Spot Reduction Myth

Woman Measuring Waist
Tell me if this sounds familiar:

"I just want to get rid of the fat around my stomach, so I'm just going to do sit-ups"

or

"I just want skinnier legs, so I'll do lunges and squats"

A lot of us have parts of our body that we would like to be smaller - for most it's their belly or legs. It sounds reasonable that if you have a some extra weight hanging around your waist that doing sit-ups and crunches would get rid of it right? wrong.

This is a fairly common misconception about working out and it's call the spot reduction myth. It would be great if it were true, but the unfortunate reality is that the way your body uses it's fat stores in a set way. Read this excerpt from ACSM's health and fitness journal:
The concept of spot reducing is a complete myth. No exercise will eliminate fat from  a specific area of the body, just as no change in your level of caloric intake will  guarantee that the fat will melt away in the area of the body you most want to address. As a rule, the pattern in which you lose body fat is genetically predetermined. (Peterson J., 2008)
What this means is that the way your body stores and uses up fat is largely determined by your genetic make up. This is why, for example, if you exercise with a friend they my lost the fat around their belly while you lose inches of your chest or thighs - even though you are doing the exact same routine.

Doing sit-ups or lunges will only work the muscles underneath the fat. The fat itself will not be used until the body deems in necessary to use those fat stores, and this will not occur by doing sit-ups alone (unless you do hundreds or thousands and the body burns through its carbs).

So how do you get rid of that fat? A combination of diet and exercise (like interval training) will work best. There are numerous online resources to help. livestrong.com has many helpful tools and a forum for support and advice.

What do you think about spot reduction? Let me know in the comments section.
References:

Peterson, J. (2008). Ten Common Mistakes Individuals Who Are Trying to Lose Weight Make. ACSM's Health & Fitness Journal, 12(6), p. 52.

Guest Post - Yoga For Low Back Pain


Ah, back pain… Where do I start?

About 3 in 4 people experience back pain at some point in their lives so, needless to say, it’s kind of a big deal.

There are countless reasons for it and countless ways to treat it.

But, let’s say there was a way to treat it AND prevent it. Would you go for it?

Enter Yoga.

In stereo: “Hi Yoga!”

(General Disclaimer: Yoga might not work for everyone. Just like every type of exercise should be specific to your needs, you should investigate if yoga is right for you.)

Yoga is a physical, mental, and spiritual discipline, which originated in India. It is based on the premise of attaining a state of perfect spiritual insight and tranquility. There is a meditative aspect and a physical aspect to the practice of yoga. With respect to back pain, the focus here is the action aspect of yoga. Don’t discount the meditative aspect, however, as it also has it’s own benefits.

Back pain is a funny (see: annoying) thing in that it makes us want to lie on the couch all day until the pain goes away. But, in fact, that is the exact opposite of what we should be doing. We should continue to move and be active so as to help loosen off any stiffness and keep the muscles in the back and core working and strong. However, some routines may need to be changed or substituted. This is where yoga comes in.

Yoga is a low-impact exercise, which can both raise your heart rate and recruit muscles you never knew you had before.

So, here are the basics of yoga:

Sun Salutations
  • There are 3 different sequences for Sun Salutations (A, B, and C). However, each teacher, book, or video has its own slight variations.
  • These are often used to warm up the body and are often considered the “cardio” component of a yoga practice.
  • This is also where Brandon’s favorite posture—the plank—fits into the practice.
photo source yogajournal.com
Standing & Balance Postures
  • Welcome to the part where your body tries to recruit every muscle possible to keep you from falling over. While the postures may be difficult or stressful, they are wonderfully beneficial for getting every part of your body to work together.
  • Take care of your neck. Many of these postures include looking up toward the sky but, if it bothers your neck, just look to the floor. Just because the teacher or the picture looks one way doesn’t mean you can’t adapt the posture to better work for you.
  • The key to succeeding in these postures is to focus solely on YOU. It sounds silly, but the moment your mind wanders off your mat is the moment the postures don’t work for you and don’t carry the same benefits as they did before.
photo source yogajournal.com
Seated Postures
  • Many of the seated postures are about releasing tension following all that hard work earlier in your practice. Don’t be fooled though, you will still be challenged, but it will just be different from before.
photo source yogajournal.com

Supine and Prone Postures (Lying on your back or stomach, respectively)
  • These poses are great for the core, a.k.a. all those muscles surrounding your midsection. Some are active and some are passive. Some strengthen and some stretch.  It’s all what you make of it.
  • Success in these postures really comes from making a connection with your mat. Early on it will be your foundation and the source of strength from which you push. Later it almost becomes like your cocoon. Basically, your mat will be your best friend.

photo source yogajournal.com
So, what do you need to do to fix or prevent your back pain?

I could try to list off the poses which are most helpful for fighting back pain, but that wouldn’t do much for you in the long run. It’s the practice as a whole that helps. Not to mention, everyone’s pain is different. So, the poses I like most might not be the poses you like most. Just like the running shoes I like could be entirely different from the type you like.

Although, if I’m going to be honest with you… I hate running. That’s probably one of the reasons I love yoga.

Anyway, go forth, young grasshoppers! Your mat awaits you (even if it is still at the store).
In the mean time, here’s a pose you can do without a mat…
photo source yogajournal.com
Afraid to make a fool of yourself? Don’t be. Laughing on its own is a good workout for your core too!

Kaitlin Freienmuth is a MSc Physiotherapy student at Robert Gordon University with a background in Kinesiology and Psychology, emphasis on Psychology of Injury. She has a passion for fresh air, worldly travel and her dog, Maddie. She has been practicing yoga for 3 years following a string of back injuries in high school. you can follow her blog here: Adventures of the Mischief Machine

Health in The News - April 25, 2012: Weight Training Might Slow Cognitive Decline

It's time for health in the news! This weeks story comes from my homeland of Canada. Researchs at UBC in vancouver have found that weight training can slow cognitive decline in persons with dementia. The study quoted shows that women between the ages of 70 and 80 with mild cognitive impairment performed better on memory tests after 6 months of weight training than those who hadn't weight trained. Give the article a read, watch the video, and tell me your thoughts.


Guest Post - A Few Things Everyone Should Know About Water

You know what the advertisers say and what the folktales recommend, but what are the facts about fluid intake?

Do you really need eight (or 12 or 20) glasses of water a day? Is that in addition to any coffee, tea, soda or milk you drink? Can you die from not drinking enough water?
We all know we should get plenty of fluids, and most of us know we don’t get enough of the right kind. Beyond those considerations, though, is a world of superstition, wishful thinking and misunderstandings. I don’t claim to have the corner on the truth concerning water, but I have researched the subject considerably.

Here are some important observations about a critical fluid: water.

  • How much water should you drink every day? You need as much fluid as it takes to maintain optimum health—and that varies from individual to individual and from day to day. Sweat a lot and you need more fluid. You must replace the fluid you lose, but beyond that there is no set amount required. If you are thirsty: drink. Even if you are not thirsty, drink. See the Mayo Clinic site for more information about dehydration.
  • The general rule, if you want to know whether you are dehydrated, is to observe your urine—if it is dark, you need fluid. If it is clear, you are fine. Normally, dark urine will clear after you have rehydrated yourself. Again, that is a general rule. Dark urine can indicate kidney problems as well. See a doctor for a medical diagnosis.
  • Drinks other than water can come with a mixed blessing. They may cause you to urinate more (lose more water) or be packed with sodium (cause you to retain water). But they do count as fluid. The best thing to drink is good, clean water. But how often do you do the best thing for you? I thought so.
  • If you are in the state known as hyponatremia, drinking too much water can kill you. If you are severely dehydrated (have sweated profusely, suffered from diarrhea, or have vomited a bunch), you need to replenish your electrolytes along with the fluid. Failure to do so can bring on real trouble. There are several sports drinks and pharmacy solutions that contain electrolytes. No marathon runner has ever died from dehydration—but many have succumbed to hyponatremia.
 Don't feel guilty about what you drink; just be sensible about it. Whatever you do, be sure to drink plenty of water every day—and “plenty” depends largely on you and your lifestyle. Is water too bland for you to get excited about? I sometimes add just a squeeze of lemon or lime to a glass of spring water—doesn’t cost much and tastes great. It’s hard to beat that.

Take care of you number one asset: YOU.

Lane Goodberry focuses on topics related to health and wellness, environmental issues and entrepreneurship.

Low Back Pain General Advice

I've had this article sitting around for a little while, I'll likely expand on it in the near future since back pain is so prevalent.



Many of us have had low back pain to some extent in our lifetime - be it a twinge from sleeping poorly the night before or a chronic, non-relenting pain. A quarter of the population has had back pain lasting longer than a day. So what do you do when you get pain, and how to you stop it from coming back?

As a physiotherapy student I’ve had the opportunity to treat patients with low back pain. Everyone is different, but here are some general principles that may help you with your back pain.
First of all, always keep your posture in check. Sitting slouched over a desk or in a very flexed position on your couch can aggravate pain by putting the muscles in your back under stretch and weakening them. It’s important to sit up right and support your lumbar spine with a cushion, rolled up towel, or proper backrest.

Secondly, exercise. Keeping fit and active can help prevent getting back pain in the first place. It has also been found to be an effective way to relieve back pain for chronic sufferers. However, it doesn’t have the same effects for those of you with acute back pain.

In the acute stage ice for the first 24-72 hours, heat after that point, rest, and posture are the most effective ways to treat low back pain. Your GP may give you pain-killers or muscle relaxants during this period as well.

What you need to consider is if this has been an ongoing issue or if you’ve just injured your back and will be over it within a few days. Anything that has been reoccurring should be dealt with professionally. Get yourself to a physiotherapist who can give you individualized advice and treatment. Remember, what works for some does not always work for others.  The patients I have had respond well to gentle exercise and mobilization of the vertebrae, others need only advice about posture. Whatever your needs, make sure you find the right person to meet them.

Body Weight Exercises - The Plank

Oh the plank. perhaps one of the most deceiving exercises out there. It looks so simple, but somehow it challenges more than you would expect. The good news about the plank is that it is a very effective core exercise and is very easy to modify - I mean, extremely easy.

The plank is what's known as an isometric exercise - meaning that you produce force without movement. While simple in design, the plank forces activity of about a dozen different muscles. The plank will target the rectus abdominis (your 6-pack) and the following muscles as stabilizers:

iliopsoaserector spinaepectoralis major
obliquestrapeziusserratus anterior
rhomboidssartoriousquadriceps

So, why is the plank such a good body weight exercise? Well, as you can see above, there is a huge amount of muscle activity, especially in your core. A strong core is very important - it will act as a girdle to product and support your organs; as well as promote better posture, protect your spine, and support you during reaching activities. Not only does the plank activate the core, but it also activates stabilizing muscles in your upper back and hip flexors. All of this is important in maintaining good posture and alignment. 

Secondly, as I've mentioned above, the plank is easily modified, and can follow the progression seen below.


The plank can also be modified into a side-plank, which targets the obliques, rather than the rectus abdominis and will uses close to 20 stabilizing muscles, including the gluteals and the pectorals.  

Remember when doing a side plank that you have to do it on both sides to avoid muscles imbalance.

Finally, the plank requires not one single piece of equipment. if you have a free bit of floor slighter longer than you are tall, you can do a plank. 

One thing the plank will not do is get rid of the fat around your belly, nor will sit-ups, and nor will crunches. This is because there is no such thing as spot reduction, but that's a topic for another post. What it will do is give your core a heck of a work-out without moving an inch.

Sprains - the PRICE principle

Sprains occur when there is damage to ligaments and can be graded from 1-3. a grade 1 sprain being mild, and grade 3 being a complete rupture of the ligament. Whatever the grade or cause of sprain, the main object in the acute stage is to keep inflammation under control. To do this, the most common treatment is PRICE.
Sprained ankle 30min

P
Protection. the last thing you need when you've sprained a joint is to have more direct trauma.
R
Rest. This does not mean completely avoiding doing any activity, but you aren't going to be using the joint in a significant way for a while. Continue to do small range a motion movements, but avoid stressing the joint
I
Ice. Ice is a very effective way to keep swelling down. get a bag of frozen peas or and icepack if you have it, wrap it in a thin towel, and place on the affected area. Usually guidelines say ice between 10-30 minutes at a time. I usually split the difference and say for 20 minutes at a time. Do this every couple of hours
C
Compression. Light pressure on the joint in the form of a bandage or, if it's an ankle sprain, high top sneakers will help push swelling away and support the joint. Be careful not to wrap to tightly.
E
Elevation. Keep the joint up when resting if possible. This will help blood flow back towards the heart and keep swelling down

So there you have it. The PRICE method is the treatment of choice for the first 48-72 hours after initial injury. Ask your doctor or physiotherapist for more advice. after 72 hours you may need to take NSAIDs to help with inflammation and pain.

Health in the News - April 17, 2012: Exercise and Breast Cancer

This week's featured story has to do with exercise and cancer patients. A study by the University of Miami has found that women who were more physically active suffered less depression when dealing with breast cancer. Read the full article here:


If this article interest you, then you may find this post by David Haas interesting as well. 

If any of would like to talk more about the topic please feel free to go to my forum and start a thread. I'd be happy to generate some discussion.

Body Part Spotlight - The Femur

The femur is the largest, longest, and strongest bone in the human body. It is the main weight-bearing bone in the body, which is why a fracture to the neck of shaft of the femur can have devastating effects on a persons mobility, not to mention other risk factors.

A fracture neck of femur is a common injury following a fall in older adults, and it has been found that up to 35% of people over 80 will die within one year of fracture. Fracture of the shaft of the femur are relatively rare, most often occurring as a result of a car accident.

The femur is highly vascular, meaning that it has a large blood supply. This accounts for why the bone is able to get as large as it does, but also why a fractured femur is a emergency.

Anthropologically, measurement of the femur can give a good approximation of a persons height using the following formula:

(1.880 X length of femur) + 32.010 = height in inches male
(1.945 X length of femur) + 28.679 = height in inches female


The femur, along with the acetabulum from a classic ball-and-socket joint. At the distal end of the femur, where it articulates with the tibia, a pivotal hinge joint is formed.

The following muscles originate in the femur:

Muscle
Origin
Insertion
vastus lateralis
greater trochanter
quadriceps tendon
vastus medialis
linea aspera
quadriceps tendon
vastus intermedius
antero-lateral femur
quadriceps tendon
biceps femoris short head
linea aspera
head of fibula
gastrocnemius medial head
proximal to medial condyle
achilles tendon to calcaneus
gastrocnemuis lateral head
proxmial to lateral condyle
achilles tendon to calcaneus
plantaris
lateral femoral condyle
achilles tendon to calcaneus
popliteus
lateral femoral condyle
posterior tibial surface

The following muscles insert in the femur:

MuscleOriginInsertion
gluteus maximusiliac crest, posterior superior iliac spine,
gluteal surface of ala of ilium, lumbar fascia, coccyx, sacrotuberal ligament
gluteal tuberosity, iliotibial tract
gluteus mediusgluteal surface of the ala of ilium, iliac crestgreater trochanter
glueteus minimusgluteal area on ala of iliumgreater trochanter
iliopsoastwelfth thoracic vertebra, all 5 lumbar vertebra,
and iliac fossa
lesser trochanter
piriformispelvic surface of sacrum, greater sciatic notchgreater trochanter
tensor fascia lataeiliac crestiliotibial tract
obturator internuspubic ramusgreater trochanter
obturator externusobturator foramentrochanteric fossa
quadratus femorisischial tuberosityintertrochanteric crest
gemelliischial spine and ischial tuberositytrochanteric fossa
pectineusiliopubic eminencepectineal line and linea aspera
adductor brevisinferior pubic ramuslinea aspera
adductor longussuperior pubic ramuslinea aspera
adductor magnusinferior pubic ramus and inferior ischial ramuslinea aspera and adductor tubercle of medial condyle
adductor minimusinferior pubic ramus and adductor magnuslinea aspera

As you can see, tons of muscles are attached to the femur, so it's not hard to see why is the strongest bone in the body.


Health in the News - April 10, 2012

Here is an interesting article about bucking the trend of childhood obesity. Simple measures can be taking to keep our youth from becoming obese. According to the article, children need to trim, on average, 64 calories to stop the rising obesity trend. The numbers at the bottom seem overly conservative (only 12cal in a sugary drink??), but I like what the article is getting at.
64 calories a day: what kids need to cut to reverse obesity trend

Preventing Blood Clots While Flying


The following is a guest post by Ted Uhler

How to Prevent Blood Clots While Traveling

I didn’t know her, but I noticed her. Perhaps in her mid-fifties, she looked healthy. She sat in a window seat across from my aisle seat, a few feet away. Like me, she flew solo, surrounded by perfect strangers. The flight was full.

But then it happened. Three hours into our quiet evening flight from the east coast to California, her head dipped down quickly and unnaturally; she didn’t jerk it back up. She was silent and motionless. Most of the other passengers were sleeping. But the passenger sitting right next to her noticed, and he gently shook her shoulder. No response.

He quietly retrieved a flight attendant who brought someone over to check her. The entire process unfolded with very little noise or commotion. Most nearby passengers remained asleep. She had no vital signs and was covered up with a blanket, dead. The flight continued like nothing happened. No one knew why she died. “Heart attack” was mumbled by a few.

Blood Clots Can Be Lethal

There’s plenty of recent research that suggests that people who travel for long distances are at a higher risk of having a blood clot form in their legs, which, if released into the bloodstream, can lead to death. (Note that varicose veins are not a factor and not involved.)

Harvard Medical School released a report a few years ago that concluded that travelers are at triple the risk of getting dangerous blood clots compared to non-travellers. It also found that the longer the trip, the higher the risk: about 25% higher for every two hours of travel on a plane.

Another study, released this year by the American College of Chest Physicians, concluded that the average annual risk among the general public for developing a leg vein blood clot is about 1 in 1,000. However, the number falls to 1 in 500 among people who travel long distances (typically defined as four hours or more, non-stop). The study found that passengers are at the highest risk on trips lasting eight hours or longer, whether plane, bus, train or car.

Our leg muscles help push our blood through our legs and back up through the heart. If we sit in a cramped seat, immobile for too long with leg muscles unused, our blood can pool within our veins and form a clot. It’s called deep vein thrombosis (DVT) or venous thromboembolism (VTE). If the clot breaks off, it can travel through the heart and lodge in an artery in our lung. This is called pulmonary embolism and it can kill. It’s responsible for about 15% of sudden deaths each year.

Preventative Measures to Stay Healthy

Whether young or old, in perfect health or not, if you’re going to be sitting for long periods of time, you can reduce the likelihood of blood clots forming in your leg veins through one very simple solution: Movement! It pushes your blood along, preventing it from pooling. Here’s what to do:
  • While seated, periodically flex and move your feet and leg muscles. 
  • Create little set-and-rep exercises; count silently or use music to set the pace.
  • Contract your calf muscles (point your toes downward). People in healthcare call our calves a “second heart,” due to its ability to set blood in motion.
  • Flex and extend your ankles.
  • Press the toes of your feet on the floor: it moves our shins, thighs and hips. This can prevent clots that are known to form high up in leg veins. 
  • Forget what other passengers may think. Get up and walk around; stretch in the tiny restroom or elsewhere. 
  • “Disturb” others to take care of your needs. Research shows that people in window seats are far more likely to stay put.

I noticed that the woman I saw die seemed bashful and polite. I believe she never got out of her seat, a window seat. It’s also possible that she began to feel ill but decided to say nothing; after all, she probably didn’t want to disturb anyone.

Freelancer Ted Uhler writes for the iNLP Center and other websites that cover health, fitness, wellness, personal development and related topics. The iNLP Center offers NLP training and personal development coaching. Ted, a one-time competitive triathlete, believes strongly in the value of balanced living.

Online Resources

Keeping Fit In Your Golden Years


The following is a guest post, written by Stacey Cavalari for Access Rx.

Seniors today are living longer and healthier lives. Being a senior is a privilege that should be cherished, and one way to ensure good health is to keep the body active through exercise. Regular exercise is also very important, as more Baby-Boomers are overweight or even suffer from obesity, which can cause a host of other health-related problems. Seniors are combating this trend and staying fit by participating in yoga classes, going skiing, riding bikes and even roller skating. A body that moves is also less likely to suffer from falls and fractures.

Exercises for Seniors

Seniors can take advantage of the many exercise programs available, as long as their physician agrees that there are no medical conditions preventing them from doing so.

Pilates and Yoga – these gentle stretching exercises are great for seniors, especially if they suffer from arthritis or have aching backs. The poses stretch the body from the mid-section called the core. Yoga or Pilates will strengthen the body so that it supports itself better, as well as keeping the muscles limber for better balance. The stretching is gentle and relaxing, yet the body gets a complete workout. These forms of exercise also calm the mind and promote mental clarity.

Cycling – riding a bicycle is gentle on the knees. Incumbent bicycles support the upper body, especially the back. Light hand weights can be used to work the upper body while cycling and working the legs. Some people like to read a book while on an incumbent bicycle.

Zumba – for an exhilarating, fun workout try taking a zumba class. It is a mixture of Latin fusion dancing and hip-hop and gets the entire body moving. Plus, it is really fun to let loose and move the body like it moved at age 18. Zumba is for all ages, and even the rhythm-challenged person is on the dance floor having fun. Don’t worry about learning the steps, just get out there and dance.

Aerobics – even seniors can take an aerobics class, as long as they know their limits. Keeping both feet on the floor at all times, marching in place instead of jogging, and not bending the legs more than 90 degrees is a way to modify the exercise class. A person taking the class should remember that they don’t have to do what everyone else does. Instructors are trained to show the senior how to modify steps for low impact.

Walking – go to just about any mall early in the morning and there will be people walking around. Not only is walking great exercise that can be done for the cost of a pair of walking shoes, mall walking is a great way to meet like-minded people. Mall walking groups meet several times a week to get their exercise and meet new friends.

These exercises are low impact and very effective at keeping extra weight in-check and keeping your body moving. If you can’t decide which exercise suits you best, you can always try a few of them and switch from one to another to change things up and maximize your workouts.


Stacey Cavalari is a senior content writer for AccessRx.com, an established U.S. online pharmacy where consumers can purchase medications online. Make sure to visit their YouTube page to learn important tips on buying medications online

Health in The News - April 2, 2012

I'm starting a new series on my blog called Health in the News. Basically I'll just post an interesting news article relating to health or exercise. Let's start with this one about exercise changing DNA. I like the way this article is written because it explains the research. I would have liked to see a link to the original study so that I could read it myself, but this is still a good read. Check it out!

Can Exercise Change Your DNA

Resistance Exercise for Rheumatoid Arthritis

I've had a couple requests in the last week (mostly from my mother) to design an exercise program for rheumatoid arthritis (RA). I thought it would be a good idea for a blog post. This post will cover the benefits of resistance exercise for RA.

Exercise programs for RA have historically been more focused on aerobic type exercise because of the increased risk of cardiovascular events. There's absolutely nothing wrong with that and it has been shown that aerobic exercise improves quality of life, levels of pain/disability, and cardiovascular fitness in persons with RA. However, resistance exercise should not be ignored. In fact, studies show that resistance exercises can have an anti-inflammatory effect, reduce cardiovascular risk, and improve function.
image soured from reachbeyondra
Strength training using weights has been shown to be safe in a study by  Strasser et al. (2011). Participants in the study performed bench press, chest cross (flys), bicep curls, triceps extensions, and sit ups. All participants had a disease duration of greater than 2 years and were also receiving drug therapy. In the study the participants lifting a weight that was 70% of the 1 rep max 10-15 times. Once they could perform more than 15 repetitions then the weight was increased. For the first two weeks they did one set of each exercise and from the third week onward they did two sets. By the end of the study disease activity and pain had decreased, while general health and function improved.

Basically what all this shows is that a combination of aerobic and resistance exercise is best for persons with RA - and for that matter people in general.

The problem is, as in my mother's case, it can be very difficult to hold onto weights when your haven't the grip strength in your hands, or range of motion in your fingers to properly grasp. So, what do you do? The answer is you do what your body lets you do. For people with advance RA exercises like the the ones mentioned above may not be appropriate, it's very important to speak to your doctor/rheumatologist  to make sure exercises certain exercises are appropriate.

This will give you the ability to add some resistance to your upper body exercises. The use of machines in a gym may also be a good option because the risk of dropping the weight is eliminated. Like the study mentioned above, find a weight that you can do a maximum of 15 times and when you can lift that weight more than 15 times increase it. 

Finally, water-based exercise is great for RA because the water adds resistance. Find programs at your local gym. I used to teach a class called joint action at my old gym in St. John's. If you're living in that area then give them a try here: http://www.newworldfitness.com/

I will not give an example exercise program in this post because exercises should be tailored for the individual. Speak to your doctor or a physiotherapist to get a program that suits your specific needs. For more information you can try the following links:


References:

Baillet, A. et al. (2012). Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials. Rheumatology, 51, 519-527.

Strasser, B. et al. (2007). The effects of strength and endurance training in patients with rheumatoid arthritis. Clinical Rheumatology, 30(5), 623-632.