics for Cleveland Clinic Sports Health. If you have any questions about what a CSSD can do for you or want to make an appointment, call 877.440.TEAM.

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