Blog – Dr Juliet McGrattan

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Homeschooling and activity levels – why I’m worried.

Here we go again with the homeschooling. Like everything in this pandemic it’s not easy but it has to be done. I’m a mother. I worry about my children. It’s natural. This particular concern is not so much about their education, their schools have been excellent from the very first school closure. No, this is a concern about their health. Actually, it’s a concern about the health of all school children. I’m worried. Children have become home workers and as someone who has worked at home for a couple of years now, I know how much effort it takes to do it healthily.

I have a special interest in physical activity for good health, I’m seeing first hand, the plummeting activity levels of my three homeschooling teens and I know this will impact their health both now and potentially in the future. You might not think this is a big issue and that they’ll soon get their fitness back once lockdown is over. I’m sure they will but the fact that they will have had pretty much half a year not at school has more subtle and longer term effects on their health. Simply being aware of these effects can help us to encourage our kids to have a slightly healthier day. Slightly healthier days for half a year add up to a much healthier year. A much healthier year can mean a much healthier future.

I’m slanting this piece towards teens because I have three of them at home (13, 15, 17) and I think the challenges of getting them to do what you suggest are greater than that of a younger child but many of the suggestions apply to all ages.

So, what exactly am I worried about and what can be done to change it?

Let’s start by looking at the Chief Medical Officers’ guidelines for physical activity for 5 to 18 year olds. The recommendations for children are:

An average of at least 60 minutes per day of moderate to vigorous physical activity.
Participation in a variety of types and intensities of physical activity through the week to develop movement skills, muscular fitness and bone strength.
Minimising sedentary time and breaking up long periods of sitting with at least light physical activity.

The routine of the school day helps children to be healthy in ways they don’t realise and propels them towards these targets. My kids get the bus in to town (most days) and then have a ten-minute uphill walk up to school. Their rucksacks are usually extremely heavy. I struggle to even lift my sons’ bags sometimes! Their lessons vary in length but pre-pandemic, every 35 to 60 minutes they would get up and move around the school site between classes. Often that involved a bit of a run! Then of course there’s the formal P.E and games lessons which for my lot includes walking off site to access the playing fields. At lunch time my kids were often in clubs – my daughter in the dance studio, my sons doing circuits in the gym with the rowing club. Sometimes they’d stay for after school sports clubs too.

When you look at that day there’s an awful lot of movement. Moderate and vigorous activity, muscle strengthening and regular light activity to break up sedentary time. This doesn’t include out of school fitness hobbies which have obviously taken a hit too. This is their default movement pattern five days a week, every week in term time. School keeps them healthy.

Where are we now? Rolling out of bed five minutes before school starts. Stumbling over to the desk and logging in without a camera. Spending time messaging with friends between lessons or having a quick online gaming session at lunch. No games or P.E. No run to the bus. No heavy bags. Just sit, sit, sit.

The benefits of physical activity are widely known and have strong medical evidence behind them. These are the benefits I’m worried about children missing out on:

Bone health. By age 18 you have 90 per cent of your bone mass. You form another 10 percent by your late twenties and early thirties and then it starts falling. It’s vital to build as much bone mass as you can in your teens so you are starting from as high as place as possible when it begins to decline. Low bone mass later in life can result in osteoporosis, a condition where bones fracture easily leading to significant pain and disability. To be strengthened, bones need to be stressed by impact with the ground such as during running and jumping and by the muscles and tendons working against resistance and tugging on the bones to stimulates bone growth.

Muscle health. Muscles are vital to good health. The proteins called myokines that active muscles release help to reduce inflammation in the body which we know lowers the risk of major diseases such as heart disease, cancer and type 2 diabetes. Developing muscle fitness is important for children. Building pathways between the nerves and muscles is essential for good co-ordination and balance.

Healthy metabolism. Physical activity helps children to reach and maintain a healthy weight. Sedentary behaviour is linked to higher levels of obesity. Bodies were designed to move and when you sit for more than about 20 to 30 minutes your body slips into storage mood and the energy you consume is more likely to be stored as fat and gives you a higher risk of obesity and type 2 diabetes.

Brain health. Children who are physically active learn better and faster. Concentration and problem solving skills are higher after movement. Exercise has been shown to increase the size and activity of the hippocampus, the part of the brain that’s most involved with memory. The benefits decline in the weeks after activity stops. Exercise also helps sleep and sleep is so important for information processing and generally for growing bodies.

Social benefits. We’re all missing out on socialising but when it comes to teens I think the benefits that being active with others can bring are huge. There’s the motivation of others to take part in the first place – your mate’s going to badminton club so you’re persuaded to go too. Learning to work as a team. Developing sportsmanship. The encouragement to challenge and push yourself. The chit-chat and laughs you share with others. It’s much harder and less fun on your own.

Healthy habits. Physical activity levels decline as children get older and move into adolescence – particularly in girls. The habits we create as children carry through into what we are likely to do as adults. Creating and sticking to new behaviours is hard. Getting out of the habit of doing things makes it difficult to return to them. Being inactive is easier and takes less effort than being active. Inactive habits developed during lockdown could be hard to reverse.

Like most problems during this pandemic they can be solved if we accept where we are and then think creatively to find a way out of them. I know it’s tricky with teens, I have three. Getting them to do anything can be a struggle! I refuse to be a nag. I do however believe that children now are taught much more about healthy lifestyles at school and have more of an understanding of the importance of looking after their physical and mental health. I don’t know your situation by my children’s teachers are doing what they can to encourage them to move about and get outside.

I’ve worked at home for a couple of years now and have simply had to build healthy habits into my work day. It’s the little bits of movement that have been lost and it’s not too difficult to at least replace some of them. Here’s what I’m trying with my kids and I hope it might be useful to you too:

Discussion. Talk about it. Explain why you are concerned. Point out what the benefits of exercise can do for them. Show them this blog. Ask them what they think will work for them. Reflect on how it made them feel after they’ve done it. Did their day go better? Did they sleep well? Could they concentrate more? Seeing the benefits can be very motivating.
Plan and encourage routine. Help them look ahead at the day and work out when the best time for activity is. Getting up a few minutes earlier will give time for a bit of movement, even if it’s just to the kitchen for breakfast and the bathroom for teeth brushing (I’m convinced that the lack of morning routine means my three have brushed their teeth way less during lockdown). Just leaving it to ‘I’ll fit it in when I can’ leads to lost opportunities. Suggest and advise don’t instruct, it has to come from them.
Move between lessons. Thankfully my children’s schools have built some short breaks between lessons and a longer break at lunch. But the temptation of a five or ten minute break is to stay at the desk or move to the bed and reach for technology. Even going to the kitchen to get a drink is better than nothing. The more they drink the more they’ll need to pee which means more movement! Encourage them to see the importance of just getting up and walking around. If they’re keen they could do some simple exercises too.
Stand when they can. This sounds silly but it breaks up sitting time. Not all of a lesson involves writing or typing. If there’s something to watch or listen to, then do it standing up. By all means chat with your friends at break, social interaction is vital but why not do it standing or walking around instead of lying on your bed?Doing one longer bout of exercise doesn’t cancel out all the sitting in the day. It’s vital to break that up and move frequently for the best health benefits.
Get outside every day. This was so much easier in the first lockdown when the evenings were light and warm. The only chance now is before, during or just after school. My daughter and I have been taking a short ‘walk to school’ in the morning because she said it helps her. It is difficult with the heavy rain and wintery weather but a brisk walk racks up those required minutes of activity, helps children to concentrate, makes them sleep better and if the sun is out will give a boost of vitamin D too.
Be active in the evenings. If it’s hard to be active during the school day then try to use the evenings. Right after school is good. It creates a definition between work and home which all home workers find to be very important for their mental health. If it’s too dark for a walk, run or bike ride, you can turn to online activities. Lots of local clubs are offering their activities over Zoom. Sport England have a great Join the Movement campaign and provide lots of suggestions on how to get active at home including The Body Coach, POPSUGAR fitness and Yoga with Adriene which are all free and suitable for teens.
Be a role model and be active together. Many teens could think of nothing worse than doing an exercise routine alongside their parents! But lockdown in this house has actually provided an opportunity to do things together which has been nice. Walking the dog, running while my son rides his bike or doing a weights session together has helped all of us. Activity levels of adults, especially women has sadly fallen during lockdown so we need to ‘practice what we nag’ too. Role models can have a very positive influence on children’s behaviour and set the norms for a household.

I know we’ve all got a lot on. This post is in no way intended to add to the guilt on parent’s shoulders at the moment. It’s simply to highlight what I think is an important topic that not everyone will be aware of. And to come up with some ideas as to how we can overcome it. I’m struggling with it as much as the next parent but little changes really do add up. Some activity is much better than none. Any tips and ideas from you are very welcome. Perhaps there are some experts in the best way to communicate with teenagers that could give a valuable addition to this topic?

At the end of the day we’re just doing the best we can and that’s enough.

Literally just after I published this blog I saw the publication of the Active Lives Children and Young People Survey. Here’s the link if you want to have a read about the decline in activity levels and challenges faced as well as some of the great initiatives to increase activity levels.

Featured Image: Steven Weirather from Pixabay

Quick Question – Is strength or cardio exercise best?

Published by Dr Juliet McGrattan

I blogged a few weeks ago about how, after years of trying and failing, I have finally found a way to add strength work to my fitness routine. By making strength work fun and convenient I’ve managed to keep it up regularly for three months now and am definitely feeling the benefit. But is it really necessary to specifically work and build muscles? Isn’t aerobic or cardio work enough to keep you fit and healthy? Surely my regular running is enough to give me all the health benefits I need?

I’ve just read a really interesting research paper which answers this question perfectly. It was published in the BMJ and you can read the full article here.

This was a big study looking at almost half a million people and following them up for around eight and a half years. It was done in America and looked at whether people were meeting the recommended guidelines for physical activity. Specifically whether they were doing 150 minutes of moderate intensity activity every week (or 75 minutes of vigorous activity, or a combination of both) and whether they were doing muscle strengthening activities on two or more days a week. These recommendations are the same as the UK Chief Medical Officers’ guidelines for physical activity for good health.

What they discovered was:

If you just meet the aerobic guidelines you can reduce your risk of dying from any cause by 29 per cent.
If you just meet the muscle strengthening guidelines you can reduce your risk of dying from any cause by 11 per cent.
If you meet both the aerobic and muscle strengthening guidelines you can reduce your risk of dying by 40 per cent.

Adding in those two muscle work outs a week makes a big difference!

They also looked at eight specific causes of death (cardiovascular disease, cancer, lower respiratory tract disease, accidents and injuries, Alzheimer’s disease, diabetes mellitus, influenza and pneumonia and nephritis, nephrotic syndrome or nephrosis). They found:

If you just meet the aerobic guidelines then you can reduce your risk of dying from all the specific causes.
If you just meet the muscle strengthening guidelines you can reduce your risk of dying from three of the specific causes – cardiovascular disease, cancer and lower respiratory tract disease.

The authors do say that the muscle strengthening guidelines, and therefore the questions participants were asked, are not very specific. They don’t quantify which muscles were worked, how intensively or how long for. This may affect the result.

It’s interesting to look at the intensity of the aerobic exercise too. They included light to moderate intensity exercise and not just moderate. We’re beginning to understand how even light exercise can bring huge health benefits. This is great because it’s accessible and possible for everyone, including those with long term medical conditions. It adds to the statements that ‘every little helps’ and ‘doing something is better than doing nothing’.

There was also a slightly increased benefit from those that were doing vigorous activity over those that were doing moderate. Greater intensity seems to give greater benefit. That’s good news for us runners. More minutes exercise over all could provide greater benefit too- there’s more work being done here.

So, my summary of this is that if you only do one form of exercise then you’ll get the greatest health benefits from meeting the 150 minutes of moderate intensity exercise per week guideline. But if you want to add an extra 11 per cent reduction to your risk of dying then add in two muscle strengthening exercise sessions each week too. If met, the current physical activity guidelines will improve your survival.

Ultimately any form of exercise is good and finding one you enjoy is very important. You’ll never keep it up if you don’t get pleasure from it. Obviously, its not just about living but about living well. Exercise certainly helps me to enjoy life more. Research studies always have their limitation but this one has definitely given me a boost in motivation to keep up with my Fiit classes. See you on the mat!

Featured image: Stephen Buissinne from Pixabay

My Top Five Blogs of 2020

Published by Dr Juliet McGrattan

It’s my annual blog post review! I love looking back and seeing what my most-read posts were. It helps me to figure out what everyone wants and what I should focus on writing in the coming year. This is my sixth year of blogging and I’m very proud of my blog. I aim for it to be both useful and enjoyable. It’s my little bit of the internet that I’ve created for you. A place where you can get good, sound advice and information on health-related topics. It’s also somewhere that I share what I’m up to and how my life is going, in an open and honest way. I always welcome feedback and ideas so never hesitate to comment or get in touch.

The blog had a quiet start to 2020. I was writing my next book and there just wasn’t enough brain power or hours in the day to do much blogging. I picked it up again in April once the book was submitted to the publishers. It’s out in March 2021 and is called Run Well: Essential health questions and answers for runners. I’m very excited about it and I’ll be sharing plenty about it next year that’s for sure.

Like most people’s blogs, by far the largest portion of my views come from search engines. That means from people putting what they want to know into Google (other search engines are available!) and ending up on my blog. This means that my most-read posts just indicate what people are looking for and whether the words on the blog match up. I have a lot to learn about SEO (search engine optimisation) and that’s on my to-do list for 2021. After search engines, most of my 2020 traffic has come from Facebook, Twitter and Instagram – in that order. I haven’t done any adverts on these platforms so these are purely people that follow me and see my posts about new blogs and click on them. This is my lovely engaged audience who I think about when I’m writing. I’m so grateful for their loyalty and enthusiasm, we have some great chats about the topics on social media too.

Here’s my 5 most-read posts of 2020:

1 How to Return to Exercise After the Flu. I actually wrote this in 2018 but it’s the third year in a row that it has taken the top spot. It’s about flu in general and not about Covid-19 – that didn’t exist when I wrote it! It’s not rocket science, just sensible advice that it’s hard to find anywhere else. It’s so easy to get carried away and try and get back to normal too quickly. I’ve had a lot of feedback about how useful it is. I did write a post for netdoctor about returning to exercise after Covid-19 which you can read here – do bear in mind the situation may have changed since it was written!

2. Quick Question – How soon can I swim after giving birth? This is another one of those questions that it’s hard to find the answer to. It’s the sort of thing that a patient would have asked me and I would have realised I didn’t really know because no one had taught me. So, using common sense and medical knowledge I put this together and it’s obviously a much needed subject considering it’s made it to number 2 in my 2020 blog chart.

3. Exercise and the Menopause. Another blog that just keeps on giving. I’ve written a few blogs and done some IGTV posts about the menopause in general but this post has got the most love. In part this is due to someone, somewhere with a large following mentioning it on Facebook. Over a few days my blog exploded with people being directed to this from Facebook. I’ve got some other menopause posts lined up for next year too – it’s a much needed and underexposed topic.

4. Dogs as Running Buddies. People love their dogs! This is a post from three years ago but it’s still in the top five. I think runners who are thinking about getting a dog look online to get advice about breeds and how to run with your dog. I’m still running with Honey and published a post about this again very recently, maybe this will turn out to be just as popular.

5. Quick Question – Why does my nose run when I exercise? The Quick Questions are doing well on the blog this year. I’m glad because when I started the series I really wanted it to be helpful. If you have any quick questions you want to ask then please let me know. Runny noses when you exercise are common and annoying and I hope I’ve helped a few people through this blog!

So, that’s my top 5 for 2020. I’ve enjoyed getting back to more regular blogging after the short break for book writing. There’s always so much in my head that I want to share with you. I’m going to be blogging more about my own running and exercise in 2021 along with plenty more Quick Questions. I have restarted my Active Woman Interview series too so do get in touch if you’d like to feature in that.

Thank you everyone for supporting me and reading this blog, I really appreciate it and value your time and input. Raising a glass to more blogging adventures in 2021.

Featured image: Free photos from Pixabay

Merry Christmas – 2020 Gratitude

Published by Dr Juliet McGrattan

I remember being a young girl at Sunday School and winning a prize in a competition to count your blessings. You simply had to write down every blessing you had. I took this very seriously and recall pages and pages of spidery letters spelling out what I was grateful for. I don’t remember the content but I know I went full on with everything I could think of! I guess this was my first experience of the concept of gratitude. Whether it’s a gratitude diary or simply taking time to think about what you are grateful for each day, it’s a powerful way to lift your mood and make you feel positive.

A year like no other is coming to a close. It’s been hard in so many ways – for everyone. Staying positive has certainly been a challenge. Rather than blog about the difficulties I’ve faced personally, I’m closing the year with a list of what I’m grateful for in 2020. Focusing on the good stuff really helps.

This year I’m grateful for:

My children’s attitude. They have astounded me this year. Their resilience, adaptability and conscientiousness. Although they seem to have taken it all in their stride I know it hasn’t been easy for them. I couldn’t be prouder of them. They haven’t complained once about all their cancelled events and other disappointments. And they looked after an allotment!

My wonderful husband. As an ICU consultant this has been the hardest of times for him. On his knees with exhaustion at times he has never stopped putting others before himself. We’re all so proud of him and grateful that he works with an amazing team who keep each other going.

My small but mighty work team. Having a team of people that pop up on your computer screen full of ideas, enthusiasm and positivity everyday has made 2020 so much easier. Yes, there have been huge challenges at 261 Fearless, as there have been for all companies, but the way the team has worked with creativity, determination and perseverance has been truly outstanding. What the team have achieved together this year is incredible and I’m so grateful to be part of it.

Running. I don’t need anyone to tell me how great running is because I know but this year has made me truly understand how lucky I am to have running in my life. It’s been a constant in a year of change. It’s kept me healthy both physically and mentally. The people I run with have given me so much support. Meeting for chatty runs when allowed and online running club were a lifeline to me (and to others) offering connection at a time of isolation.

My holiday. I didn’t write about this at the time but I am so incredibly blessed that we managed to get a last minute holiday in the summer. We thought long and hard about whether we should go and what the risks were. In hindsight it was a good move and so restorative, particularly for my husband. It really was an unexpected gift and we all savoured every single second.

Time and opportunities. Without school runs and ferrying kids to activities I gained a couple of hours each day. I knew this wouldn’t last forever so was determined to make the most of it. I’ve used the time to finish my next book, take on some new writing work and to learn more about myself. It’s been transformative. I’ve read some great self-help books and listened to podcasts that have helped me be more productive, focused in what I do and not feel afraid to aim high. I’ve also developed some new habits including online strength classes which will stay with me beyond all lock downs. I’m grateful for the time I was gifted and the new opportunities that have opened up when lots of things were shutting down.

I think I could go on and on and end up with a list like I presented at Sunday School! Even when you think there’s not much to be happy about there are always things you can be grateful for. It might be as simple as a warm bed or seeing the frost on the leaves. I already feel lifted in spirit through the process of writing this. 2020 on the surface has been rubbish but it has stripped life back to what really matters. It has taught me how important a positive outlook is, given me new skills and made me appreciate how much I have.

Thank you to all my readers and followers for your continued support during 2020. I truly appreciate you and am grateful for you. I wish you a very Happy Christmas.

What are you grateful for this year?

Featured image: Ylanite Koppens at Pixabay. Others: drjulietmcgrattan.com

Running With My Dog

Published by Dr Juliet McGrattan

One of my most popular blog posts is ‘Dogs as Running Buddies‘ which I wrote over three years ago. Since then I’ve seen more and more runners getting dogs and enjoying their miles with them. It’s just wonderful to see. I still stand by all those reasons I like to run with my dog Honey and we’ve had lots of adventures running together. Running with a cockerpoo is fun and as a breed we definitely chose well for our family. Here are some of the many things I’ve learnt in over six years running with my dog:

Build up distances gradually. There’s been a couple of times when I’ve randomly decided to increase my distance and taken Honey on a long run without any build up to it. I know I shouldn’t do it myself as a runner but sometimes you just need that long run! I’ve realised part way round the route that it was too much for her and she’s started really slowing down. While she hasn’t had any issues with sore paws from too much running I’ve felt bad and realised it’s not fair. Better to leave her at home when that notion takes me.

Adjust food intake. I’d been doing regular miles over a few months and when I took her to get her haircut I suddenly realised she was looking a bit thin. I thought she’d been a bit demanding around food. She was obviously hungry. Running with your dog is a great way to keep them in shape (I always feel sad when I see overweight dogs struggling on a walk) BUT don’t forget to increase and decrease their food intake according to how much running you’re doing. I usually give her a treat after a long run and just add an extra scoop of food that evening.

Plan routes with access to water or carry it. I’m lucky where I live as there are plenty of rivers and streams but sometimes in the hot weather and on some of my routes, there isn’t much water about. Dogs get so hot and thirsty. I’m going to look at collapsible bowls which will be easier than cupping my hands and letting her drink from that. On a very hot day I don’t run with her.

Have a light lead. We have a lot of sheep round here. I try to avoid running near them but there are times when every field and path is full of them. I don’t trust Honey near sheep so have to put her on the lead. Running without a lead is obviously more fun for dogs but it’s important to get dogs used to running on the lead too. A light one fits easily into my pocket or round my wrist when I don’t need it.

Short hair is easier to manage. When I first got a cockerpooo I didn’t want to have her coat cut at all. I wanted a really hairy hound. However, I soon learned that long dog hair, mud and water is a nightmare. She was getting so matted which isn’t nice for her or me. It’s been much easier since I got her trimmed every eight weeks. Honestly, she has more haircuts than all the members of this house. It pays off though. I’ve also got her a coat which gives some protection to her underbelly. I throw it in the washing machine with my wet, muddy running kit.

Running helps nail care. Honey gets her nails clipped when she’s at the groomers but during the long lockdown when she was well overdue they were getting long. I remembered that a run on the tarmac files down nails pretty well. So while I know she likes to be on the trails, a road run has its uses!

Some dogs hate bangs. We live in an area where pheasant shooting goes on all the time during the shooting season. It didn’t used to bother Honey but as she’s got older it has affected her more and more. Fireworks night and the days around it this year were just dreadful. She was so stressed, shaking, panting and drooling for hours. She wouldn’t go out of the house for days and then only when we made her. We did what we could to make it better for her with music, a dark hidey hole behind the sofa etc. I’m going to look for medications for her I think. Now, any pop, not a bang, even from a very distant gun completely freaks her out. If she’s off the lead she runs home, across roads and everything so we’re having to be very careful. Others have told me their dogs have got worse as they’ve aged too.

Watch your running posture. When I’m road running, I try to have Honey on a short lead at my side between me and the hedge. I know she’s safe there and I can easily stand between her and a car if needed. She’s pretty good and the lead is often loose but sometimes she’s pulling ahead in front of me which means my right arm isn’t a useful part of my running mechanics. My upper body and shoulders are out of place too. Just be mindful of how running with your dog alters your posture which can have a knock-on effect to your running gait. If you’re doing lots of off road and want to have the dog on a lead, then have a look at canicross where you have a lead extending from your waist.

Invest in a good harness. I’ve tried many over the years. My friend recommended the Julius K9 harnesses and I haven’t looked back. They’re so easy to put on the dog, robust, easy to clean and adjust. They’re strong and I’m only on my second because I stood on the plastic buckle and snapped it. A good harness makes so much difference and is way better than a lead directly on the collar, especially if you have a dog that pulls.

Dogs are better runners than humans. Honey makes me laugh. There I am, out of breath and running as fast as my legs will go and there she is, literally trotting along beside me! It’s a good reminder that I have a lot further to go in my running journey. She’s always got a good bit left in the tank when she sees a rabbit or a squirrel and beats me in a sprint every time. By miles!

Honey is nearly eight now. I think she’s already starting to slow down a bit. I know there will come a time when she doesn’t want to or is unable to run with me. In the meantime I’m just enjoying the company, the motivated running partner and the adventures we have.

Tell me about your dog. Do you run together?

All images drjulietmcgrattan.com

Running in Williamson Park

Published by Dr Juliet McGrattan

There are over 27,000 public parks and green spaces across the UK and research done by the Heritage Lottery Fund found that over 57 per cent of people in the UK regularly use a park, that’s over 37 million people! It might be a huge parks with lots of amenities or a small neighbourhood green spaces but as a nation, we love them and use them.

Unsurprisingly, people who live in urban areas use parks more than those who live in rural areas. Over 90 per cent of those with children under five use their park at least once a month. This fits with my park use. As an adult, I didn’t really go to parks at all until I had small children to occupy. Parks with play areas, ducks and paths suitable for buggies and trikes became a godsend. It wasn’t until parkrun set up that I really began to use and appreciate my nearest park – Williamson Park. Now I love running there and lead my 261 Fearless Club Lancaster women’s running group in Ryeland’s Park on the other side of town. Suddenly I’m spending a lot of time in parks!

Williamson Park is right near my sons’ school and if I’m persuaded into giving them a lift, I try to stop off for a run. I love running here and so does the dog. The park was given to the people of Lancaster in 1881 by the Williamson family. It was originally open moorland with disused quarries. James Williamson Senior began the work to turn it into a recreational area in the 1860s. During the cotton famine of 1852-1865, unemployed cotton spinners were given work laying out the gravel paths across the moorland. He died before this was finished but his son Lord Asthon (James Williamson Junior) saw that it was completed.

At the centre of the park and a highlight on the skyline of Lancaster, is the stunning Ashton Memorial, built as a folly in 1908 by Lord Ashton, in memory of his second wife. It really is a remarkable building. Apparently it’s known as ‘the Taj Mahal of the North’! Inside, there’s a beautiful interior ( I can see why people choose the location for their wedding) and you can climb the steps up to the balconies for incredible views of Morecambe Bay and across to the Lake District. Outside there are dozens of granite steps which make a great workout when you run up and down them.

The park is on a hill which makes it a very challenging park to run in. There is so much variety within its 54 acres. Wide, open tarmac paths with views across Lancaster and beyond and smaller paths and muddy trails though woodland. There are lots of little nooks and crannies with gazebos, ponds, sculptures and bird observations points.

It’s such a wonderful mix and this means that running here is never boring. When I’m there with the dog in the morning I always meet lots of other really friendly dog walkers. In non-lockdown times there’s a cafe, two great children’s play areas, a butterfly house and a mini-zoo. The local theatre do incredible outdoor performances in the park; I’ll never forget coming to see The Hobbit. Oh and there’s parkrun every Saturday too (hopefully back soon!).

I usually do a couple of loops of the park, making sure I take in all my favourite spots and a mix of terrain. It means running up a few hills twice but that just adds to the fun. It makes a nice change from the muddy fields and country lanes that I usually run on.

I know that parks don’t magically maintain themselves. The council are responsible but recognition must be given to the Friends of the Park, a charity set up to help manage and look after the park. My mum and step dad are active members and I know how much time and effort volunteers give to raise funds and carry out work to keep the park looking beautiful. One highlight for me is running through the Friend’s Garden which always looks stunning and has such a variety of interesting plants.

By exploring the park, finding out about its history and how it’s looked after just makes running there even better for me. I’d encourage you to do the same for your local park too. There’s an interesting House of Commons Public Parks Report where I got the stats for this post. Do have a read if you are interested in learning why parks matter to people, the challenges parks face and how we can make sure parks have a sustainable future. I’d love to know if you run in your local park and what you particularly enjoy.

Pilates with a Stoma

Published by Dr Juliet McGrattan

What is a stoma? As stoma is when a small opening is made in the wall of your abdomen and either the bowel or urine tubes are brought to the outside. A colostomy is when the colon is brought out and an ileostomy is when it’s the small bowel. A urostomy is when urine is diverted to the outside but is less common than a colostomy or ileostomy. Faeces or urine is collected in a bag which sits close to the body and can be emptied when needed. Stomas are needed for a variety of reasons including damage to the bowel due to inflammation or cancer. Sometimes they are temporary and are reversed once the bowel has healed and sometimes they are permanent.

I know quite a few people who have had a stoma. Many of these people I met through my work as a GP and some are friends and family. While the reasons for having them have varied, one thing has been a constant. Fear. And fear has meant lots of questions. How do you manage? Will the stoma bag show? Will it burst? And importantly, can you exercise with a stoma?

I knew very little about the last question until a few years ago when I was writing my first book Sorted: The Active Woman’s Guide to Health. I wanted to include women who had overcome challenges to remain active and I came across Sarah Russell. Sarah had to have emergency surgery in 2010 for a perforated bowel due to a condition called diverticulitis. As a rehabilitation, biomechanics and running coach, an international rower and triathlete, Sarah was desperate to return to exercise as soon as she could following her operation. She saw her stoma as a challenge to overcome and found ways to work round it. it wasn’t an easy journey – physically or mentally. Two years after her surgery she became the first person to run the Himalayan 100 – a one hundred mile race over five days in the Indian Himalaya. Sarah says that after that race she felt invincible and it sparked a new passion – to help others who have stomas to get and keep active.

Sarah went on to write The Bowel Cancer Recovery Toolkit. A wonderful guide to getting back on your feet after bowel cancer and all it throws at you. I was honoured to write the foreword for this. I know how vital it is to exercise alongside cancer treatment and as part of recovery. I also know how challenging it is and this book takes you step by step through how to do it safely, including if you have a stoma. I leant it to a dear friend with bowel cancer and a stoma who told me she wished she had had that information from the hospital and that everyone with bowel cancer should read this book.

Lack of information and guidance is a huge problem. Sarah highlights that regaining your abdominal strength is vitally important. But how do you work those abdominal muscles safely when they have been separated during surgery for the stoma to be formed? Are planks and sit ups ok? Can you lift weights or will that make the stoma bulge and cause a hernia? How much can you exert yourself and what do you need to be careful of?

Sarah has taken all her knowledge and experience and created a wonderful new service, The Ostomy Studio. It’s a specialist online Pilates studio for anyone that has had stoma surgery. Using Pilates based exercises it helps participants build strength and confidence. It doesn’t matter whether your stoma is recent or your surgery was years ago, the classes will help you to exercise safely, build up a strong core and give you the knowledge and skills to enjoy being active throughout your life. Because it’s online you can do the classes from your home. You can be confident that you are learning from a highly qualified instructor who really does understand, from personal experience, the challenges you face but also the fact that they can be overcome. You can feel strong and confident again.

You can read Sarah’s blog about Pilates with a Stoma and head directly to The Ostomy Studio to book your place.

Making Strength Work Fun

Published by Dr Juliet McGrattan

I know that doing strength work is important. I know that I need to do it regularly but if I’m completely honest, I’ve failed. I alway struggle to keep myself motivated to do it. I’ve tried various ways of incorporating strength work it into my fitness routines and daily schedules but it’s never lasted more than a few weeks. I think mainly because I find it dull. How do you make strength work fun? I finally seem to have found something that suits me and I wanted to share it with you.

I’m 48 now and I’ve been doing so much work around the topic of the menopause. From the research and work I’ve done – writing, being a guest on podcasts and social media posts, I’m feeling really knowledgeable and empowered to cope with my own menopause. I’m pretty sure I have some peri-menopausal symptoms. One of the things I know is essential is strength work. I know my muscle mass will now be decreasing (you can read my blog on this). I know that I don’t actually feel as strong as I used to. I know that if I take action now I can make a huge difference to my future. I’m also aware that I’m gaining some fat around my middle, despite not changing any of my diet or fitness norms and I don’t like it.

It was time to take action. Going to a gym is not an option. I’ve tried it so many times in the past and it doesn’t work for me. It’s a time factor. I live in a rural village and in the time it takes to get to a gym I could have done the work out. I work full-time and the evenings are precious times with my family. I know there are a couple of strength classes in a near-by village hall but again I don’t want to give up my evening and can’t commit to the same time every week. I’m usually ferrying the kids to their activities in the evening. It has to be done at home. It has to be available whenever I get a small window to do it.

I’m pretty focused and very disciplined with my time. I have to be as a freelance home worker. I’m good at sticking to run training plans and motivating myself to run. But when it comes to strength work, I appear to be very weak willed! I tried working out with my son as he is incredibly motivated. This was fine to start with but his work-out times never seemed to suit me and this plan soon dissolved. I tried writing my weights and reps in a little note book and aiming to do a bit each day but it soon went by the wayside. What to do?

Lockdown really showed me that online classes suit me. I was leading and participating in them regularly with 261 Fearless and my online ballet class. It also changed the norm in our house. Suddenly it became entirely normal for me to be in the bedroom doing a yoga class, my daughter having a ballet lesson in the kitchen and my husband on his turbo trainer on Zwift in the TV room. Thank you to B4RN for the incredible broadband! New habits and new acceptable behaviours began.

I decided that an online strength class was the way forward. And I’m loving it. I chose Fiit. This isn’t a sponsored post or an ad. I just thought it looked good and ticked the boxes I wanted. I did the 14 day free trial and then signed up. I meant business so I signed up for the year which works out as £10 per month. I’ve been doing it for 5 weeks now – religiously. I haven’t missed a class and have even done a few extra ones. I started with a four week power plan. Four classes a week, one is a stretch class. Some are 25 minutes and others are 40 minutes and there are a few different coaches that lead the classes. All you need is dumbbells of a couple of different weights. I either do it on my phone or mirror it onto the big TV. There’s good instruction, good music and great variety in the exercises, each coach seems to have their favourites. They really encourage you to work hard and I always sweat a lot. I have an apple watch which links up to the app and shows my heart rate and calories burned – not that I really pay attention to it. You can also get a different chest strap heart rate monitor that will show you your reps if you want. There’s a challenge section in each work out when you try to do as many reps as you can in the time allotted. I can imagine if you are competitive or are really tracking your progress closely that you might want to see this. It’s enough for me to just know I’m trying my best. There are lots of other studios you can visit too so I’ve also done some Pilates for runners. I’ve yet to explore the yoga, barre and cardio studios but I will definitely try them at some point.

Can I notice any difference? Yes I can. I’m definitely starting to see some muscle definition. I think at the start I wasn’t pushing myself enough with the weight so in the last couple of weeks I’ve tried to increase that. I’m definitely more toned around my middle and have got the belly fat more under control. I’m weak in my upper body and am a long way off proper press ups but I’m getting better. In terms of my running, yes, I think it is helping. My core is stronger and I’m sure this will help my running technique. I also feel I have more power in my legs. When I want to turn up the speed dial a bit, I do feel there is more there. I’ve been focusing on frequent, shorter runs recently so I’m not sure what effect it has had on endurance. Time will tell.

Most important of all, I know that it is doing me good inside. The best results from it are yet to come. I’m feeling proud that I’m embracing this time in my life and taking positive action to future proof my body. I’m doing it for me. Feeling strong is very empowering. I’ll give you another update in a month or two!

I’d love to know what strength work you do and how you make it fit into your weekly routines. Do you enjoy it? What works for you?

Featured Image: Ichigo121212 and dumbbells Ozkay from Pixabay.

Others: drjulietmcgrattan.com

Quick Question – How can I get rid of visceral fat?

Published by Dr Juliet McGrattan

My last quick question looked at what visceral fat is, why it’s harmful and how you can tell how much visceral fat you have. Do read that first if you need to, you can find it here. Now let’s consider how we can get rid of visceral fat. What can we do to make ourselves healthier on the inside and reduce our risk of major diseases such as type 2 diabetes, heart disease and cancer?

It’s good to know that there are steps we can take to reduce our visceral fat and significantly improve our future health. Here are some simple, every day things we can all do:

Mix up your exercise. Visceral fat is very responsive to exercise so increasing the amount you do will help to reduce its levels. Abdominal exercises like sit ups aren’t going to reduce that central fat though, even if they feel as if they should. You need to do lots of exercise where your heart rate is high and you are out of breath. Running long distances is good but lots of brisk walking every day will help too. High intensity interval training is very effective for reducing visceral fat and short sessions of this can be easily fitted into most people’s day.
Tackle your diet. Diet is key to reducing visceral fat. Cut back on your carbohydrates and increase your protein. In the extreme you can use a ketogenic diet but personally I prefer smaller changes that I can easily sustain. Reduce your sugars, increase your vegetables, protein and wholegrains. Don’t be afraid of healthy fats such as olive oil and avocados. Make lots of small healthy choices.
Reduce your alcohol. Alcohol is such an easy way to guzzle unwanted calories and these often end up stored as fat around the middle and as visceral fat. Small changes all add up, just cut back a bit.
Sleep well. According to research, a lack of sleep can increase your visceral fat levels. Sleeping excessively however is known to increase weight so that’s to be avoided too. Aim for 7 to 8 hours per night. Regular exercise is proven to help sleep and will of course help to reduce visceral fat while you do it – win win!
Stress less. Easy to say and hard to do but it’s worth trying. Stress causes an increase in the level of the hormone cortisol. Cortisol is made in the adrenal glands which sit just above the kidneys. It’s involved in many body processes including metabolism and the immune system. It increases blood sugar levels and it’s thought that it increases visceral fat levels. Stressing less means less cortisol. Do whatever works for you, laugh with friends, ask for help and don’t forget exercise can really help to manage stress levels.

Don’t worry about what the scales are telling you. This is not about weight loss per se. It’s about making you healthier from the inside out and reducing the levels of harmful fat in your body. This is for all of us, not just for those that are overweight. People who have a normal BMI can have lots of visceral fat too. We shouldn’t judge ourselves or make judgements about others. Just choose one thing. Keep going and make it a habit. You will be making yourself healthier and shaping your future.

Let me know how you get on.

Featured image: Engin Akyurt from Pixabay

There are more answers to questions like these and lots of health information to help you lead a happy and active life in my book Sorted: The Active Woman’s Guide to Health. Published by Bloomsbury and awarded First Place in the Popular Medicine category at the British Medical Association Medical Book Awards 2018.

Disclaimer: I can’t give personal medical advice and as always with health advice, reading something online doesn’t replace seeing your doctor who knows your medical history and can assess you in person. So, if you are unsure then always seek the opinion of a health care professional.

Quick Question – What is visceral fat?

Published by Dr Juliet McGrattan

When we think of fat we probably think of subcutaneous fat. That’s the squishy fat that sits just underneath our skin. With many people complaining about their ‘bingo wings’ and ‘muffin tops’, subcutaneous fat is often what makes people feel unhappy about their body shape. There is however a different type of fat that we should be far more focused on – visceral fat. Visceral fat is deeper in our body and is stored in and around our major organs such as our heart, liver and intestines. It’s an unhealthy fat and high levels of it mean we have a bigger risk of many serious diseases including type 2 diabetes, heart disease and some types of cancer.

Why is visceral fat harmful?

We now know that most major diseases are caused or worsened by a low level of inflammation in the body. Visceral fat is ‘pro-inflammatory’ which means it causes and adds to inflammation. It releases inflammatory agents and messages into the blood stream and decreases the production of some anti-inflammatory agents too. Having lots of visceral fat therefore means there is more inflammation in the body and a higher risk of many medical conditions including strokes, heart attacks, dementia and depression.

Visceral fat also reduces the body’s sensitivity to insulin. Insulin is made in the pancreas and it regulates blood sugar levels. It determines how much glucose is used and how much is stored. If the body becomes less sensitive to insulin, then blood sugar levels rise and type 2 diabetes can develop.

How do I know how much visceral fat I have?

It isn’t possible to tell how much visceral fat someone has by just looking at them. You can only really do that by having an MRI or a CT scan which shows the amount and location of fat. There are home scales that you can stand on that will measure your body fat but they won’t tell you whether it is visceral or subcutaneous. Some more expensive and advanced ones that measure you externally from different angles may give a more accurate result and some idea about fat distribution, but an MRI scan is the gold standard. Clearly we can’t all have one of these so hopefully technology will continue to advance and give us better and cheaper ways to measure the amount and location of body fat.

If you’re skinny, don’t be lulled into a false sense of security. Even if you don’t have much subcutaneous body fat, you can still have harmful levels of visceral fat. A normal waist size or a normal BMI (body mass index) doesn’t necessarily mean you have low visceral fat levels. Being slim doesn’t always mean you are healthy on the inside. Similarly being fat doesn’t always mean you are unhealthy. We all need to take steps to minimise our visceral fat.

Being slim doesn’t always mean you are healthy on the inside. Similarly being fat doesn’t always mean you are unhealthy.

As a general rule however, the bigger your waist measurement, the larger amount of visceral fat you are likely to have. So, if you are apple-shaped with most of your fat around your middle, then you will probably have more visceral fat than someone who is pear-shaped with most fat around their hips. When women move towards and beyond the menopause, their fat distribution changes and more fat is stored around the middle. The same can be said for men to some extent. This is middle-age spread. More fat being deposited centrally and a resulting larger amount of visceral fat, is one of the reasons our levels of risk for numerous diseases increase as we get older.

Grab a tape measure …

You can measure your waist and get some indication as to whether your size indicates an increased risk of health problems. A waist size of greater than 80cm (31.5 inches) in women and 94cm (37 inches) in men, gives you a high risk of health problems. Greater than 88cm (34.5 inches) in women and 102 cm (40 inches) in men, indicates an even higher risk.

You can also measure your waist to hip ratio to see if your body fat is more centrally stored. Simply divide your waist measurement by your hip measurement. A waist:hip ratio of 0.85 is high for a woman and above 1.0 is high for a man. A woman with a ratio of less than 0.8 and a man with less than 0.95 is considered low risk. (WHO).

Maybe this has got you wondering how much visceral fat is inside you! It certainly got me thinking the first time I heard about it. I always assumed that if my weight was in a healthy range for me that everything must be fine on the inside. Thankfully there are things that we can all do to reduce our visceral fat and that’s coming up in next tomorrow’s quick question. In the meantime, start doing some brisk walking!

Featured Image: Hans Braxmeier from Pixabay.