20120515 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, MAY 15, 2012

Illustration: Tom Jellett

HEALTH POST

High-intensity workout not for the faint-hearted >PAGE 6

Fit to drop

TRAINING THE BRAIN TO THINK POSITIVE >PAGE 8

GET READY FOR GOLF – A NEW SERIES >PAGE 9

2 NEWS APP OF THE WEEK

HEALTH BITES

Weight loss plan lacks body

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Jeanette Wang jeanette.wang@scmp.com

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Katie McGregor healthpost@scmp.com

On the same wavelength To focus on a conversation in a crowded bar, your brain filters out the noise around you. This is known as auditory selective attention, and University of Washington scientists are studying the process’ mechanism as a first step to developing devices that allow users to control things like wheelchairs through thought alone. The researchers had 10 subjects try to focus on just one target sound – a continuous utterance of a single letter – among a total of up to 12 such sounds. The subjects had to determine when an “oddball” item (the letter “R”) was inserted into the target sound stream. The target was successfully identified 70 per cent of the time in the most difficult conditions. “We hope to create a system that presents a user with an auditory ‘menu’ of sounds – similar to the letter streams here – and allows the listener to make a choice by reading their brainwaves to determine which sound they are focusing on,” says researcher Ross Maddox.

Jillian Michaels Slim-Down Solution – Diet, Fitness, Exercise Advice US$1.99 Rating 5/10 Jillian Michaels has been a powerful presence on the United States reality television show The Biggest Loser.

With her mix of tough love and grit, she has successfully driven the black team to win more often than not at the weekly weigh-ins. Now you can buy the app and see if the Michaels’ magic works for you.

At US$1.99 you might consider this a good deal, but after logging in, you’ll realise that to truly get whatever benefit there may be, you’ll need to sign up for a weekly US$3.99 subscription plan. With this, you are promised personalised fitness with exercises and workouts based on your body type, a customised meal plan, membership to JillianMichaels.com, plus other things.

So you sign up and follow the five steps to customise your plan, where you select your fitness level, basic personal statistics and weight goal.

Then you choose which two days you will take off, your metabolic type – I randomly selected “fast oxidiser”, whatever that is – and daily calorie goal from a choice of three bands.

You then have access on your iPhone to a daily fitness and meal plan. The meals are creative but probably not practical for those whose families are not on the same diet or who don’t have the advantage of a private chef.

Similarly, the exercise plan looks good, with individual videos for each exercise, and Michaels does a good job of explaining how to get the most out of a particular routine.

But the videos do not run as a single sequence.

As a subscriber, I also have access to the online community, where many of my reservations about the app are voiced by others. Why is there no meal or exercise tracking function on the app itself? Can I just eat the same food for a whole week for convenience and economy?

Perhaps the answer is that flexibility is not allowed.

I do agree with Michaels’ weightloss philosophy: there is no magic involved; it’s just a sum of calories; you must burn more than you consume. But the app is disappointing. Try any of the free weight-loss communities first.

ASK THE DOCTORS DR LIM LIAN ARN Q: I’m fond of cracking my knuckles and my mum tells me it’ll give me arthritis. Is this true?

A: Cracking knuckles is the practice of forcibly extending or flexing finger joints just beyond their usual range and producing a cracking sound.

People like to do this out of habit and because it gives a sense of relief and release. There are a few theories about how the sound is produced.

One of the more commonly accepted theories is cavitation. As the joint is pulled out of position, bubbles form inside the joint cavity. These quickly collapse and cause the sound.

Despite the commonly held notion that repeated knuckle cracking causes finger arthritis, doctors and researchers have found no such evidence.

However, attention should be turned to more common and proven causes of finger arthritis. These include osteoarthritis and specific types of inflammatory arthritis.

Osteoarthritis is degenerative in nature and seen in people who use their hands and fingers in manual or repetitive work. Common types of inflammatory arthritis include rheumatoid arthritis, gouty arthritis and post-injury arthritis.

Patients with arthritis complain of pain, swelling, deformity and loss of finger motion.

Treatment of finger arthritis depends on the cause and severity of the condition and includes oral medication, physiotherapy and steroid injections.

Sometimes, the damage is too severe for these to work, and surgical options such as fusion or artificial joint replacement are required.

If you think you have hand or finger arthritis and it is affecting your work, daily activities or recreational activities, a visit to your orthopaedic specialist should give you the answers you need.

Dr Lim Lian Arn is an orthopaedic surgeon with Gleneagles Hospital in Singapore

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888.

No stone left unturned Many patients with multiple sclerosis suffer from spasticity, a condition in which the muscles become tight and difficult to control. A new study published in the Canadian Medical Association Journal has found that smoking cannabis may provide relief from muscle tightness and pain to patients who don’t respond well to existing treatment – though there may be adverse effects on mental processes. Researchers from the University of California, San Diego, conducted a randomised, double-blinded controlled trial with 30 participants of an average age of 50. More than half of the participants needed walking aids, and 20 per cent used wheelchairs. Those in the cannabis smoking group had improved control and felt about 50 per cent less pain than the placebo group. But the cannabis group’s cognitive function was negatively affected temporarily, as measured through an addition test. The researchers say larger, long-term studies are needed to confirm their findings.

Beast interests at heart Until now, China had required that cosmetic companies test ingredients and products only on animals. But Chinese officials plan to introduce the country’s very first non-animal test method for cosmetic ingredients by late summer, according to animal rights organisation, People for the Ethical Treatment of Animals (Peta). The test, used widely in the United States and Europe, analyses chemicals for their potential toxicity when they come into contact with sunlight. Avon, Estée Lauder and Mary Kay – which have not tested on animals in decades – had been required to pay for animal testing to market their products in China. Late last year, Peta awarded a grant to scientists at the Institute for In Vitro Sciences (IIVS) in Maryland, US, to travel to China to offer expertise and guidance. “We congratulate [the Chinese officials] for acting swiftly to implement the first of several available non-animal tests,” says Peta vicepresident of laboratory investigations Kathy Guillermo.

The moo the merrier Do you know what goes into your steak? Meat fillers, antibiotics or hormones, perhaps? Dine with greater peace of mind. Secret Ingredient, a local home dining delivery service, has teamed up with

Australian beef company OBE Organic to create a special rib-eye steak dinner for two. Not only will you have the recipe, step by step instructions, and all the ingredients to whip up the scrumptious meal,

but you’ll also eat happily knowing your beef came from healthy cattle that were born and raised in the wild. The special steak dinner will be offered from June 18 to 30 on www.secretingredient.com.hk.

NEWS 3 ENVIRONMENT

Toxic times: studies shed light on the impact of chemical contaminants ......................................................

Kay Judge and Maxine Barish-Wreden We live in a world of toxins. There are the pesticides, hormones, antibiotics, food additives, and genetically modified organisms that lace much of our food supply. There are chemicals we use to clean our homes and clothing, and the environmental pesticides, industrial toxins and other chemicals that plague the earth.

We ingest and are exposed to thousands of chemicals every day, many of which have never been thoroughly tested for their health effects on humans or other species.

Two recent studies on the effects of toxins in our environment shed concern about their impact on human health.

This month, a study was published in the journal Diabetes Care looking at the impact of phthalates on the risk of diabetes.

In this study of more than 1,000 senior citizens in Sweden, researchers found that phthalate metabolites in the bloodstream were associated with a 25 to 35 per cent increased risk of diabetes. Phthalate metabolites may reduce insulin secretion or increase insulin resistance, thus leading to diabetes.

Phthalates, also known as

plasticisers, are industrial chemicals that are added to plastics, cosmetics, and medical devices to help keep them soft and flexible; they are found in hundreds of consumer products from toys and vinyl flooring to nail polish, lipstick and shampoo. They are also in our food and water supply.

Phthalates are part of a group of chemicals known as “endocrine disruptors”, meaning they can disrupt the normal functioning of the hormones in the human body.

The second study, from the University of California, Davis, MIND Institute and Washington State University, looked at the impact of PCBs on autism. PCBs, or polychlorinated biphenyls, are industrial chemicals that were extensively used in insulation materials, engine fluids, paints, plastics and other products.

Their production in the US was stopped in 1977 due to health and environmental concerns, but they remain in the environment for years and are still thought to be a health hazard. They can damage the endocrine, reproductive, nervous and immune systems. They can also cause miscarriage and problems in infants who are exposed to PCBs inutero or from breast milk.

In this new study, scientists found that rat pups born to mothers

QUIZ ......................................................

Jeanette Wang jeanette.wang@scmp.com Are you a Facebook addict?

Researchers from Norway have developed the Bergen Facebook Addiction Scale, a new instrument to measure addiction to the social networking site.

Dr Cecilie Schou Andreassen, a psychologist who heads the University of Bergen’s Facebook addiction research project, found that symptoms of Facebook addiction resemble those of addiction to drugs, alcohol and chemical substances. The results of the research, which involved 423 students (227 women, 196 men) were published recently in the journal Psychological Reports.

It was found that dependency on the social networking site occurs more regularly among younger than older users, and more in women than men. People who are anxious and socially insecure also use the site more than those with lower scores on those traits, probably because the latter find it easier to communicate via social media than face to face, Andreassen says.

People who are organised and more ambitious tend to be less at risk of Facebook addiction.

They will often use social media as an integral part of work and networking.

Those with high scores on the Facebook Addiction Scale tended to have a somewhat delayed sleepwake rhythm.

The researchers are also working with instruments measuring other addictions, such as work. In the

meantime, find out if you’re a Facebook addict here: Answer the following questions by scoring yourself on the following scale: (1) Very rarely, (2) Rarely, (3) Sometimes, (4) Often, (5) Very often.

• You spend a lot of time thinking about Facebook or plan use of Facebook.

• You feel an urge to use Facebook more and more.

• You use Facebook to forget about personal problems.

• You have tried to reduce the amount of time you are on Facebook without success.

• You become restless or troubled if you are prohibited from using Facebook.

• You use Facebook so much that it has had a negative impact on your job/ studies.

Andreassen’s study shows that scoring “often” or “very often” on at least four of the six questions suggest that you may have a Facebook addiction.

Scientists recommend avoiding drinks that have been stored in plastic containers. Photo: Corbis who were exposed to PCBs had significant changes in some brain tissue in those that are genetically at risk for this disorder. As a result, the pups have a greater risk of autism.

So what can one do to reduce exposure to environmental toxins?

Start by eating organic food, especially the most heavily contaminated ones like apples, celery and strawberries. Use safe cleaning products in your home and avoid the use of pesticides.

Shop for cosmetics and lotions

Many chemicals we ingest and are exposed to daily have never been thoroughly tested DRS KAY JUDGE AND MAXINE BARISH-WREDEN

that are free of phthalates and other chemical additives. Store food in glass containers and avoid drinking beverages that have been stored in plastic containers. For more information on other ways to protect yourself and your family, look up the Environmental Working Group at www.ewg.org.

Drs Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine programme in Sacramento, California

4 MEDICAL

CASE HISTORY

Childbirth delivers a low blow ......................................................

The birth of her second child 14 years ago left Judy Wong with an embarrassing problem: urinary incontinence. She would often leak urine, especially in the early days after delivery, but Wong (whose name has been changed for patient confidentiality reasons) quietly accepted the condition as an inevitable and common side effect of child birth. Besides, she was too shy to speak to even her doctor about the problem.

Wong was right that urinary incontinence is not uncommon after childbirth. The pelvic floor muscles, vagina and ligaments help to support the bladder. But the physical stress of pregnancy and trauma of childbirth can sometimes weaken these support structures, and the bladder pushes slightly out of the bottom of the pelvis towards the vagina.

Dr Winnie Lau Nga-ting, a specialist in obstetrics and gynaecology at the Hong Kong Sanatorium and Hospital, says that the bladder and bladder neck normally rest on top of a taut pelvic floor muscle. Childbirth can cause the muscle to lose some of that tension and sag a little.

These changes prevent the muscles that squeeze the urethra shut from working as forcefully and effectively. Called stress incontinence, urine leaks out when sudden and vigorous pressure from coughing, sneezing or other activity is exerted on the bladder.

However, what Wong did not know is that incontinence is treatable. Hence, she spent more than 10 years suffering in silence.

When the leakage was bad, especially when she had a cold that caused her to cough and sneeze, she coped using sanitary pads. When leakage was light, she made do with panty liners. But the condition improved such that she would only suffer urine leaks once or twice a year so she continued to bear with the occasional inconvenience.

When Wong reached menopause two years ago at age 51,

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

she found that the incontinence worsened. According to Lau, the drop in oestrogen after menopause causes changes in the tissue texture of muscles and fibre, and that in turn can aggravate an incontinence problem.

Moreover, Wong had put on weight over the past decade, which prompted her to exercise more.

Unfortunately, the physical exertion also increased the incidence of urine leakage. Frustrated by the leaks, Wong scaled back her jogging and badminton routine.

Wong only found out that incontinence was treatable from her girlfriends, whom she confided in about her problem. One friend had even had surgery to address the condition. Encouraged, Wong approached Lau for help.

Lau first interviewed Wong to find out if she had other types of urinary problems such as frequent night urination or problems passing urine. A physical exam confirmed that Wong leaked urine when she coughed, and a basic urine test ruled out infection.

Childbirth can cause the pelvic floor muscle to lose some of that tension and sag a little

Next, Lau asked Wong to keep a diary of her fluid intake, urine excretion amounts and frequency, as well as leakage incidents to have a better idea of her bladder habits.

The diary showed that Wong had normal fluid intake and excretion, and leaks were limited to about twice a week, usually as a result of coughing or exercise.

All indicators pointed to stress incontinence. Hence, the first line of management was physiotherapy to help Wong strengthen her pelvic floor muscles. Although the pelvic muscle exercises are fairly simple, a physiotherapist was needed to ensure that Wong was doing the exercises correctly and squeezing the right muscles.

Wong was encouraged to exercise her pelvic floor muscles daily. Her condition improved after the first few lessons and stabilised for the next three to four months.

Lau notes that most patients who conscientiously do the exercises see a 40 to 60 per cent improvement.

However, during winter, Wong’s symptoms worsened as reduced

perspiration in the cold resulted in increased urination. Colds and flu are also more common during the season, and the increase in coughing and sneezing aggravated the problem. Furthermore, Wong didn’t do the exercises as frequently.

She did eventually resume the exercise regimen, but the incontinence worsened. More drastic measures were necessary.

Lau suggested surgery. Of the options available, the gold standard and most commonly used procedure for stress incontinence is Tension-Free Vaginal Tape surgery, which cures 85 to 90 per cent of women. TVT involves placing a 1cm wide mesh tape under the urethra to support it and keep it closed.

Whenever the woman strains, coughs or sneezes, the urethra will press on the tape and the resulting kink will prevent urine from leaking out.

The advantage of TVT is that it requires only three 1cm long incisions in the patient’s vagina, lower abdomen and/or thighs near the groin. Needles are used to pass the mesh tape into the body via the tiny incisions. Once in place, the needles are removed. The procedure involves little pain and quick recovery. Over time, the body will encase the mesh tape in fibrous tissue and it becomes a permanent part of the body structure.

Wong agreed to the surgery. It took about 30 minutes and she was discharged in two days. She has remained dry since, and has resumed her exercise routine.

Lau says that while stress incontinence is not a lifethreatening condition, it can have a devastating and debilitating effect on a woman’s self-esteem and quality of life. Some women grow increasingly isolated because they fear leaving the house and may become depressed. Many are also too embarrassed and ashamed to speak to anyone about the problem.

The biggest fallacy is that stress incontinence is an inevitable part of being female or ageing.

As Wong has shown, sufferers can indeed reclaim their quality of life.

HEALTH 5 TECHNOLOGY IN MEDICINE

Read my blips: home health devices ......................................................

Jeanette Wang jeanette.wang@scmp.com High blood pressure, or hypertension, is one of the most important risk factors for cardiovascular disease – the second biggest killer in Hong Kong, accounting for 15.5 per cent of all deaths in 2010.

Self-monitoring is an easy step to keeping the condition under control. Along with regular physician visits, it is recommended by the American Heart Association to help health care providers know whether treatments are working.

While home blood-pressure monitors are nothing new and widely available, a new gadget that exploits the capabilities of Apple devices makes monitoring, tracking and analysing your personal measurements easier and more convenient than ever.

CardioDock, which made its Hong Kong debut at last week’s Hong Kong International Medical Devices and Supplies Fair in Wan Chai, connects with the free VitaDock App on an iPhone, iPad or iPod Touch to measure blood pressure and pulse within seconds.

You can choose between taking one reading or the average of three for better accuracy. After each reading, you can key in additional information and notes concerning your activities or condition. All this is stored in a diary on your Apple device – no need for pen and paper – where you can review and track your data over a week, a month or a longer period in the form of a graph or Excel tables. You can also e-mail the data to yourself or your doctor.

“This allows you to work more efficiently with your doctor,” says Annelie Thomas, managing director of the Asia-Pacific arm of Medisana, the 30-year-old German company behind the CardioDock. “It saves time because you don’t need to go to the doctor so often. It saves costs for both the doctor and patient.”

CardioDock, which has been registered with and approved by European health authorities (hence approved for sale in Hong Kong, says Thomas) and Apple, was first launched in Europe in August. Three other products that also pair with the VitaDock App followed: ThermoDock, GlucoDock and TargetScale.

Response to the products at the three-day Medical Devices and Supplies Fair was overwhelming, says Alan Yeung, director of Market Force Hong Kong, the agent for VitaDock products in the city.

“Those who showed interest include private clinics, the Hospital

You don’t need to go to the doctor so often. It’s cost savings for both the doctor and patient ANNALIE THOMAS, MEDISANA

1.9% Rate by which type-2 diabetes patients can lower a key measure of blood sugar control in a year with mobile software

Authority, the Housing Society, Baptist Hospital and elderly health care facilities,” he says.

The response indicates a growing realisation and acceptance of the valuable contribution mobile phones can make to health care.

Many studies have looked into the efficacy of mobile health, including a recently published Cochrane Systematic Review by researchers from the University of California, San Francisco, who found HIV patients were less likely to miss doses if they were sent mobile phone text message reminders.

Another study, published in the September issue of Diabetes Care, found that type-2 diabetes patients who used mobile health software and blood glucose meters to manage their condition lowered a key measure of blood sugar control by an average of 1.9 per cent over one year.

“Mobile health care solutions can slow the dramatic health care cost increases by allowing chronically ill patients to take their vital signs at home,” says Dr Pablo Mentzinis from Germany’s Bitkom Federal Association for Information Technology, Telecommunications and New Media.

The VitaDock app, which encourages health self-monitoring of up to four user accounts, is the central software for presenting and evaluating vital body and health values. The user interface is intuitive and easy to use.

ThermoDock gives contactless temperature readings using infrared technology: hold it 5cm from the centre of your forehead and get a reading in five seconds. It is about the same thickness and width as the iPhone, about 3cm long and weighs just 20 grams.

GlucoDock measures blood sugar for diabetes management.

Smaller than a matchbox, it uses a proprietary test strip to absorb a drop of blood and produce a blood sugar reading in seconds. You can set your own target values to receive feedback with each measurement; the app also keeps track of your medication and food.

TargetScale supports weight management by analysing body composition – bone mass, body fat, body water, muscle mass and Body Mass Index – via bioelectrical impedance analysis (sending a low, safe electrical current through the body). The scale, which can be used without an Apple device, identifies you when you step on it, and allocates your avatar and memory.

Prices for the VitaDock products start at about HK$800 for the ThermoDock.

CardioDock, which made its Hong Kong debut last week, uses software that connects with various Apple devices

6 COVER STORY

Cross purposes I You never realise how sedentary your lifestyle is until you try a high-intensity workout, Charley Lanyon discovers

finish my last row and stumble to the nearby stool, head between my knees. Am I going to be sick? On the bright side, I have read that if you throw up at a CrossFit gym, they give you a free “Pukey the Clown” T-shirt.

They must give quite a few of those tees away, since high-intensity work and pushing the body to – or even past – its limit is the staple of the CrossFit regimen. The first CrossFit gym was opened in Santa Cruz, California, in 1995, and there are now more than 2,000 affiliated gyms worldwide.

CrossFit Asphodel in Quarry Bay has seen its membership grow steadily to about 100 since it opened early last year. Its clients are mainly professionals and housewives aged between 30 and 45, many with little or no athletic experience, says Asphodel’s coach, Alix James.

Fabio Comana, an exercise physiologist and spokesman for the American Council on Exercise (ACE), says CrossFit has a “cult-like following” among current and former athletes, and those who enjoy competition and tackling an intense challenge. In the US Army, CrossFit is replacing or augmenting traditional physical training methods.

Created by former gymnast Greg Glassman, CrossFit is a strength and

conditioning programme that combines gymnastics, Olympic weightlifting and cardiovascular exercise. The goal is to develop a broad and general fitness level through constantly varied, highintensity, functional movements.

As Glassman says on his website, the workouts are designed to prepare trainees “for any physical contingency – not only for the unknown but for the unknowable, as well”.

In a sense, the regimen is about being a jack of all trades and master of none. The aspects of fitness worked on are: cardiovascular and respiratory endurance, stamina, strength, flexibility, power, speed, co-ordination, agility, balance and accuracy.

The core of CrossFit is the workout of the day, posted daily on crossfit.com. One staple workout, for example, is the “Murph”, named after a US Navy lieutenant who was killed in Afghanistan in 2005. Done against the clock, it includes: a 1.6kilometre run, 100 pull-ups, 200 push-ups, 300 squats, and another 1.6-kilometre run to finish.

Before my session at CrossFit Asphodel, I do some research into the phenomenon. It’s hardly encouraging and leaves me a bit shaken: there are many sceptics decrying the workout as dangerous and irresponsible, and an even larger number of bright-eyed and burly converts showing off their CrossFit tattoos.

Pukey, the unofficial mascot, comes up repeatedly, pictured crawling away from a barbell, vomiting all over himself. He is joined by a more disturbing clown, Uncle Rhabdo, who is portrayed hooked up to a dialysis machine and standing in a pile of his own bloody organs.

Rhabdo is named after rhabdomyolysis, a condition induced when the body is pushed beyond its limit. Skeletal muscle breaks down and enters the bloodstream, where it can cause kidney failure. Glassman has written about the risks of rhabdo and warned participants about the potential problems linked with the unforgiving CrossFit workout.

“You’ll be fine, Charley. I think you might even like it,” says my friend Adam Martin, director of lifetime fitness at a weight-reduction

Alix James supervises Charley Lanyon during his spa in South Carolina, on the phone, although he is aware of my sedentary nature. Martin has been doing CrossFit for three years, up to five days a week, and recommends the workout to everyone.

“You will definitely survive,” says another friend, Sarah Gillio, from Boston. “Pain is temporary; glory is forever.”

They are right. My experience at the gym is challenging but rewarding. Asphodel is a spartan warehouse space furnished with concrete flooring and old-school gym equipment including free weights, hanging rings, pull-up bars and jump ropes. Rowing machines are as fancy as it gets; there are none of the treadmills and ellipticals that you find at other fitness facilities.

The day I visit, the workout consists of shoulder presses with a barbell, followed by three bouts of 500 metres on the rowing machine with the goal of improving your time at each go. I manage to complete the workout and keep my lunch down.

James, who has a degree in sports science, understands my limitations and encourages me to push myself. I feel consistently challenged but supported; exhausted but certainly never in danger.

I think I do rather well with the shoulder presses. James points out that I am lifting the same weight as one of the regulars, a petite and very fit-looking woman next to me. I am elated with what I think is a

COVER STORY 7

s CrossFit workout in Quarry Bay (above); shoulder presses (lower left); trying to complete a 500-metre distance on a rowing ergometer without earning a “Pukey the Clown” T-shirt. Photos: Edward Wong compliment, until he says: “So, obviously you have a lot to work on in terms of strength.”

Members write their times on a board to track their improvement and standing within the group. (You can also post it for the world to see on crossfit.com.) Competition is a big part of the CrossFit experience – not a macho rivalry, but a supportive and fun one. “Everyone is humble,” James says.

In fact, what I really like about CrossFit is the sense of community.

“At other gyms you go with your headphones in and pay little attention to anyone else,” says Martin. “At CrossFit you interact with dozens of individuals who help push you to your max.”

Because of the intensity of the exercises, there are many benefits, says Pete McCall, an exercise physiologist with ACE. CrossFit burns an impressive number of calories in a short time frame. According to Comana, women can burn 13 to 15 kilocalories per minute and men 15 to 18 kilocalories per minute – plus extra bonus calories during recovery following such an intense workout.

That’s about 50 per cent more calories than traditional machinebased weight training.

McCall says it also improves aerobic fitness while promoting the anabolic hormones that are responsible for muscular growth and may have an anti-ageing effect.

“However, the intensity of the exercises which deliver the benefits can also increase the risk of injury if not done correctly,” he says.

Comana disagrees with CrossFit’s concept of universal scalability – where the same exercises are used for everyone regardless of experience, but scaled by load and intensity rather than by programme. “Although CrossFit does offer beginner workouts, pushing someone to complete a 500-metre distance on a rowing ergometer as fast as possible on day one may be a little excessive.”

The biggest weakness of CrossFit seems to be its lack of consistency.

One’s experience depends on the specific gym and individual trainer – and the competence of CrossFit trainers can vary enormously.

CrossFit instructors only have a few days of training before being certified. But good strength coaches usually spend years attaining this level of expertise, says Comana.

“The reality is that many of these [CrossFit] trainers do not possess the appropriate levels of knowledge commensurate with the complexity of many of the exercises performed.”

Before beginning a CrossFit programme, McCall advises to work with a personal trainer to learn how to perform the movements required, and to develop the necessary mobility, stability and movement skills required.

CrossFit Asphodel requires all

It is not a recommended programme for people just starting to exercise or returning after a long hiatus PETE MCCALL, EXERCISE PHYSIOLOGIST

new members to take four one-hour “on ramp” classes that teach basic movements and core philosophy, safety tips and nutritional advice.

According to the CrossFit webpage, the ideal diet is 30 per cent lean and varied protein, 40 per cent predominantly low-glycaemic (complex) carbohydrates, and 30 per cent predominantly monosaturated fats. The basic rule to “base your diet on garden vegetables, especially greens, lean meats, nuts and seeds, little starch, and no sugar” is fairly non-controversial and in line with the opinions of many nutritionists.

The fact that CrossFit encourages practitioners to embrace the “paleo

diet”, or the “caveman diet” – based on the presumed eating habits of early humans – is more divisive.

The idea of the caveman diet is that “evolution has not kept pace with advances in agriculture and food processing resulting in a plague of health problems for modern man”.

The actual CrossFit session lasts about an hour, and includes a dynamic warm-up, strength/ movement practice, the WOD, and a cool down. Each class usually has between six and 15 participants.

Steve Wilson, a locally-based construction firm project manager, started at Asphodel 10 months ago after injuries forced him to retire from high-level rugby. He finds the workouts “tough, competitive and fun”.

But is there a down side?

“Sometimes it’s frustrating when you think you are fit, but then get shown a new CrossFit movement and suck at it and have to work hard just to get competent at it,” he says.

But the great thing is, you won’t be short of people egging you on.

Says Gillio: “Everyone really supports each other, cheers each other on, shares stories and revels in the challenges. We’re all in it together.” charley.lanyon@scmp.com Find out more about CrossFit Asphodel at www.crossfitasphodel.com or phone 3568 7719

8 HEALTH

THERAPY

Mind frames ......................................................

Elaine Yau elaine.yau@scmp.com Mental treatments involving counselling and psychotropic drugs often leave patients with expensive medical bills. In coaching sessions with psychologists, patients have to recall traumatic events that precipitate their neuroses or phobias.

For those who baulk at the bills or the soul-baring chats with psychiatrists, a new type of therapy

might be able to offer some fresh hope.

Cognitive bias modification (CBM), a form of cognitive behavioural therapy (CBT), has generated much buzz recently.

In recent years, researchers have been looking into how CBM helps those with social anxiety and substance abuse problems.

Professor Samuel Ho Mun-yin, from City University’s department of applied social studies, is recruiting people for a large-scale study on how CBM can help people prone to

Professor Samuel Ho and third-year psychology student Lau Shing-on conduct research on bias modification. Photo: Jonathan Wong

post-traumatic stress disorder (PTSD). These include children with chronic or life-threatening illnesses, people with a history of drug abuse or family violence and recovering schizophrenic patients.

“How people see and process trauma has to do with their personalities,” says Ho. “Some focus on the good and develop resilience.

Others fixate on the bad and keep thinking about bad experiences, which leads to PTSD. Our perception is affected by our attentional bias or automatic and unconscious bias.”

Psychologist Colin MacLeod from the University of Western Australia is among the pioneers in CBM therapy. He developed the dotprobe test, where people view a computer screen on which positive (a smiling face), negative (a feral dog) or neutral (furniture) images are flashed briefly, adjacent to each other. After the images disappear, dots appear where one of the images was, and the person has to respond by pushing a button. People with anxiety consistently respond more quickly to dots that appear where the negative image was located.

Similar tests have recently been turned into smartphone apps.

It is assumed that if the viewer’s attention is caught by the negative picture, he is likely to respond faster to the dot that appears in the same place because his attention is already fixed on that area of the screen.

After long sessions, psychologists can assess whether the player is predisposed to suffer social anxiety in a crowd of people, which might be the case if his attention subconsciously turns to a minority of hostile faces and ignores the pleasant faces around him.

Ho says a similar version of this dot-probe test is being developed for local patients, using Chinese words and pictures that have relevance to Hongkongers. “Both pictures and words can be used for the tests. We have compiled a list of 60 Chinese words, with positive, neutral and negative meanings. We are looking for pictures with a local context.”

Ho says the exercise can be also configured to snap people’s eyes away from the part of the screen that shows negative images. “Our brain is

Our brain is adaptable, and repeated exercises over a long period can condition it to break bad habits PROFESSOR SAMUEL HO, CITY UNIVERSITY

adaptable, and repeated exercises over a long period can condition it to break bad habits.”

In similar exercises used by Western psychologists to treat people with anxiety, the dots always flash in locations where neutral or positive images appear.

In a study conducted by the University of Amsterdam published in Psychological Science last year, more than 200 alcoholics who were at least three weeks out of detox were recruited. Half the participants did four 15-minute CBM sessions on four consecutive days. This consisted of deliberately pushing the joystick in reaction to pictures of beer, whisky and so forth (literally and figuratively pushing the temptation away), and pulling the joystick in response to pictures of soft drinks. The control subjects had no training or sham training sessions. Researchers found that a year later, 46 per cent of CBM group had relapsed, compared to 59 per cent of the control group.

Researchers at Tel Aviv University are examining whether there’s a connection between cognitive biases and PTSD in American and Israeli soldiers. Ho’s study on 170 local breast cancer patients, published in PsychoOncology last year, showed that those with attentional bias were more likely to dwell on their traumatic cancer experience and develop PTSD. In spite of all the buzz surrounding CBM, Wong Cheewing, clinical psychologist and chairman of the Chinese Association of Cognitive Behaviour Therapy, has doubts about the whole idea.

“There’s little evidence to show that CBM can treat anxiety,” he says.

“Attentional bias is just one of the myriad factors that can lead to mental disorders. Anxiety is caused by many things, like a patient’s personality traits and upbringing.

The whole CBM concept is based on a simple premise that patients are attracted to sad images while ignoring happy faces. The idea that you can play a phone app for two hours to get your condition treated is immature.”

Wong adds that CBM is yet to be incorporated into standard treatment guidelines, such as those for Britain’s National Institute for Health and Clinical Excellence. CBM is a nascent field without rigorous clinical trials, says Wong, but CBT has a wealth of research and clinical data to support its efficacy.

“Computerised CBT sessions are not games like those CBM apps.

When we use CBT to treat [anxiety] patients, we train them to evaluate the probability of bad things happening. Other techniques are used to help them avoid exaggerating dangers. There is computer-assisted CBT for selflearning. But the role of therapists is not excluded – they have online chats with patients.”

Even MacLeod told The Economist last year that CBM is not quite ready for general use. He said that there should be more large, long-term, randomised clinical trials to show the effects of CBM. Clinical psychologist Michelle Chan Wing-chiu says CBM can go hand in hand with traditional treatments.

“Though CBM development is still in its infancy, research has shown a proven link between bias and anxiety. Computerised practices can train the brain to break bad habits. However, at this stage, we cannot tell how long the effects will last and whether those effects will hold under all circumstances, including stressful situations.”

Ho says ordinary people who are not diagnosed with mental ailments can use it to boost their resilience.

“How we perceive or interpret things has to do with our subconscious thinking, which contains biases we are not aware of.

By zooming in on the biases, CBM has the potential to boost the treatment of mental problems.”

FITNESS 9 GET FIT FOR GOLF WEEK 1

Loosen up and get into the swing ......................................................

Nicole Chabot healthpost@scmp.com Golf isn’t all about what you do on the course; what you do off it counts, too. World No 1 Rory McIlroy, for example, credits much of his success to strength and conditioning in the gym with Steve McGregor, the fitness guru who also works with newly crowned English Premier League champions Manchester City and the New York Knicks.

For the next three weeks, Health Post has teamed up with Hong Kong touring professional James Stewart and his trainer, Ross Eathorne, to help lift your golf game through a series of exercises that work your flexibility, posture and strength.

This week, the focus is on stretching – something former Hong Kong No 1 Stewart says has been paramount to his golfing success.

“I stretch every day to maintain my

flexibility,” says Stewart, executive director of J&J Golf Academy at Discovery Bay Golf Club. “If I don’t stretch prior to playing, I really notice it as my golf swing tightens up, and my rhythm and timing are affected. It’s especially important to stretch after long car rides or flights.”

About 90 per cent of pro golfers do some type of stretching for 10 to 30 minutes before they play, says Stewart. But most amateurs don’t stretch at all, says Eathorne, a golf biomechanics coach with Optimum Performance Studio in Central.

“Like everyone, James has tight muscles that can lead to injury and swing faults especially under pressure,” he says. “For men, flexibility will have the greatest impact on the game, as when men reach 40, their spines start to stiffen.

Women are generally more flexible in their spines.”

Here, Stewart demonstrates a pre-swing stretching routine.

Chest stretch What it works: lengthens the pectoralis minor and opens up stooped posture. Tight chest muscles can contribute to shoulder impingement injuries. A tight right side will restrict backswing and encourage closing the club face at impact.

Method: stand, back against a wall with right arm raised and bent, elbow just above shoulder. Gently turn torso towards the right so that your chest now faces the wall. Hold for 20 seconds and repeat one to three times on each side.

Pro golfer James Stewart works out at the Optimum Performance Studio. Photos: Jonathan Wong

Groin stretch What it works: the inside thigh muscles that often tighten up in response to a weak pelvis and spine.

Those with tight groin muscles will lift their leading heel and lose stability and swing power.

Method: sit with knees bent and soles of feet together. Grasp ankles and gently force knees down using elbows. Keep the spine fairly straight.

Hold for 20 seconds and repeat one to three times.

Levator scapula stretch What it works: the muscle that attaches from the top of the shoulder bone to the top of the neck. It elevates the shoulder blade (scapula) and rotates the neck. A tight left side will restrict shoulder rotation and possibly pull your eyes off the ball and lead to neck ache or tension headache after golf.

Method: stand tall and tuck your chin in. Hold side of head with opposite hand. Gently pull head until you feel a mild stretch on the side of your neck.

Rotate chin down and forwards and feel the mild stretch move to the back of your neck. Hold for 15 seconds and repeat one to three times each side.

Latissimus dorsi stretch What it works: the side trunk muscle that plays a massive role in swing width. It attaches from the pelvis to the arms. A tight left side will shorten swing width, and a tight right side will restrict follow through. Your swing will be choppy and encourage the club face to close on impact.

Method: stand with feet apart, with one hand behind the body and opposite arm stretched upwards. Lean sideways. Hold for 20 seconds and repeat one to three times on each side.

Spinal rotation stretch What it works: stretches the large and small trunk and hip muscles. Restricted spinal rotation will result in excessive internal shift and rotation of the hips during both the backswing and follow through. Coil action will also be limited, and this results in an attempt to accelerate the club with the arms and can lead to golfer’s elbow.

Method: lie with left arm out to the side and left leg bent at a right angle in the air. Place opposite hand on left knee and pull it towards your right side while keeping shoulders on the ground. Aim for the knee to touch the ground. Hold for 30 seconds and repeat one to three times on each side

Deep glute stretch What it works: the deep lateral rotators of the hip, which tighten to compensate for ankle, knee or pelvic instability.

Tight hips will limit rotation and may lead to the spine compensating and, therefore, a back injury. This stretch can reduce casting of the club head and reverse pivots.

Method: sit on floor with legs bent at about 90 degrees, one in front and one behind you. Lean forward while keeping the spine straight. Hold for 20 seconds and repeat one to three times.

10 WELL-BEING EAT SMART

Out of the frying pan, into the fibre ......................................................

Jeanette Wang jeanette.wang@scmp.com Hongkongers love fried rice, and arguably the dish is delicious because the oil-coated grains are full of fat and flavour. But can rice taste good without all the unhealthy stuff?

Yes, according to Ivy Ng, president of the Hong Kong Nutrition Association. Consider this baked brown rice recipe contributed

by Shing Hin Catering Group’s City Top restaurant at City University in Kowloon. “Flavourful baked rice can be prepared with the use of garlic and fresh basil instead of cream and

butter, which add to fat intake,” says Ng. Brown rice and pumpkin also increases dietary fibre in the dish.

Each serving contains an estimated 626 calories, 15 grams of fat, 99 grams of carbs, 30 grams of protein, and 750mg of sodium.

Baked brown rice with pumpkin and seafood Serves 1 800 grams pumpkin 30 grams brown rice 2 tsp olive oil Some minced garlic 5 tbsp fish broth 2 oyster mushrooms

2 prawns, rinsed 2 slices squid, rinsed 2 blue mussels, rinsed 2 small fish fillets, rinsed Some white wine 1 ⁄4 tsp salt 2 tbsp vegetables, diced 6 fresh basil leaves • Preheat the oven to 190 degrees Celsius.

• Rinse pumpkin. Cut off its top and discard the seeds. Bake the pumpkin at 190 degrees for about 15 minutes.

Set aside.

• Rinse and drain brown rice. Add 1 tsp oil,

aromatic. Set aside.

• Heat the last 1 tsp oil.

• Add minced garlic, seafood and white wine.

Cook ingredients until 70 per cent done.

• Add salt, vegetables, fresh basil, mushrooms and rice. Cook for one minute.

• Transfer seafood and rice into the pumpkin. Bake pumpkin for five more minutes and serve. minced garlic and some fish broth in a pot. Cook brown rice until 70 per cent done. Set aside.

• Roast oyster mushrooms until dry and

Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk

WALKING HOME

Forks in the road .................................

Rob Lilwall healthpost@scmp.com Last week, my cameraman Leon McCarron and I entered the legendary karst landscapes of the Li River, near Guilin. We have now walked about 4,000 kilometres, and have fewer than 1,000 to go. It’s the beginning of the end. Over these six months of walking, surviving and slogging, a big part of each day has been finding food. These are the top three meals we’ve had.

Mongolian noodles in a magical ger A week after departing Mongolia, we were walking through the frozen hills of the Gobi. There had been a terrible wind all day. With the sun setting and no settlements in sight, we were dreading another night in our icy tents.

Suddenly, I spotted a dog scampering across the barren landscape. A dog meant humans, and then Leon exclaimed: “A ger!” It was like a magical Christmas scene –

a beautiful round white tent against a hillside, with a small smoke trail gently floating out of its chimney. We hurried over to meet an old man who was just returning home with his goats. He invited us inside, into the glorious warmth of a stove-heated room. The relief to our shaking bodies was incredible, and we burst out smiling as the kind goat herder and his wife offered us a patch of warm floor to sleep on.

While the man used a car battery to power a single light bulb, his wife cooked us Mongolian winter fare – thick noodles (a bit like tagliatelle) with soup and goat meat. It was fatty, tasty and hot – a perfect end to a long day in the Gobi.

Family feast on Lunar New Year’s Eve On January 22 – Lunar New Year’s Eve – we were in the third month of our expedition and walking along a road above the frozen Yellow River.

Darkness arrived, I was cold, and my bruised feet were aching badly, and we were still two hours from Hequ.

When we arrived, it looked like all

Two of the three top meals during a 5,000-kilometre walk: thick noodles with goat meat in soup at a Mongolian ger (above); Lunar New Year feast with a generous host family near Hequ, Shanxi. Photos: Rob Lilwall the adults were inside enjoying a big meal, while the children were outside setting off fireworks.

Suddenly, as we neared the city centre, an SUV pulled up, and a middle-aged man leaned out and invited us back to his house for his family dinner. We marked our exact spot to start walking the next day, jumped in his car, and 10 minutes later were being welcomed into a little house full of smiles. Several women were busy cooking, while several men were sauntering around a well laid-out table.

Soon we all sat down, and the dishes appeared – plates of pickled bean sprouts and cabbage, fried chicken wings, tasty soups, incredible dumplings (with coins hidden in them), and bottles of Canadian ice wine. We ate, drank and toasted the evening away, and when it was time to go, our hosts drove us to the nicest hotel in town, and insisted on paying for us to stay the night there.

Fragrant meat at a truckers’ paradise In March, we approached the Yangtze River on a road that ran around the spurs of an enormous valley. At nightfall we entered a

Over the last six months of walking and slogging, a big part of each day has been finding food horrible truckers’ town full of mud, dodgy looking hotels and big trucks.

We found a place to stay, and went to the restaurant across the road to eat. Our food vocabulary was still fairly limited, so we often ended up eating some variety of fried rice or soupy noodles. But that day, Leon had been listening to a Chinesepod.com lesson about meat strips in “fish-flavoured” sauce, and so he blazed forth with his best tones, and to our delight the cook understood us, and gave us a brilliant bowl of yu xiang rou si.

And the worst meal?

You may have noticed that all of these “top” meals were not cooked by myself or Leon. I am not the world’s greatest cook on the best of

days, and on a walking expedition, it is impossible to carry more than basic ingredients.

The worst meal of the trip was on our final night camping in the Mongolian Gobi. It was my turn to cook. I pulled out our petrol stove, two packs of instant noodles, some water bottles and a tin of beef. I then discovered that all of our water had turned to ice, and our tin of beef was so frozen I could not get my tin opener into it.

After a 40-minute struggle, I filled Leon’s bowl with some warm mush, and we tucked in. Unfortunately, the mixture of burned instant noodles and barely melted dog food-esque meat tasted as bad as it sounds. So we went to bed still hungry that cold night in the Gobi – thankfully without food poisoning.

Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series.

Every week in Health Post, he will write about the progress of his new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. Join his May 30 welcome home party – details at www.walkinghomefrommongolia.com

WELL-BEING 11 THE TASTE TEST INSTANT NOODLES ......................................................

Jeanette Wang healthpost@scmp.com Annie Chun’s Soup Bowl Miso HK$39 for 169 grams, Just Green This allnatural cup noodle uses fresh cooked udon. It comes with a miso paste sachet and a block of dehydrated tofu and spring onions that look like styrofoam. Each bowl contains 240 calories and just one gram of fat – but a whopping 990mg of sodium.

Verdict: palatable on its own, but I added some sweet corn kernels and it was much better. And avoid the tofu; it feels and tastes like sponge.

Thai Kitchen Bangkok Curry Instant Rice Noodle Soup HK$16 for 45 grams, Nature’s Village This gluten-free, steam-cooked noodle is relatively cheaper perhaps because it provides only 170 calories per pack – more of a snack than a meal. The soup is said to be made with a “traditional blend of authentic Thai spices and coconut milk”, but diluting the red powder and red oil sachets in water did not produce anything close.

Verdict: slightly spicy and fragrant.

Watch out for the 780mg of sodium.

Dr McDougall’s Thai Peanut Noodle HK$19 for 53 grams, Just Green Dr John McDougall is said to be one of the founding fathers of natural wellness. He has been studying the effects of nutrition for more than 30 years. And so his version of cup noodles are baked, not fried, and contain 220 calories, 3 grams of fat and 480mg of sodium per serving. It comes with a powder that turns into a creamy peanut sauce when mixed with water.

Verdict: the thin, flat noodles have a good bite, and the sauce is tasty, though far from authentic Thai.

FIT AND FAB

It’s make or break ......................................................

Rachel Jacqueline healthpost@scmp.com Andrew Wong Kee got a black belt in karate at 11 years old. At 13, he became a competitive rugby player, and by 15, he had a New Zealand amateur boxing title under his belt.

Now 34, the Samoan-Chinese believes these early childhood achievements and his “Polynesian warrior spirit” give him the competitive edge in his latest physical challenge: Brazilian jiu-jitsu.

He describes the aim of the sport as “submitting your opponent into defeat by choking them, putting them to sleep or breaking a limb”.

Broken arms, he says, are a common injury, as male bravado often gets in the way of the imminent need for submission.

But despite its brutal nature, Wong Kee explains that BJJ has noble roots as a way of empowering the “little guy to beat the big guy”.

BJJ is a Brazilian twist on the Japanese martial arts of judo and jiu-jitsu. The story goes that a Brazilian student of a martial arts prodigy developed the fighting style during the early 20th century to overcome all other forms of martial arts, no matter the size of the opponent.

However, it was not until the mixed martial arts Ultimate Fighting Championships during the 1990s – in which BJJtrained fighters captured the early titles – that the discipline finally earned respect in the world of martial arts. These days, almost every UFC fighter is trained in the BJJ style to some extent.

Wong Kee recently won the bronze medal in the BJJ World Championships in Abu Dhabi in the 82kg blue belt category.

When he’s not travelling for competitions or training, he’s running JABMMA Studios in Central, training the next

generation of Hong Kong’s corporate fighters.

How is BJJ different from other sports?

BJJ allows you to go 100 per cent every time until you tap out. It’s the ultimate workout requiring strength and endurance. You use and connect with your whole body, rather than doing linear or isolated movements, as you may do in a gym. You build a strong body and an even stronger mind. It also develops strong ties among your brothers in your dojo (training place).

Can anyone do BJJ? It’s definitely not for everyone. Your opponent is literally trying to break your arm. If you’re not strong enough to begin with, both in your body and mind, you will get hurt.

You need to practise, understand the technique and learn. Having said that, anyone can enjoy the benefits of BJJ. It’s a really good way to release some steam.

What made you switch to the sport?

I changed from boxing to preserve my looks and my brain cells. Jokes aside, I am now hooked on the sport.

The irony is that BJJ has given me “cauliflower ears” (swollen ears due to trauma) and I often get grazes over my eyes. But I think that gives me more of a rugged look, so I’m happy with that.

What’s your favourite body part?

My ears (or at least they used to be). I look at them every morning, and they are a reminder of all the hard work that I put into the sport.

Is there anything that most people don’t know about you?

I love to learn. After obtaining my diploma of sport in New Zealand, I went on to become a certified and registered Trigenics practitioner, a method to instantly improve the strength and length of a muscle by manipulating the nervous system.

I am also certified in Poliquin

Andrew Wong Kee believes his warrior spirit from his Samoan side gives him an edge. Photo: Thomas Yau

Your opponent is literally trying to break your arm. If you’re not strong enough to begin with, both in your body and mind, you will get hurt ANDREW WONG KEE

strength and conditioning. I have travelled overseas twice this year for martial arts-specific education and training, including “Training for Warriors” certification and training with a world-leading MMA trainer, Marv Marinovich. I also practise

activated isolated stretching, which I learned after training with its creator, Aaron Mattes.

What motivates you to get out of bed in the morning?

Put simply, I love what I do. That’s the advice I would give to anyone: find something that you love, and everything else will follow.

Of all of your achievements, what is your greatest so far?

Developing JABMMA Studio from a one-man band into a great team.

Everyone who has come in contact with JAB over the years knows our ethos for training hard and the passion we have for fitness. This year five members of JAB’s staff are going to the world championships in their respective sports. We all train and learn from each other daily, and JAB breeds a passion for training hard and smart.