2011 06 07 Health Post #3

YOUR GUIDE TO LIVING WELL

HEALTH POST For some people, getting a good night’s sleep is the stuff of dreams

Nap of luxury JOIN THE RAW FOOD REVOLUTION >PAGE 8

BETTER BY A LONG STRETCH >PAGE 10

>PAGE 4

TUESDAY, JUNE 7, 2011

2 NEWS HEALTH BITES

NEW IN THE SHOP ......................................................

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Jeanette Wang jeanette.wang@scmp.com

Jeanette Wang jeanette.wang@scmp.com Great guzzler Take the SteriPEN Journey (left, HK$1,011) on your next hike: it uses UV light to purify water, so you can refill at a tap and drink up safely. The technology destroys more than 99.9 per cent of bacteria, viruses and other illness-causing parasites, and is used by major cities around the world. It takes just 48 seconds to purify 500ml, and lasts for nearly six years if you purify four litres of water every day. And at just 128 grams, it won’t weigh you down. Available from Gadget App; tel: 2861 2101

Cool kicks Eric Koston who? Most of us wouldn’t have a clue about the Thai-American skateboard star, much less about the sport itself. But don’t let that stop you from lacing up some cool skateboard sneakers and flaunting it like you mean it.

The Nike SB Eric Koston (above, price unavailable) features lightweight yet plush Lunar foam cushioning, a suede upper and stitch-free lining for ultimate comfort. www.nike.com.hk

Your baby is what you eat Women who have a high-fat diet during pregnancy may be setting their baby up for diabetes – even if they’re not obese or diabetic.

University of Illinois researchers have found that the typical Western diet (45 per cent fat) modifies genetic expression in the livers of offspring, making the baby more likely to overproduce glucose, which could cause early insulin resistance and diabetes. “We urge pregnant women to eat a balanced low-fat diet that follows government guidelines,” says Pan Yuan-xiang, the university’s nutrition professor.

Petite packer As the war rages on against bisphenol A (BPA) – the compound used in the production of plastics that could affect a child’s brain, behaviour and sexual development – have peace of mind by ensuring your kid chows down safely. The Yubo Deluxe Lunchbox (right, HK$375) is BPA-free, dishwasher safe and contains a food-safe, anti-microbial agent that inhibits bacteria growth. It comes with interchangeable face plates, three snack containers and an ice pack. www.hocusadabra.com

Hog stuff It’s not easy being a carnivore these days, with the reports of meat tainted with drugresistant bacteria caused by feeding livestock antibiotics. But it’s heartening to know there are safe restaurants like Linguini Fini in Hong Kong. Set to open at the end of the month in Central, the Italian joint will showcase pork and home-made pasta, whipped up with TLC under direction of executive chef Vinny Lauria, formerly of Mario Batali’s Babbo in New York City. The pigs used hail from Bath, England, and are raised in Hong Kong sans hormones or antibiotics. www.linguinifini.com

Pull the plugs The idea behind the Ysnore Nasal Spray (right, HK$280 for 10ml) is that if your nasal airway is clear, you won’t have to breathe through your mouth while you sleep, and hence you won’t snore. Ysnore’s patented formula of yam and antiinflammatory ginger root extracts claim to give temporary relief by increasing air flow through the nasal valves – and reportedly worked on the world’s loudest snorer, Mel Switzer. www.ysnore.com.hk

APP OF THE WEEK

Facts and recipes nudge you to add ‘superfoods’ to your diet ......................................................

Katie McGregor healthpost@scmp.com Superfood HD – US$0.99 Rating 7/10 If you need a nudge to include more fruit and vegetables in your diet, this app is it. By arming you with the knowledge of the amazing benefits of “superfoods”, it can help motivate you to improve your eating habits, which in turn will boost your health.

Superfoods, say the app’s developer, Silver Beech Studios, are rich in phytochemicals – nutrients that have properties that enhance health and fight disease.

More than 40 plants or plant groups with exceptional nutritional content, such as arugula, bee products and figs, form the basis of this app.

Each food’s health benefits and nutrition facts are provided, as well as several recipes.

For example, you will learn that

Having trouble concentrating? Most Hongkongers do, according to a recent online survey of 500 people aged 15 to 54 commissioned by GlaxoSmithKline. Some 30 per cent of respondents experienced daily mental slumps – defined in the survey as having poor concentration, alertness and memory – and another 40 per cent experienced them two to three times a week. Nearly half sought coffee or tea as a solution, while others had a snack, sugary food and/or carbonated drinks. But what the body really needs is glucose, says Spencer Tong, a registered dietitian. Although the brain takes up only 2 per cent of body mass, it consumes 20 to 30 per cent of the body’s energy intake.

papaya, with its enzyme papain, is beneficial for the digestive tract, promotes good cardiovascular heath and provides protection against colon cancer.

Hit “More” and the app will break the benefits down by body part, as well as detailing the advantages of the minerals and vitamins found in the food. You will also find a few recipes like “Papaya Catcha Wave”, a papaya, banana and spinach smoothie.

The app is a database, so you shouldn’t expect any great functions, and it’s a pity that the recipes can’t be printed or e-mailed and there is no search function.

It is also North America-centric, so some of the foods mentioned, such as nettle and mesquite, may be hard to find in Hong Kong.

However, the app is interesting, concise and nicely laid out, and it will inspire you to eat more superfoods and put you on the road to better health.

Happy employees They can be yours if you give them greater variety and independence in their jobs, according to a British study based on government data on more than 22,450 employees. Such “enriched jobs result in less stress and more satisfaction”, says lead researcher Stephen Wood, professor of management at the University of Leicester. Sharing company information and consulting employees also help. “This research shows there are ways of treating people at work that can make them happier, which have little to do with money,” Wood says.

Sex and the City’s saving grace Carrie Bradshaw and gang have had some success at getting both men and women to talk about sexual health with their partners. A study by Ohio State University found that college students were more than twice as likely to do so after watching a Sex and the City episode featuring characters Samantha and Miranda having similar conversations, compared to those who saw different episodes. “When participants saw the characters demonstrate the confidence and ability to successfully navigate these tricky conversations, it gave them a social script to follow in their own lives,” says study author Emily Moyer-Gusé. > CONTACT US Culture Editor: Janelle Carrigan janelle.carrigan@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; advertising@scmp.com

The Superfood HD app is packed with nutritional information about and recipes for foods that are rich in phytochemicals

This issue’s Health Post advisory panel contributors: Dr Michael Cheng (family medicine) and Dr Carmen Lo (dietitian)

MEDICAL 3 CASE HISTORY A PAIN IN THE NECK

Swelling hints at deeper malaise ......................................................

When 40-year-old John Tang (an assumed name, for reasons of patient confidentiality) first came down with a fever, sore throat and enlarged lymph nodes on both sides of his neck – classic symptoms of an upper respiratory tract infection – his doctor prescribed antibiotics and sent Tang home to rest.

But Tang’s fever persisted even after he popped the last pill. The swelling in his lymph nodes, which are bean-shaped collections of infection-fighting cells found throughout the body, didn’t subside.

Tang’s doctor then performed a standard investigative procedure for enlarged lymph nodes called fine needle aspiration. A slender needle was inserted into the enlarged lymph node to extract cellular material. This was used to determine whether a more insidious cause, such as tuberculosis or cancer, lay beneath. But Tang’s test drew a blank.

For three weeks, his lymph nodes continued to enlarge while he faded in and out of fevers. Finally, doctors removed one of the lymph nodes for further tissue tests – known as a biopsy – and found lymphoma. This is a cancer of the lymphatic cells of the immune system.

In lymphoma, the lymphocytes – the white blood cells – become abnormal (cancerous). Instead of protecting him, part of Tang’s immune system was now threatening to kill him. He was referred to Dr Raymond Liang, director of the Comprehensive Oncology Centre at the Hong Kong Sanatorium and Hospital.

The next challenge was to narrow down the type and extent of Tang’s lymphoma to ensure an accurate prognosis and treatment plan. This was done through special tests, such as the monoclonal antibody test, which detects specific antigens (substances which trigger the production of antibodies).

PET – or positron emission tomography – scans were used to determine the affected lymph nodes more clearly, and a bone marrow biopsy was carried out to determine whether the cancer had affected

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

Tang’s bone marrow.

Liang found that Tang had diffused large B-cell lymphoma, a common type of lymphoma that accounts for about two in five of all cases. With the lymph nodes in his neck, armpits and abdomen all affected, he was classified as having stage-three lymphoma, in which the cancer had spread to both sides of his diaphragm.

The causes of lymphoma are unknown in more than 90 per cent

Overall, lymphoma is a curable disease if patients are given the correct form of treatment DR RAYMOND LIANG

ASK THE DOCTORS DR MICHAEL CHENG Q: My kids have somehow caught head lice in school. How can I treat it and prevent them getting lice again?

A: Head lice live exclusively on the scalp and lay eggs (nits) on the hair shaft. The condition can be treated with a special medicated shampoo. After using the shampoo, you need to use a fine comb to remove the dead lice from the scalp and nits from the hair.

Sometimes you may need to repeat the treatment one week later. A more drastic treatment is to shave off all the hair, though this is usually not done now.

Head lice are passed by close bodily

contact, so they are usually passed from one child to another when they play together. Lice may live for several days in bedding, but routine laundering will usually kill them.

The only way you can actually prevent your children getting lice again is to prevent contact with other kids.

Treat each case promptly, and if other family members are at risk, they should also be treated. Lice can only survive a few days away from the human body.

Dr Michael Cheng is a specialist in family medicine and a member of the SCMP Health Post advisory panel.

of cases. The survival rate for this type of cancer is fairly good for sufferers under age 60 if they get the right treatment, Liang says.

In stage one, where the cancer is found in only one region, there’s an 80 per cent chance of survival. In stage two, where two regions or more on the same side of the diaphragm are affected, it drops to 60 to 70 per cent. When the cancer has penetrated the bone marrow and spread outside of the lymphatic system, the patient is in the fourth and final stage. Even so, the rate of survival is as high as 40 per cent.

Tang, at stage three, had a 50 per cent chance of beating the cancer.

The caveat: he had to be able to withstand the aggressive treatment, which involved chemotherapy and complementary radiotherapy.

Surgery is not a good treatment option, Liang says, because lymphoma tends to be widespread.

A bone marrow transplant is usually the last resort for patients who have relapsed or are at high risk of doing so. Fortunately, Tang had age and a relatively early detection on his side.

After six months of treatment, he is now in remission.

Liang notes that Tang’s case

highlights the importance of doing a biopsy early if lymphoma is suspected. This is because the small sample size obtained through fine needle aspiration cannot accurately reveal lymphoma.

Often, the giveaway for lymphoma is the persistent presence of enlarged and painless lymph nodes. If it is just a regular infection, the lymph nodes typically enlarge with white blood cells, but they usually feel tender and the swelling subsides when the infection is cured. Another telltale sign is enlarged nodes – commonly found in the neck, armpits, abdomen and groin – in more than one region.

Two underlying conditions may be complicated by chemotherapy, Liang says, as the treatment suppresses the immune system.

Hepatitis B-positive patients run the risk of activating the dormant infection, which can result in fatal liver failure. HIV-positive patients, who are more likely to develop lymphoma in the first place, may be more prone to infections after chemotherapy treatment.

But overall, given the right treatment, lymphoma is a curable disease, Liang says.

4 COVER STORY

Rest is history Insomnia is a common urban problem. It can even affect your sex drive, says Richard Lord

D

epression, irritability, temper tantrums, high blood pressure, obesity and sexual dysfunction.

With a list of effects like that, it is no wonder that sleep deprivation is one of the favourite weapons in the torturer’s arsenal.

Just last week, a study published in the Journal of the American Medical Association revealed yet another health problem caused by skipping slumber – it messes up the mojo of healthy young men.

Those who got less than five hours of shut-eye a night for one week had significantly lower levels of testosterone than when they had a full night’s sleep.

Researchers at the University of Chicago Medical Centre found that the reduced testosterone was similar to the effects of ageing 10 to 15 years. Lack of sleep also leads to reduced strength, muscle mass, bone

density, well-being and vigour.

Sleep deprivation is a form of torture that millions of Hong Kong men and women willingly inflict on themselves every night.

Many people suffer from the nightmare of insomnia – they want to sleep but simply cannot. But many others give up slumber voluntarily.

The problem is particularly bad

The whole world is living in a sleepdeprived era.

This will become a major public health issue in the future PROFESSOR WING YUN-KWOK

in this city, with its lifestyle of long working hours and late nights, cramped living conditions and excessive noise and light.

A recent Chinese University study of children aged between five and 15 found that children in the city average only nine hours of sleep a night.

That is an hour less than they should be getting.

The study also found that sleepdeprived children were three times more likely to become overweight, because sleeplessness triggers a series of hormonal changes that affect appetite.

Professor Wing Yun-kwok of the university’s department of psychiatry, who co-authored the report, says studies show modern urbanites get one to two hours less sleep than their counterparts 50 years ago. That is under seven hours a night on average, and less than the eight they need.

“The whole world is living in a sleep-deprived era,” he says, and with children also affected “this will become a major public health issue in the future”.

Sleep is undoubtedly important.

But the reason is still not fully understood. Clearly, a good night’s rest is necessary for the brain to feel refreshed and alert.

But recent research has shown other ways in which shut-eye is fundamental to our well-being.

A study by Duke University Medical Centre in the US, published in The Journal of Neuroscience, found that sleepdeprived gamblers are more likely to take risks.

They focus on potential positive outcomes and discount negative ones. In other words, lack of sleep can affect decision making. It alters a person’s evaluative framework without him or her even knowing.

A study published in the same

journal, from the University of Lübeck in Germany, discovered that sleep helps people to store useful memories.

During slumber, the brain processes memories, sifting through the day’s events and keeping the important, relevant ones for future use. It is a selective process.

Professor Gilles Einstein, an expert in memory at Furman University in the US, says these findings help explain why you are more likely to remember a conversation about impending road construction than chit-chat about yesterday’s weather. So if you cannot recall that road detour or new dance step, you likely need more snooze time.

Other recent studies have found that the brain only connects new memories to existing knowledge during sleep. If that did not happen, learning new stuff would be

COVER STORY 5 pointless. Sleep also helps the brain to reorder and change memories in a way that appears to be central to thinking creatively.

Jessica Payne, co-author of a study from the University of Notre Dame in the US, says: “In our fastpaced society, one of the first things to go is our sleep. I think that’s based on a profound misunderstanding that the sleeping brain isn’t doing anything.”

It is a misunderstanding that is common in Hong Kong.

“We’ve got a lot of distractions in Hong Kong: a lot of work, entertainment, gadgets and also the environment. Sound and light around living areas is a big issue,” says Dr Amos Lo, an ear, nose and throat specialist at Matilda International Hospital.

Anyone who has lived near a road or close to one of the city’s ubiquitous outbreaks of pneumatic drilling – and, let’s face it, that is everyone – can attest to the sleepsapping powers of noise.

Meanwhile, Hong Kong’s artificial starburst of nighttime illumination is hardly ideal when it comes to getting a good night’s kip.

Light affects the body’s circadian rhythms, and lots of light is a signal to stay awake.

There are also cultural and lifestyle factors at play.

“A lot of people in Hong Kong adopt a style of living where they stay up late, watch TV, play games and use computers,” says Dr Simon Ip Kar-shun, resident consultant in respiratory medicine at Baptist Hospital. “They finish work late, eat

late, sleep late. This makes them prone to sleep deprivation.”

It’s not only duration that matters. Lack of quality sleep can cause excessive daytime fatigue.

The sleeping body goes through a series of cycles, but it takes a while to get to the deepest, most important ones.

In sleep apnea, a common disorder, the sleeping muscles relax, and airways become obstructed and can close. The brain responds by shifting from deep to shallow sleep, and is not properly refreshed.

Still, Ip says he has patients with apnea who simply don’t want to sleep.

“So they have themselves to blame to an extent. A very common complaint is that their boss isn’t happy because they keep falling asleep during meetings,” he says.

“Some patients get depressed as a result, others get temper tantrums, and some even have problems with their sex life.

“Among the most severe cases, there’s a greater chance of developing high blood pressure and cardiovascular problems.”

Forgoing sleep for work – or play – is usually counterproductive, because tiredness can dramatically affect performance.

“Take kids who are under stress.

They want to study more, so they sleep less. But they fall asleep in class, then suffer even more stress, and it all gets worse,” Wing says.

“It’s the same in adults – they lose productivity.”

To get a good night’s sleep, it is important to ensure that all the

DOS AND DON’TS FOR THE PERFECT NIGHT’S SLEEP Do: • Go to bed and get up at the same time every day.

• Stick to a pre-bedtime routine.

• Exercise – but early in the day.

• Eat at least three hours before bedtime.

• Sleep on your side.

Don’t: • Watch TV, use a computer or other electronic device close to bedtime.

• Take phones or other electronic devices into the bedroom.

• Drink caffeinated drinks in the evening.

• Exercise close to bedtime.

• Go to bed hungry.

• Drink a lot of alcohol.

• Take daytime naps.

Sleep-deprived Hongkongers young and old end up taking catnaps in MTR stations and at their desks.

Constant construction and light pollution are no help to those who need sleep. Photos: David Wong, Dickson Lee, Oliver Tsang, Sam Tsang

conditions are right – a process known as sleep hygiene.

Some of this is pretty obvious stuff. Caffeinated drinks in the evening are a bad idea owing to their stimulant effect, while alcohol’s relaxant properties can also be an issue for people with conditions such as sleep apnea.

With food, the issue is timing. Go to bed hungry and it will keep you awake. But eat too soon before retiring and reflux could hamper your chances of nodding off. Lo recommends a three-hour gap.

Exercise is tiring, so clearly it is going to help you sleep. But again, it is a question of when.

“Moderate exercise is good, but the timing is important,” Wing says.

“Your core temperature drops when you sleep, so if you have too much exercise before you try to sleep, you’ll be too hot.”

But experts differ about how long before bedtime people should abstain from exercise. Wing favours two hours, but Lo thinks six – and advises against post-work runs and gym sessions. Imposing a regime of self-discipline at bedtime also pays dividends.

“People should go to bed at the same time and get up at the same time. That way, their body follows the same routine,” Lo says. “If you don’t do this, there will be chaos in your biological clock.”

Wing’s recent study found that childhood habits are linked with sleep deprivation.

“We need to look at school start time policy,” he says. “A lot of kids start at 7am, which means

they’re getting up at 5.30am. But they’re not going to bed until after 10pm.”

He suggests starting an hour later. That way pupils would be able to get enough sleep.

Lo thinks that children should be given less homework and encouraged to stop communicating with friends late at night.

Young or old, lack of sleep often means daytime drowsiness and its near-inevitable outcome: napping.

For people who can usually get to sleep without problems, a quick daytime nap to catch up after a bad night or two’s sleep – say, for 20 or 30 minutes – is fine. But anyone with ongoing insomnia should avoid napping altogether and focus on sleeping at night.

“Creating a good environment is very important for sleep. Use curtains that block out light,” Lo says. “Obviously, if you live close to a road, always close the doors and the windows. And don’t put your iWhatever next to the bed – you’ll only play with it.”

The need for sleep is not something that should be treated lightly, Wing says. “The most important thing is that people have to recognise that adequate sleep is central and important, and not see sleep as an indulgence.

“To tolerate sleep deprivation is sometimes seen as an honour, especially in some professions.”

Ironically, some of the worst offenders, he says, are people who work in the medical sector. healthpost@scmp.com

FAMOUS INSOMNIACS History is littered with the stories of famous people who have had strained diplomatic relations with the Land of Nod – some who have rubbed along just fine with inadequate rest, and others who have paid the price.

Napoleon conquered Europe on four hours a night, and former British prime minister Margaret Thatcher had about the same, famously declaring that “sleep is for wimps”.

Opinions differ – but possibly not too much – on whether this had an effect on the mental stability of either of them.

Charles Dickens got inspiration for stories while killing time wandering the nighttime streets of London.

Groucho Marx passed his numerous sleepless hours ringing up strangers and insulting them.

Marilyn Monroe died of an overdose of the sleeping pills she took to combat chronic sleeplessness.

And the hapless Vincent van Gogh anaesthetised himself – poisoning himself at the same time – by applying camphor to his pillow.

6 HEALTH TRADITIONAL CHINESE MEDICINE

Weigh up the risk of what you take ......................................................

Jeanette Wang jeanette.wang@scmp.com In March, a 21-year-old woman stumbled into the accident and emergency department of a hospital in Sham Shui Po. She was sweating and her hands and knees trembled.

Doctors found that she was not suffering from a disease. Rather, she had taken 20 to 30 capsules of a Chinese medicine for slimming over a period of about two weeks. She was admitted to hospital.

The Chinese medicine she had taken was found to contain a Western drug called sibutramine, an appetite suppressant banned for raising cardiovascular risk.

The woman returned to a stable condition and was soon discharged, with the memory of this experience hopefully serving as a reminder to be more careful about the Chinese medicine she buys in the future.

She was one of four cases of patients in the first 100 days of this year who felt unwell after consuming Chinese medicines.

All had taken products bought outside Hong Kong and not registered here.

To protect public health and ensure the integrity of the Chinese medicine you may be taking, the government put into force on

December 3 a law that requires all proprietary Chinese medicines to be registered before being imported, manufactured or sold here.

Only products that meet requirements for safety, quality and efficacy set by the Chinese Medicines Board of the Chinese Medicine Council can be registered.

This means passing tests for heavy metals and toxicity, pesticide residue and microbial limits; quality checks on ingredients, shelf life and manufacturing method; and, possibly, clinical trials to prove their effectiveness for treating certain conditions.

The reality is that only a few products have managed to meet all the requirements. By March 31, just 26 out of 16,800 products for which registration applications had been made had been granted full registration and issued a certificate with a registration number starting with HKC. A further 55 per cent (9,160 products) were given transitional registration (numbers starting with HKP), which means they met essential safety requirements but further assessment is needed before a full licence is granted.

From December 1 this year, all Chinese medicine products will need to carry labels that specify, among other things, their

ingredients, country of origin, registration number and expiry date.

A detailed package insert that states dosage, methods of use, functions, precautions and side effects will also be obligatory.

It is an offence to sell, import or possess unregistered products in Hong Kong. From December 1, any person found selling products without the required label and package insert information can be fined up to HK$100,000 and jailed for two years.

To be on the safe side, go to www.cmchk.org.hk/pcm/eng/ idx_dis.hm for a list of registered products. Note also: • Natural products may not always be safe.

• Even proprietary Chinese medicine may interact with other medicines. Inform your health care provider about the medicines you have taken or are taking.

• Keep all medicines out of the reach of children.

• Study the label and instruction insert of the product carefully.

• Don’t buy medicines from dubious sources.

• Seek medical advice promptly if you have an adverse reaction or symptoms persist using a product.

Information supplied by the Department of Health

FROM THE EXPERTS

Nutritionists versus dietitians: there’s a healthy difference between them ......................................................

Eileen Aung-Thwin healthpost@scmp.com With growing public awareness of the importance of good nutrition, many of us choose to seek professional advice on how to improve our diets. But should you go to a dietitian or a nutritionist?

Most people assume they are one and the same. To confuse matters, in Hong Kong, the term dietitian translates as yin yeung see in Cantonese, while nutritionist is yin yeung hok kah. Because yin yeung hok kah is not well understood by the public, many nutritionists call themselves yin yeung see, or dietitians, says Terry Ting Ho-yan, president-elect of the Hong Kong Nutrition Association (HKNA).

The definitions and educational backgrounds of dietitians and nutritionists initially appear to be indistinguishable. According to proficiency standards published by the Singapore Nutritionist and Dietetics Association (SNDA), both nutritionists and dietitians are degree holders in nutrition, and both rely on the science of nutrition to promote health and prevent nutrition-related problems. Both may assume wide-ranging roles in health promotion, food service management, research,

administration and consulting. But a key difference in the standards is that a nutritionist’s expertise is confined to the concerns of healthy people, while a dietitian may advise both the healthy and the sick.

The HKNA’s scope of practices is more explicit: nutritionists may not engage in individual dietary

counselling, group therapy or medical nutrition therapy. But dietitians may advise individuals and groups on nutrition-related matters, and they may modify diets of patients in hospital to treat diseases and health concerns such as obesity.

Why the difference? It’s all down

to postgraduate training. Although dietitians and nutritionists both begin their careers with a university degree in dietetics, food and nutrition, or a related area, dietitians undergo practical training via a clinical placement or dietetic internship after graduation.

Dietitians are highly regulated and must pass an exam to hold a licence as a registered dietitian.

In Hong Kong, dietitians must have a postgraduate diploma (or MSc) in human nutrition and dietetics from the Hong Kong University SPACE Institute or an equivalent qualification from the US, Britain, Canada or Australia.

But nutritionists are not regulated. The title is not legally protected in most countries – Hong Kong included – so anyone can claim to be a nutritionist. Dietitian Dr Carmen Lo says some practitioners in Hong Kong call themselves nutritionists having only a certificate in nutrition studies.

Trained nutritionists are likely to be working as academics, researchers and in commercial settings, Ting says, whereas dietitians often work in a medical setting. They counsel patients in the right food choices for their condition and help draw up suitable meal plans. They may also oversee the nutritional needs of hospital

patients who are unable to eat normally or have to rely on intravenous feedings.

Dietitians are also involved in the diagnoses and dietary treatment of many diseases, Lo says, including diabetes and cancer. They consult with doctors to provide patients with complete care. For instance, after following a dietitian-designed meal plan for three months, someone with diabetes or a fatty liver may show improvement and doctors may then adjust the medication.

Despite the HKNA’s recommended scope of practices, many nutritionists in Hong Kong are engaged in health, beauty and slimming businesses to provide dietary consultations to individuals and groups.

Overweight people, Ting says, should consult a dietitian for managed weight loss, as obesity often brings with it other health complications that a dietitian would be qualified to deal with.

Nutritionists do not undergo clinical training and, therefore, should not engage in diagnosing or treating any disease. So when it comes to choosing a professional to advise you on health and nutrition, be sure to seek a dietitian’s care if you have medical concerns. If you visit a nutritionist, always ensure he or she is qualified.

HEALTH 7

Keith Robertson (with ball) at the Grand Championship semi-finals puts an enormous strain on his knees as he charges down the field at the Hong Kong Football Club. Photo: Felix Wong

OSTEOARTHRITIS

When it comes to the crunch ......................................................

Elizabeth Snouffer healthpost@scmp.com Keith Robertson, fly-half for the Hong Kong Rugby Football Union, has a swollen right knee that is full of fluid. “Can you see it?” he asks, poking it with his forefinger and making a putty-like indentation appear. “It’s pretty much a mess.”

Before, he used to kneel, sit on his ankles and stretch his quadriceps before a game. Now, he says, doing that is too painful. Past injuries and osteoarthritis, diagnosed in December, are responsible for the 24-year-old’s knee problems. But so far it has not stopped him from playing fast and furiously on the pitch.

Osteoarthritis, also known as degenerative joint disease, is the most prevalent form of arthritis worldwide, affecting more than 135 million people. By comparison, rheumatoid arthritis is the second most common arthritic condition, affecting 20 million.

Osteoarthritis is a progressive disorder of the joints. It is indicated by a gradual wearing down of cartilage. It inflicts severe pain and stiffness in joints, typically in the knee or hip. The pain often hinders everyday functions. There may be a

rubbing, grating or crackling sound when the joint is moved, and the pain is often worse after exercise.

The cause of osteoarthritis is not known, although it is mainly related to ageing. It typically occurs during middle age. But, as Robertson has shown, it can also affect young people. In fact, experts say they are seeing more patients with signs of the disease at a younger age.

Janice Morton – director of physiotherapy at Asia Medical Specialists, an orthopaedic and sports medicine practice – says signs can start to show up in people in their 20s and 30s. “Osteoarthritis doesn’t favour any age and can be present in individuals as young as 20 or as old as 80,” Morton says.

Anyone who spends a great deal of time on their feet, works a desk job, plays a high-impact sport or carries heavy machinery is at risk. This is due to factors such as poor posture, inappropriate footwear, inadequate sports training, sports injuries, obesity and genetics.

More than half of all sports injuries involving ligament reconstruction lead to a diagnosis for osteoarthritis.

Many believe that the rising incidence in younger populations is due to better technology and

Osteoarthritis doesn’t favour any age and can be present in individuals as young as 20 or as old as 80 JANICE MORTON, DIRECTOR OF PHYSIOTHERAPY AT ASIA MEDICAL SPECIALISTS

knowledge in the therapeutic category, including wider use of MRI for earlier detection. Others credit an increase in leisure time, and the attraction of contact sports and activities such as downhill skiing.

“Weekend warriors are often a problem because they may not be conditioned for high impact or contact sports,” says Dr Jason Brockwell, medical director of Asia Medical Specialists.

Robertson, the injured fly-half, suffered his first significant injury at the 2006 Doha Asian Games when he was 19. “My studs got caught in the ground and I twisted around, tearing my lateral meniscus,” he says, referring to the cartilage in the outer side of the knee.

The next year, he joined the Hong Kong Rugby Sevens team and suffered a second injury, tearing the meniscus all over again. This time, the injury could not be repaired.

Robertson continued on the pitch with only 30 per cent use of his meniscus, which acts as a shock absorber for the knee.

Since 2005, Robertson has muddled through pain and stiffness with anti-inflammatory medicines, buttressed by intense training and physiotherapy to strengthen muscles surrounding the joint.

But things got even worse last year, when he was hit hard from the side. Dr Daniel K.H. Yip, Robertson’s orthopaedic surgeon, says it “completely devastated” his knee.

“It was a grade-three tear to his medial collateral ligament, which provides stability. That’s important for the game Keith plays,” Yip says.

In December, Yip performed surgery on Robertson’s knee to clean it and assess his ability to continue playing. That’s when he saw the first signs of osteoarthritis.

“It was like a patch of grass missing.

There was a divot where the cartilage had disappeared,” he says.

“We need to fill that patch up, but Keith needs to give us at least six months of his time for that.”

Pain is a sign for treatment “While many people in pain may be in the dark about osteoarthritis, ignoring pain is a big mistake. People should pay attention to symptoms which are easy to detect,” says Janice Morton, director of physiotherapy at Asia Medical Specialists. “Sitting in a cramped class or the cinema, or walking down steep hills and feeling significant pain in a knee joint is often the first sign.”

If a kneecap has been pulled out of its groove, grinding wears down the protective cartilage, causing intense pain. This condition, known as patellofemoral syndrome, is very prevalent in Hong Kong, and is treatable if identified early enough.

The harsh truth is that there is no known cure for osteoarthritis. But there are a variety of treatments that may delay its progression and offer some relief from the pain.

In the early stages of treatment, the patient may be asked to stop high-impact sports, and undertake physiotherapy to strengthen muscles around the joint. This helps preserve what remaining “shockabsorbing” cartilage is left.

Unfortunately, the human body does not regenerate cartilage, but doctors today can encourage scar cartilage or fibrous cartilage in the knee through a procedure called chondroplasty, or micro-fracture surgery, a safe, effective and minimally invasive procedure performed by arthroscopy.

“A micro-fracture will give a return of 90 per cent of Keith’s previous performance, but only if he allows himself the six-month recovery time,” Yip says. It is hard to convince an active patient to do this.

“I’ll probably do it some time soon,” Robertson says, “whatever it takes to stay in the game.” For now, the fly-half can take heart in the fact that he is “years away” from a total joint replacement, according to Yip – and that his passion will tide him through the pain.

RISK FACTORS FOR OSTEOARTHRITIS

Rugby player Keith Robertson receives physiotherapy for osteoarthritis.

Incidence of the disease is increasing in young adults. Photos: K.Y. Cheng

• Flat or over-pronated feet • Weak hip rotators • Engaging in high-impact or contact sport • Sports injuries involving ligament reconstruction • Obesity – it’s especially hard on weight-bearing joints • Poor posture – prevalent in desk jobs • Work involving repetitive motion or heavy machinery • Family history

8 DIET NUTRITION UNCOOKED

Salad days for raw food enthusiasts .....................................................

Katie McGregor healthpost@scmp.com It’s hard enough to stick to a “five-aday” plan, but what if you ate mostly raw fruit and vegetables? For most people, that may sound highly unappealing. But Hong Kong’s raw food enthusiasts are persuasive.

“You have more energy and sleep better, and your body feels more efficient and works differently,” says Kim Baker, founder of Raw Food Groove, an online shop and raw food website.

On the west coast of the United States, where raw food is popular and has celebrity followers such as Demi Moore and Woody Harrelson, restaurants, shops, chefs and raw gourmet food schools abound.

In Hong Kong, resources are far fewer, but that’s changing. There is a flow of knowledge across the Pacific, and raw food chefs and nutritionists here are doing their part with training courses, books and educational websites. It seems like we’ve always had Life Café.

ThreeSixty appeared more recently, and now chains of salad bars are springing up.

Raw doesn’t necessarily mean uncooked. Food is just not cooked above 40 degrees Celsius, and alcohol, refined sugars and caffeine are taboo.

Raw usually means a lot of peeling, chopping and blending. “A high-speed blender can really

change your life,” says Anita Cheung, founder of Integrative Living and i-Detox. “You can blend almost anything in a smoothie, from the usual fruit to fresh greens and even hard nuts. You can add warm water to make it more like a soup.”

But man cannot live on smoothies alone, and fans of raw food have been creative in “cooking” up food that doesn’t look too different from what you might typically have on your plate. Google “raw food recipes” and you will find instructions for ice-cream, desserts and – you may need to invest in a dehydrator for these – burgers, biscuits, breads and crackers.

US-trained raw food chef and instructor Shima Shimizu makes a convincing spaghetti al’arrabbiata using thinly sliced zucchini (see recipe). Daikon, carrots or cucumber are also good spaghetti substitutes, she says.

As for other starches, such as rice, Shimuzu says brown rice can be sprouted by soaking the rice for one to two days before cooking. “It’s not difficult to do, and the result is slightly sweet,” she says.

Raw food comes with a lot of benefits, says Dr Penny Nicolle, a family doctor. It means that you are eating more fruit and vegetables, which are low in fat, calories and salt, and generally high in fibre. In addition, vitamins are not destroyed or lost during cooking.

But she warns that an exclusively raw diet can lead to a loss of vital

You have more energy, you sleep better, and your body feels more efficient and works differently KIM BAKER, RAW FOOD GROOVE

nutrients. “Not all cooked food is bad for you. Some foods are better for you when cooked and some foods have to be cooked to be eaten,” she says.

Tomatoes, for example, have shown to have higher levels of the cancer-fighting antioxidant lycopene when cooked. A study published in the British Journal of Nutrition found that those who

followed a strict raw food diet had normal levels of vitamin A and relatively high levels of betacarotene, but low levels of lycopene.

Traditional raw food lovers talk of plant enzymes – which are destroyed by heat – doing the work of human enzymes. But there is little scientific evidence to support this.

It’s all about moderation and balance. There are many shades of green between a completely raw diet and a “supersize me” diet. A few raw foodies interviewed admitted they didn’t only eat raw, and one ate meat now and then.

Shimizu was originally a pure raw food lover, but soon found that she was getting stressed about keeping to the diet.

She says: “In the end, I realised that the negative effect of the stress was far outweighing the benefits of living a 100 per cent raw diet.”

CULTURALLY COLD In Chinese culture, raw food is considered “cold and damp”, and having too much is believed to be harmful to the dietary system.

“The Chinese market is definitely more resistant to the idea of raw food,” says Anita Cheung, founder of Integrative-Living and i-Detox. “But it’s a bit simplistic to say all raw food is cold and damp. Some foods are regulating or warming, such as nuts, goji berries and other foods that are high in fats and proteins.”

Together with chef Moises “Moy” Mehl, Cheung is working to develop raw food recipes that are palatable to Chinese diners. “We’re still experimenting, but we are optimistic,” she says.

Love carbs but hate the guilt? This spaghetti al’arrabbiata is your answer ......................................................

Shima Shimizu healthpost@scmp.com

Shimizu recommends using fresh organic produce. Photo: Edward Wong

I love this vegetarian dish for a few reasons. Firstly, the tomato sauce tastes so real. Made with fresh organic tomatoes and pure sun-dried tomatoes, its flavour is thick and fresh. Once you try it, I guarantee it’ll be hard to go back to the ones from cans and bottles. Secondly, I love carbs and pasta, and this is a great guilt-free version that I fell in love with after going to raw culinary school in California.

It is very easy to make – you don’t have to cook. For the freshest produce, I get mine from Homegrown Foods, a local organic vegetable delivery service. The pasta is made of thinly sliced zucchini, which makes the dish gluten-free and perfect for those on a low-carb diet. You will be surprised how the raw vegetable changes its texture, becoming pasta-like.

Because everything is uncooked, the full goodness of the vegetables is there for your body to absorb. One of the main benefits of this dish is in the fresh organic tomatoes, a vital antioxidant called lycopene that helps fight against

diseases and combat wrinkles. If you wish to stay young and healthy, this is the way to go.

Raw spaghetti al’arrabbiata Serves 2 Ready in 10 minutes For the sauce 300g cherry tomatoes 35g sun-dried tomatoes 1 clove garlic, ground 3 tbsp extra virgin olive oil 1 tsp salt ½ tsp onion powder ¼ tsp black pepper ¼ tsp red chilli flakes 4 fresh basil leaves For the spaghetti 1 zucchini, peeled and cut into long strips For the garnish 4 cherry tomatoes, halved 4 fresh basil leaves Puree all the sauce ingredients in a food processor. Make the zucchini spaghetti.

Mix the spaghetti and sauce, and top with cherry tomato halves and basil leaves.

Serve immediately. The sauce can be kept in an air-tight container in the fridge for up to one week.

Raw food chef Shima Shimizu is the managing director of Sesame Kitchen (www.sesamekitchen.com) and conducts classes and events in Hong Kong and around the region.

DIET 9 FOOD FOR THOUGHT

......................................................

Kathleen Doheny New research suggests that lowcarbohydrate diets, with regular exercise as part of the plan, don’t appear to harm the arteries, as some experts have feared.

“It’s pretty clear low-carb is effective for weight loss,” says study author Dr Kerry Stewart, director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.

“The concern has been that because you are eating more fat this is going to put stress on your blood vessels.”

So, Stewart and his team evaluated the short-term effects of a low-carb, higher-fat diet after a single meal. The researchers also compared a low-carb diet with a low-fat diet in dieters. In each case, they found no ill effects on blood vessel health.

Stewart presented his findings on Friday at the American College of Sports Medicine meeting in Denver.

However, one nutrition expert says longer-term research is needed before concluding that high fat intake doesn’t hurt blood vessel health.

For the first study, Stewart’s team looked at the effects of eating an extremely high-fat McDonald’s breakfast. The breakfast had more than 900 calories and 50 grams of fat.

“That’s half of what you should eat in a whole day,” Stewart says.

The researchers then evaluated a marker of arterial stiffness and another measure of blood vessel health, known as endothelial function. “Even after eating this one meal, we didn’t find any vascular changes from before to after,” he says.

The arterial stiffness, in fact, improved, he noted, although he is not sure why.

Neither study had industry funding; both were financed by the US National Heart, Lung, and Blood Institute.

For the diet study, Stewart assigned 55 men and women who were overweight or obese to the lowcarb diet or a low-fat diet. They also had abdominal obesity and a large waist circumference (89cm or more for women, 100cm or more for men).

Both are risk factors for heart disease.

The low-carb plan included up to 55 per cent fat at the beginning, and phased down to about 40 per cent. It

had about 15 per cent carbs initially, and then went to 40 per cent.

The other dieters followed the American Heart Association’s low-fat diet, with no more than 30 per cent fat a day.

Both groups had supervised exercise three times a week.

At the meeting, Stewart reported on 46 dieters, 23 from each group, who lost 4.5kg. “In the low-carb group, they reached that loss at 45 days,” he says. The low-fat group needed 70 days to shed the load.

Their calorie intake was similar, whichever diet they were on.

Stewart performed the same blood vessel measures as in the breakfast study. “There were no differences in any of the vascular measures,” he says.

The researchers will continue the study for six months.

While Stewart cautions that these are initial findings, he adds: “We are pretty confident this is a real result.

At the 4.5kg weight-loss mark, we don’t see any harm to the vasculature.”

Stewart says he put on weight a few years ago, went on a low-carb plan while also exercising and dropped 18kg. He has kept if off for four years.

While the study is intriguing, long-term research is crucial, says Connie Diekman, director of nutrition at Washington University in St Louis and past president of the American Dietetic Association.

“When it comes to the impact on blood vessel functioning, as a registered dietitian I would like to see more studies in healthy and unhealthy subjects and longerduration studies before concluding that this high-fat intake does not impact blood vessel health,” she says, although the study does show that exercise is important.

The breakfast study, with its onetime test, does not provide much information about what impact these diets will have in the long term, she adds.

The New York Times

A fry up or fruit for breakfast? Either way, researchers say your arteries are safe. Photos: Antony Dickson, Felix Wong

Photos: May Tse

No damage seen in higher fat intake

THE TASTE TEST SEED AND NUT BARS

No dry, tasteless granola bars; these healthy bites are yummy ......................................................

Jeanette Wang jeanette.wang@scmp.com Kuranda Natural Health Bars, Almond & Cherry HK$58 for four 40g bars, City’super To make something sweet, either load it up with processed sugar or flavour it naturally. This Australianmade bar does the latter, using dried cherries and honey. With its mixture of sunflower, sesame and pumpkin seeds, though, I couldn’t help feeling like a bird while eating it.

Verdict: The result is a pleasantly sweet, protein-packed, gluten-free bar that is satisfying enough (203 calories, 10.7g fat) to replace a meal on the busiest of days.

Kashi Go Lean Crunchy, Chocolate Peanut HK$19 per 50g bar, City’super A little sample nibble turned into big bites, and soon all that was left was the wrapper and a memory of how delicious this bar was. Each bar has 180 calories, 5g fat, 6g of fibre and as much protein (9g) as a chicken thigh, to keep you feeling full for longer. So despite being relatively pricey, this bar really does go a long way.

Verdict: Who knew that something that looked so dry could pack just the right amount of moisture, crunch, chewiness and sweetness?

Nature’s Path Chewy Granola Bars, Pumpkin-N-Spice HK$48 for six 35g bars, City’super It may have been April when I first tasted these, but for a moment my taste buds told my brain that it was Christmas. Organic pumpkin seeds, sweet cinnamon, whole grain oats and flax make for a surprisingly perfect combination that is both moist and moreish. This Nature’s Path best-seller is also an excellent source of heart-healthy omega-3s.

Verdict: At 140 calories and 4g of fat per bar, I figured I could afford to scarf down two at a go. So, I did.

10 FITNESS EXERCISE YOGA FOR THE OFFICE

Flex appeal in the workplace ......................................................

Jeanette Wang jeanette.wang@scmp.com Sitting in front of a computer all day sounds like it should be easy on the body. It’s not exactly manual labour, after all. But it’s the little things we do that lead to pain.

The problems will probably be familiar to many: a strain in the

neck, a spasm that shoots down to the shoulder blades, difficulty turning the head and a numbness or tingling in the arms.

Marla Apt, a Los Angeles-based yoga instructor who is in town this week for the Asia Yoga Conference, says most of these injuries can be attributed to incorrect postural habits. “Our interaction with many of the conveniences of modern life

Side arm pose Stand with your right side facing the wall.

Place your right palm on the wall in line with the shoulder, with the hand turned outward so that the middle finger is parallel to the floor. With the right elbow slightly bent, turn your upper arm out from the shoulder socket. Press the entire hand into the wall.

Drop your right shoulder back and down, away from the ear, and straighten your right arm. If the wrist hurts, try facing fingers upwards.

Return to Tadasana, the basic standing position, and repeat on the other side.

Twist on a chair Sit on the right side of a chair and place your feet flat on the floor, hip-width apart. Turn to the right and place your hands on the top corners of the chair’s back. As you inhale, lift the sides of the torso and roll the shoulders back. Spread the elbows apart and expand the chest. As you exhale, turn your chest to the right. Lift and turn the chest without pushing the lower back forward. Keep weight on both feet equal and both hips even on the chair. Exhale and revolve the chest to the right and turn the head to look over your right shoulder. Exhale and turn to the centre, then repeat on other side.

causes the majority of repetitive strain injuries,” she says.

Spending hours slumped forward in a chair makes the upper back and upper arm muscles lose the tone which helps to hold us upright. The muscles in the chest and the front of the shoulder become disproportionately tight.

As a result, the shoulders are pulled forward and down, the upper

trapezius muscles (between the neck and shoulders) become hard and the head projects forward.

A few minutes of simple yoga stretches interspersed through the work day will help to relieve the pain. Apt, who will conduct a “yoga for the neck and shoulders” session at the conference on Thursday, explains: “Yoga strengthens weak parts and relaxes and stretches

overused areas that are holding tension.”

Below, Janet Lau, an instructor at Pure Yoga studio, demonstrates seven stretches suggested by Apt that you can do in the office or any workplace.

For more details on the conference, which runs from Thursday to Sunday, visit www.asiayogaconference.com.

Cobra pose Lie face down. Place your hands below the shoulders. With your forehead on the floor, lift the shoulders, expand the chest and press your tailbone down. Roll your shoulders back as you lift the head and chest off the floor. Arch the upper back, keeping the tailbone pressed down. Lengthen forward from the lower abdomen towards the top of the sternum. If your chest feels open and your neck feels free, look up .

Clasped fingers pose Interlock fingers snugly. Turn the palms away from your chest and stretch the arms in front of you, parallel to the floor. Keep the arms straight and raise them overhead. Try to take the hands farther back so that the arms come beside the ears.

Without dropping the arms, release the trapezius muscles. Exhale and return to Tadasana.

Repeat with the hands clasped the other way, so that that the opposite index finger rests on the top.

Upward extended arm pose Stand with your back against a wall, with feet hip-width apart. Press your thighs and shoulders against the wall. Raise your arms straight overhead. Reach the hands upwards while releasing your shoulders down and keeping your lower back against the wall. Rotate your arms so that the biceps revolve back towards the wall. Continue reaching upwards with the arms straight as you release the trapezius muscles away from the ears.

Exhale and lower arms back down by your sides into Tadasana.

Half forward bend at wall Stand facing a wall. Place your hands on the wall, shoulder-width apart at chest height. Spread the fingers. Without moving your hands, step back and lower your chest towards the floor until the spine is parallel with the floor. Place the feet directly under hips, legs perpendicular to the floor. Look down.

Rotate the upper arms out until you feel the shoulders spread away from the neck. Push your palms into the wall and spread your shoulder blades. Press the heels into the floor and your thighs back as you expand the rib cage.

Cow face pose – arms only Raise your right arm, bend the elbow and place your hand on your upper back. Bend the left elbow and place the back of the hand between the shoulder blades.

Clasp hands or use a belt. Turn the upper left arm outward and roll the left shoulder back and down, while extending the right elbow. Continue to expand the chest without turning the torso or arching the lower back. Return to Tadasana briefly before repeating on the other side.

FITNESS 11 STEP RIGHT UP: WEEK 3

Wind down on the home stretch

......................................................

Jeanette Wang jeanette.wang@scmp.com It’s tempting to wrap up a workout quickly and head for the showers and food, but spending just a few minutes stretching after exercise can do wonders for your walking.

The debate about what stretching can or can’t do has been going on for years; some experts claim it boosts performance and reduces muscle soreness and injury risk, while others say it makes no difference to the agony you feel after a workout.

But there is no arguing against the fact that regular stretching keeps you flexible, and when you’re suppler, you can perform tasks better, from tying your laces to walking faster, because your joints and muscles can move through their full range of motion.

During exercise, muscles contract and lengthen repeatedly and are put under lots of stress.

Static stretching after a workout, like the following demonstrated below by walking coach Freeman Lee Pingchiu, will help to release tension, maintain muscle length and keep your body flexible.

Hip flexors Found on your upper thighs just below your hip bones, the hip flexors allow you to bend at the waist, lift your knees and move the hip forward when walking or running. If you spend a lot of time sitting, you will likely have tight hip flexors, which can lead to lower back pain.

• Kneel on your left knee, with top of left foot resting on the ground.

• Place your right foot in front of you, with the knee bent at 90 degrees.

• Keep your back straight and abdominal muscles tight; avoid bending at the waist.

• Exhale and shift more body weight onto right leg; you’ll feel a stretch in your left thigh.

• Hold for about 30 seconds then repeat on other leg.

Quadriceps This is a group of four muscles found at the front of the thigh. They allow the knee to straighten and the leg to extend – without which walking would not be possible.

• Stand near a wall or permanent fixture that you can hold on to for balance.

• Grasp your ankle with the opposite hand, flex the knee and gently raise heel to the buttocks until you feel a stretch in the front of the thigh.

• Keep the abdominal muscles tight and the knees close together.

• Hold for about 30 seconds, then repeat on the other leg.

Hamstrings Three separate muscles make up the hamstrings, which are found at the back of the upper leg. They work together with the quadriceps and are vital for walking.

• Stand with the right leg in front of the left, about a metre apart.

• Reach forward and hold on to your right foot, while keeping your right leg straight and left leg bent.

• Shift your weight to the back foot to increase the stretch.

If you spend a lot of time sitting, you will likely have tight hip flexors, which can lead to lower back pain

• Hold for about 30 seconds, then repeat on the other leg.

Calf Located at the back of the lower leg, the calf muscle is responsible for pointing the foot away from the body – or pulling up the heel bone as your foot pushes off the ground while walking. Overuse can cause muscle strain.

• From the same starting pose as the hamstrings stretch, this time bend the front leg and keep the back leg straight.

• Exhale and push the rear heel into the ground to feel the stretch.

• Hold for about 30 seconds, then repeat on other leg.

Lower back Known as the child’s pose, this move also stretches the shoulders and hips.

• Kneel, with your butt resting on the heels, keeping the tops of the feet on the ground.

• Stretch the arms straight out in front, keeping the palms on the ground.

• Relax the neck so the head faces down, hanging towards the ground.

• Spread the knees apart a little if the pose feels uncomfortable, especially on the knees.

• Hold for about 30 seconds.

Abdominals These muscles work in tandem with your back to keep your posture upright while walking.

• Lie face down and lift the upper body by pressing the elbows and palms into the ground. Keep elbows under the shoulders, and shoulders down and relaxed.

• Maintain pressure between the ground and the hips.

• Avoid excessive pressure on the lower back; feel comfortable while doing the stretch.

• Hold for about 30 seconds.

Walking coach Freeman Lee demonstrates stretches (from top to bottom): hip flexors, quadriceps, calf, lower back, abdominals. Photos: May Tse

TAKING IT ONE STEP AT A TIME Week 3 Mon Walk an easy 20 min Tues Core training Wed Power walk 20 min Thurs Core training Fri Walk an easy 20 min Sat Rest Sun Power walk 20 min Training tip Hold your arms comfortably at your sides while walking, aiming for maximum relaxation. Bend them 90 degrees at the elbows, and move them forwards and back at your waist. Bend your fingers into a relaxed grasp, and don’t let your hands sway back and forth across the middle of your torso.

Illustration: Martin Megino

12 WELL-BEING

PERSONAL BEST GROUP EXERCISE

Run with the pack and stay keen ......................................................

Davide Butson-Fiori healthpost@scmp.com Do you find yourself socially active only in front of a computer? Are you alone in a room, munching on junk and watching your body literally fill out the chair? And when you actually feel like exercising, do you get to the gym and leave within 10 minutes, saying you’ll spend more time there tomorrow?

If that’s the case, you may need to get involved with group exercise.

It’s important to find and join others who are interested in getting fit. The encouragement, motivation and structure from working out with a group will help you continue these athletic endeavours.

The accountability and camaraderie make you willing to try and push harder, and knowing that you have friends depending on you and keeping tabs on your fitness will give you a more proactive mindset. Plus, a group setting is always more fun; you feel as if you’re playing rather than just grinding out sweat.

Before Facebook, before Match.com, before the internet, people connected in different ways – and one big way was through athletics. Today, despite Facebook and all the other social networking sites, meeting with others face-toface is still irreplaceable – especially when you need someone to push you when you’re lacking in energy and inspiration.

No cyber contact can replace the live connection and energy we feel while participating in activities with another person. It’s even more compelling when there is a group involved.

Group exercise can evolve in various ways. You might start by just working out with a circle of friends from work or school. Then, as you push yourself harder to try competitive racing and events, you’ll begin to meet people from all over the world with similar interests and goals.

If you really want to go the distance, you can get involved in specific challenges such as marathons, triathlons or specialised events such as the Racing the Planet endurance series, which has a huge following. And what better way to stay on the ball than by meeting likeminded people who share your motivation, competitiveness and endurance?

Once you start exercising with other people and enter that world of athletics, you realise what a connected and small world it really is. No matter what language you speak or where you come from or what your homeland’s customs are, if you start training with other people, all the boundaries fall.

I know this only too well. When I started training for triathlons, I met people who inspired me to become a triathlete. Coaches and athletes such as Dr Phil Maffetone, a worldrenowned fitness expert, and Mike Pigg, a triathlete, gave me the

The encouragement, motivation and structure from working out with a group will help you continue athletic endeavours

strength to train for something I had never thought possible. They not only got me going, but also kept me on track with my quest to become fit, and I was soon competing in triathlons all over the world.

At the same time, I also started meeting competitors from every corner of the earth. The same people I’d meet in San Diego, I’d then meet in Chicago; people I met in Hawaii, I later saw in Japan.

Even before Facebook existed, I had a global network of friends. And when I wasn’t competing, it helped to stay in touch and chat with these new friends to remain focused and excited for the next race. Plus, wherever I ended up going to participate in a triathlon, it was inevitable that I’d run into someone I had connected with before. These personal connections were what encouraged me, and what keeps me enthused to this day.

Being in a group is important.

Take a look at soldiers in war, who know they constantly have someone watching their backs. This psychology encourages them to do what they can to defeat the enemy and survive. Another example would be construction workers, who need to rely on others to make sure all the pieces fit together.

In the same way that these people make up efficient teams, athletes also need this camaraderie to feel like someone’s got their back and that they can indeed make it to that finish line. They don’t want to let their friends or the group down,

so their pain threshold increases and they make bigger gains.

In group exercise, make sure you find a group that isn’t too big. You don’t want to feel anonymous, as if your presence won’t make a difference. At Circuit25, we keep the classes at fewer than 20 participants so that the trainer can give every person individual attention.

If the classes do get bigger, additional trainers are brought in.

This way, no one is left behind; everyone is doing the exercises correctly and can stay energised.

Also, don’t hesitate to reach out to an instructor or someone in the class so that you can feel a bond, which will translate into motivation – for you and the person or people you connect with.

As a result of all these benefits, today’s training has evolved into a group effort. It’s important to pull people away from their television and computer screens, and not let them sink into the lethal activity of sitting. Get them outdoors and working together as a group, to be socially healthy and physically fit.

Plus, it’s a great way for children to get out and meet others, too. If they see their parents doing it, they will want to do the same.

Remember, just as others in the group motivate you, you can also be a motivating force for someone else.

Davide Butson-Fiori is the founder of Circuit25 (www.thecircuit25.com), which specialises in bootcamp/outdoor group personal training.