Sunday, March 23, 2014

Pondering Push-Ups

Saturday morning I woke up and performed 100 push-ups, after my coffee, of course, in five sets of roughly 20 repetitions. I'm not sure why I did this. Maybe it was because all the lifting I'd done the previous day at work had infected my psyche, leaving my subconscious to believe that I needed to balance myself out with some push movements. Perhaps I was just taking full advantage of a little down time to jump-start the day in a decidedly healthy manner, as any weekend fitness blogger would, while also setting a positive example for my family. Or maybe this early morning burst of energy was more preemptive in nature, an innocent way of looking preoccupied so that I wouldn't be tasked with taking out the trash or wiping down the table before breakfast. Whatever the root cause, the fact of the matter is that push-ups have been on my mind this week, and I wanted to share with you now some of what I learned while researching this time-honored, closed chain compound exercise.

That's the first thing I learned: that because the body is in contact with the floor and more than one joint is involved at the same time, the push-up is considered a closed chain compound movement. Trivial, I know, but knowledge which could come in handy if you ever find yourself on Jeopardy. There are many varieties of the push-up, which I won't get into here, designed to place stress on different muscle groups and/or increase the difficulty of the movement. For example, I use push-up stands to increase the depth of the push-up, which makes the exercise more demanding.

Push-ups require moving about 66% of bodyweight. There are ways to cheat this, thereby defeating the sole purpose of performing push-ups, while at the same time safely maintaining a strong ego. Perhaps the most common way of cutting corners in the push-up is to simply avoid the bottom portion of the movement, or the most difficult part, by performing only partial reps. Allowing one's hips to sag fools an individual into thinking he is performing full range reps, as the hips will touch the ground before the chest. This also reduces the amount of bodyweight being lifted, obviously making the exercise much easier.

Hand position can also make a difference in the level of difficulty. High and wide hand placement makes for an easier push-up because it is easier to produce force from this position. Keeping the hands closer together with elbows tucked requires greater muscle activation in the pectoral muscles and triceps.

Former football great Herschel Walker set a record at the University of Georgia with a 375-pound bench press. Quite impressing, particularly given that he did not lift weights. Instead, Herschel relied on push-ups, performing up to 1,500 on a daily basis. Now, I can't perform this many push-ups in a day, nor would I want to even if I could. But because push-ups do build strength and muscle endurance, they should be included as part of an ongoing conditioning program. Most people will not build mass the way Mr. Walker did, but there are better, more efficient methods of accomplishing this (progressive overload bench press, for example) if this is your goal.

Like I said, push-ups are a great compliment to any strength routine. They can be used at the end of a session to really "finish off" the pecs and triceps, without fear of a loaded barbell crashing down upon you as you reach muscle failure. I recently began sandwiching my push-ups around the other exercises in my Tuesday night routine. Once a week, I will do two of sets of 20 at the onset of the workout and three sets of 20 at the conclusion for a 100 rep total. Before, I was performing sets in a contiguous fashion, satisfied with completing four sets for an 80 rep total. My new practice has increased my push-up total by 25% in the same amount of total workout time.

I'm not setting the world on fire, but this does represent progress for me. Achieve enough progress over time and the end result is success. And as transplant recipients, we all have a vested interest in achieving health success.

Sources accessed in composing this post:

Wednesday, March 19, 2014

Dumbbell Power Clean and Press

Here's an exercise seemingly tailored-made for kidney transplant recipients, or nearly anyone else for that matter. This compound movement is praised for both its strength-building and endurance-enhancing qualities. And rightfully so, as this exercise works practically all muscles in the body while taxing the cardiorespiratory system as good as, or better than, any set of squats or deadlifts can.

I won't go into all the reasons renal transplant recipients - particularly those taking prednisone - should be regularly exercising (click on heart health in the list of labels in the right-hand margin for posts relating to this topic), but a quick recap of some of the most important points is worthwhile:

  • We are 4-6 times more likely to die from cardiovascular disease than the general public
  • Studies show patients have greater fat mass 1-year post-transplant than study control groups
  • We remain low in peak oxygen uptake compared to sedentary normal controls and have a lower exercise capacity
  • From the beginning, prednisone causes a breakdown of muscle (catabolism). This is most striking in the quadriceps, glutes, and shoulder girdle. Many on long-term corticosteroids develop very thin arms and legs. At the same time, prednisone has been called "pro-obesity."
  • Prednisone is associated with osteopenia, a weakening of the bones, and osteoporosis, a disease which can cause spontaneous bone fractures.
The National Institutes of Health has stated that "aerobic exercise is necessary to reduce the risks for cardiovascular disease, minimize osteoporosis, and facilitate weight loss, whereas strength-based exercise is necessary to minimize sarcopenia," a degenerative loss of skeletal muscle mass and strength associated with age (and prednisone).

So, according to the National Institutes of Health, incorporating both aerobic- and strength-based exercises into our routines can act as a counterbalance to many of the physiological challenges working against us as transplant recipients. The dumbbell power clean and press, though not usually performed as an aerobic exercise, certainly works the anaerobic system, which is crucial to enhancing muscular strength and muscular endurance while also combating the deterioration of lean muscle mass.

Bill Starr, one of the NFL's first strength and conditioning coaches, once wrote that cleaning and pressing dumbbells is an excellent way to build size and strength in the shoulders (see the 4th bullet point above) that no other upper-body exercise can match. Even if you're not looking for size or strength gains, Starr notes, cleaning and pressing dumbbells makes a fine addition to any conditioning program. "You don't need heavy weights," says Starr. "If you only have light dumbbells, just run up the reps. You can clean the dumbbells and press them 30 or 40 times, or you can turn this simple exercise into an excellent cardio [aerobic] workout. Clean the weights, press them overhead, set them back on the floor and repeat: clean, press, clean, press. Do that for 20 or more consecutive reps, and I guarantee that you'll be blowing at the end even if you only use 15-pound dumbbells."

Of course the clean and press can also be performed with a barbell, but the dumbbell version has some distinct advantages. First, there is the simple fact that dumbbells require less space and are generally safer to train with, particularly when training alone. Because dumbbells require equal work from both arms, any strength imbalances can be more easily identified. As dumbbells are more unwieldy to handle than a barbell, more stabilizer muscles are recruited by the body to perform the movement. And in the clean and press, dumbbells have to be pulled higher than a bar because it's so much harder to dip under them as you would a bar prior to the pressing motion. This means the deltoids have to work a little harder than they do in a barbell clean and press.

In either option, barbell or dumbbell, the entire body receives a vigorous workout. Legs, hips, glutes, back and abs are all involved, and not in just a supportive role. The power clean and press is a very demanding exercise which will produce great results. Use it how you want - for strength or cardio, or both. Currently, I perform three sets in the 8-10 rep range with 35-pound dumbbells. In the demonstration video below, I performed 5 reps and was already breathing heavy.

Sunday, March 9, 2014

Day Hike: Henry Horton State Park

The KTF Blog hit the road Saturday for an all-day outing featuring cross country, hiking, and tennis. With the sun shining brightly and afternoon highs at or near 70 degrees, it was a perfect day to be outdoors after an unusually cold and downright dreary winter. The middle school x-country meet, an event sponsored by the Tennessee State Parks Run Club, was held in Marshall County, near the town of Chapel Hill. My oldest daughter competed in the 2-miler, which saw both the Dickson County boys and girls teams come away victorious.

Running in 7th place, along the banks of the Duck River
This was our third trip in little more than a year to Henry Horton, yet we'd never hiked any of the trails. Being such a nice day with a couple of hours to kill before tennis practice in Nashville, we knew the time was ripe for backwoods exploration. We picked two 1-mile loop trails to cap our outing at the park, the Hickory Ridge Loop and the Wilhoite Mill Trail. These wooded trails are both clearly marked and easily navigated.
Along the Hickory Ridge Loop
Where the Wilhoite Mill Trail parallels the Duck River

Man-made creek as seen from the Wilhoite Mill Trail
The final leg of our outing planted us indoors in Nashville for our youngest daughter's weekly tennis session. But the nearly perfect weather lured my wife back outside to continue our walk, this time around the paved trail at Centennial Park. We walked the mile loop three times, bringing our total for the day to five miles on foot. What a great way to kick off meteorological spring!



Saturday, March 1, 2014

Italian Study Looks at the Effects of Exercise in Renal Transplant Recipients

A review of evidence-based results headed up by Giulio Romano, MD and Professor of Nephrology at Misericordia University Hospital, hoped to discover whether or not it is possible to reduce cardiovascular risk and influence graft (kidney) survival of renal transplant recipients (RTRs) other than pharmacologically. The idea came about because, even after a successful kidney transplant, the RTR continues suffering from the consequences of the illness accompanying kidney failure, uremia. And because RTRs already carry the burden of administering a large drug regimen, it becomes very important, the authors say, to introduce "non-pharmacological" therapies to end the medication madness. As you may have guessed, based on the URL of this blog, the "non-pharmacological" therapy in question is exercise.

Romano, Eric Lorenzon, and Domenico Montanaro (the paper's other two contributors) point out many studies have shown over the last twenty years that physical training can improve graft function, work capacity and quality of life, as well as reduce cardiovascular risk. Sadly, a large number of RTRs report low exercise rates. The reasons are varied. Some believe it is because of the fear of injuring the transplanted kidney and/or the transplant professionals' silence (read: ignorance) regarding the benefits of exercise. Other reasons may include an overly protective attitude of family and friends or are simply the result of a lack of structural support (something I strive to at least contribute to through this blog). Lastly, some patients of culturally and ethnically diverse backgrounds may not place a great deal of importance on exercise and self-maintenance.

Measured against the general population, renal patients are at an increased risk of having a cardiovascular event. With a mortality rate 10 to 20 times higher than the at-large population, cardiovascular events remain the major cause of death in kidney patients. The main cause of this elevated risk is accelerated atherosclerosis, which is a chronic inflammatory response in the walls of arteries. The threat of accelerated atherosclerosis continues into post-transplantation and is, in fact, the most important late complication for all organ recipients, representing the main cause of death in RTRs. What are the major risk factors associated with the development of atherosclerosis? High plasma cholesterol levels, high blood pressure, diabetes mellitus, smoking, and a sedentary lifestyle.

Romano et al note that because elevated levels of IL-6 represent a trigger factor of inflammation, they may significantly contribute to the cardiovascular risk of RTRs. Exercise, it has been shown, reduces the levels of IL-6 in RTRs. One note of caution, however, is that overtraining (i.e., strenuous exercise) actually increases IL-6 production. Therefore, the authors advocate RTRs perform an "appropriate level" of exercise consisting of 30-45 minutes of aerobics (walking or cycling) three or more times per week. So while an exercise regimen that is too intense may be bad, moderate exercise is good. When participating in what is considered to be an appropriate amount of exercise, physical strength in RTRs improve while IL-6 levels are reduced. The net biological effect, the authors say, is overwhelmingly positive.

A few other highlights of the review of the evidence-based results include:

  • Greater physical activity is a statistically significant predictor of improved graft function over a one-year period, based on glomerular filtration rate. The authors believe that exercise leads to improved cardiovascular function, which likely improves perfusion and oxygen delivery to the grafted kidney.
  • Exercise reduces the dependence on blood pressure medication for lung and kidney transplant recipients.
  • Patients with advanced chronic kidney disease have lower cardiorespiratory fitness that remains reduced by 30% post-transplant, when compared against age and gender matched control subjects. Exercise improves cardiorespiratory fitness and muscle strength in RTRs.
  • Homocysteine is a factor related to a higher prevalence of cardiovascular disease. It remains elevated in RTRs versus the general population, but physical activity may significantly lower the levels of this amino acid.
  • Anxiety and depression are common among the RTR population and contribute to an increased cardiovascular risk. Exercise can reduce anxiety and depression in this group.
The authors conclude that an appropriate amount of exercise is a useful, safe, and non-pharmacological contribution to the transplant patient's treatment through the reduced risk of cardiovascular disease, the improvement of the grafted kidney's function, the increase of energetic metabolism, and an improved quality of life.

And regardless of the type we choose, the authors state that physical training can always yield remarkable health benefits. Yet despite all the positives outcomes associated with physical activity, most RTRs do not meet established minimum exercise guidelines. They call on the professional transplant community to consider exercise not as merely an assistant or luxury accessory, but as an integral part of the complex treatment of RTRs.

This article was published in the World Journal of Transplantation and can be accessed at:

Please share and help get the word out!

Monday, February 24, 2014

DIY Low Pulley Cable Row

Over the last couple of weeks I've been working on an idea for a low cable row pulley system that I can incorporate into my home-based workout routines. Because I train with weights in the living room, all of my equipment must have a small footprint and be assembled and disassembled both quickly and easily. I looked into the resistance bands with the door anchors - and some of those I really like - but I just don't have a good place to use them. One day, after finishing a squat workout, I took a good look at my portable squat stands and wondered how they could provide the support for a pulley system.

An Internet search turned up some good sources, one of which provided detailed instructions on a simple but heavy-duty DIY loading pin made largely from plumbing supplies. I then found a video featuring a homemade high cable pulley attached to a pull-up bar and another attached to a homemade power rack. I thought a little more about my squat stands and, using the DIY tips discovered online, came up with an idea which I thought might work for me. I'm not an engineer so I'm unsure about maximum loads, beyond those limits listed on various pieces of equipment. This contraption is just something I've done for myself, and I thought I'd share it here. In the video below, I go into some detail describing my homemade system for performing low cable rows.

Saturday, February 8, 2014

DIY Dip Station

Exercise equipment is expensive. And so is square footage. For this reason, I frequently exercise in the living room and search for creative and affordable options when it comes to meeting my equipment needs. Fortunately, the Internet is packed full of valuable ideas for do-it-yourself exercise enthusiasts on a budget. This is where I found the instructions for my homemade dip station.

For years I have wanted to integrate dips into my exercise regimen, but could never figure out a good way to accomplish this. My equipment must be portable and, preferably, collapsible so it can all quickly be put back in the corner when I'm finished. That way, I earn my gold star for the day and get to stay up a half-hour late on Saturday! But because dip stations are typically fixed and heavy, I had just about given up on being able to perform this excellent upper body exercise at home. Coincidentally, that's about the same time I came across a blog called Homemade Strength. Carl is the author of this blog, which features numerous projects that the average DIY guy or gal can complete fairly easily. For a detailed description of the dip stands featured in this post, click through to

Since there already exists a complete how-to guide on these stands, I'll forgo the finer points of construction and stick with a summarization. Importantly, this pair of dip stands required me to buy nothing. Everything I used for this project was scrap. Even the collapsible metal sawhorses, upon which the stands are positioned, were purchased years ago for use as safety rails when performing barbell squats.

Following Carl's instructions, I started by cutting two foot-long sections of metal pipe. I then took a 2x4 and cut this board into (8) five-inch pieces. Using a hole saw, I cut holes through four of these five-inch pieces into which the pipe ends could slide. So, half of my 2x4x5's have holes through them and half don't. The 2x4x5's without holes are secured to the outside of the 2x4x5's with holes and the pipe rests in the middle, with the ends of the pipes secured inside the holes.

Dip Stands beginning to take shape
Both pipes are secured into the wood on one side by a bolt which runs through the top of the 2x4 with the hole cut. This bolt first goes into the wood from above and travels completely through the metal pipe before finally entering the wood underneath, preventing the pipe from moving. The process for this is described in great detail at the link provided above. Though it sounded a little daunting, it was really pretty easy.
This secured one side of each stand, and now it was time to secure the opposite sides. This was accomplished by attaching a plywood base to the bottom of both sides of the stands.
One solid dip stand, upside down
The dip stands complete, I needed only to secure them to the sawhorses. Because I use these sawhorses for squats and because I exercise in the living room, I have to be able to assemble and disassemble this station quickly. The sawhorses come with holes already pre-drilled, so I was able to simply drill holes through the plywood base that lined up with the existing ones. To secure his stands to his sawhorses, Carl at the Homemade Strength blog just fits a hex wrench through the plywood base and metal frame. Though this is a terrific idea, I had no extra hex wrenches laying around so I used what I did have - nuts and bolts. Finger tight is plenty enough, so it is a pretty quick process putting up and taking down these stands.
Two small bolts secure each stand to the metal frame
The project was now complete, unless I wanted to go the extra mile and paint or stain the stands. I quickly opted out of this option, preferring instead to take the pair straight to the proving grounds for a quick test drive. And, as advertised, the stands worked perfectly. My thanks to Carl at for taking the time to share this and many other projects with those of us out in cyberspace. I'm finally able to introduce dips into my strength program, and it didn't cost me a dime.
The finished product
Test drive proved the design was a success


Sunday, January 26, 2014

Johnsonville Charge, 5-Miler

Saturday marked our sixth race in this year's state running tour. This week's stop took us to Johnsonville State Historic Park in New Johnsonville, Tennessee. After most recently running 6-, 7-, and 8-milers, I was relieved that this was a five-mile course. Described as "flat, fast and easiest of all" the tour courses, I was prepared to take it up a notch and achieve a new PR.

The morning was quite cool, but not as cold as it has been around here. Still, I decided to run with gloves and a stocking cap. A musket shot set the clock in motion, and we dashed off towards a historic road built upon an old railroad bed once used to transport Union supplies between the Tennessee River and Nashville. This was a simple out-and-back course which, thankfully, was indeed flat. Running with no pain for the first time since November, I felt like I was off to a (relatively) fast start, which perhaps explained why I was heating up so quickly. Before the two mile mark, my gloves and hat came off and spent the remainder of the run alternating between my right and left hands.

There was water at the two-and-a-half mile turnaround point, but I declined - as I always do - needing instead to suck in as much oxygen as possible to keep my legs going. I lied to myself the entire race, telling myself I would slow to a walk at the turnaround cone before pushing this carrot-on-a-stick mirage back to the end of mile three and, ultimately, mile four. Once I found myself still running at the beginning of mile five, I ceased with the all the lying and admitted to myself I would fight through the pain now originating in my left knee and finish this thing like somebody who writes a fitness blog would.

I pulled in at the finish line with a time of 43:56, twenty-nine seconds shy of my personal best. Finishing 16th out of 19 runners in the men's 40-49 bracket and 66th out of 116 overall was a disappointment to which lately I've become accustomed. My daughter's performance, however, helped brighten the otherwise cloudy and chilly day. With a time of 51:10, she finished third in the girls' 10-14 year-old category, earning herself yet another tour medal.

Showing off her 3rd place medal

The post-race meal, provided by the Friends of Johnsonville State Historic Park, featured stew and chili. There was an abundance of each and both were delicious. Many thanks goes out to the Friends group for all of their efforts. It was nice having a hot meal outside in the cold and the perfect way to close out the 2014 Johnsonville Charge.

Crowd gathers around the food after the race
With the race director, Coach Redden