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THE WALL STREET JOURNAL.
© 2015 Dow Jones & Company. All Rights Reserved.
Tuesday, December 22, 2015 | D1
Exercise gurus and military
experts are pushing for
alternate exercises to
prevent back injuries
BY RACHEL BACHMAN
For anyone who has struggled
on a gym mat, hands behind head,
straining to touch elbows to knees,
there’s good news: The sit-up’s
reign as a workout standard may
be ending.
People from high-profile exercise gurus to military experts are
arguing that the sit-up, that staple
of fitness tests, presents too great
a risk of back injury.
A recent editorial in Navy
Times, an independent publication
that covers the U.S. Navy, called
for banishing the sit-up from the
physical-readiness test sailors
must pass twice each year. The editorial called it “an outdated exercise today viewed as a key cause
of lower back injuries.” The Canadian Armed Forces recently cut the
sit-up from its fitness test, citing
concern over potential injury and
its lack of connection to actual
military work.
Tony Horton, creator of the
popular P90X video workout series, says he no longer does sit-ups
or crunches, their truncated cousins. “I really believe that the traditional, antiquated crunch has seen
better days, and it’s time to make
a change,” Mr. Horton says.
Sit-ups can put hundreds of
pounds of compressive force on
the spine, says Stuart McGill, a
professor of spine biomechanics at
Canada’s University of Waterloo.
In dozens of published studies, Dr.
McGill has found that the forces,
combined with the repeated flexing motion, in sit-ups can squeeze
the discs in the spine. That combination eventually can cause discs
to bulge, pressing on nerves and
causing back pain, potentially
leading to disc herniation.
For people who want to do abdominal exercises from the traditional sit-up start position, Dr.
McGill advocates a modified curlup he developed, with the hands
placed underneath the low back
and the shoulders barely leaving
the floor.
Sit-ups can be done in many
ways, including crunches and situps on stability or Swiss exercise
balls. The injury risk with modified sit-ups depends on the exact
motion and on an individual’s
physical limitations. But some fitness instructors have ditched even
modified sit-ups.
Please see SIT-UP page D2
FROM TOP: DOMINIQUE PINEIRO/U.S. NAVY; GETTY IMAGES; CANADIAN FORCES MORALE AND WELFARE SERVICES
You Can Stop Doing Sit-Ups
Why a Drug
To Prevent
HIV Is in
Low Demand
BY SUMATHI REDDY
Public-health officials are pushing for much wider use of a drug
that has proved effective at preventing HIV infection.
The drug Truvada was approved by the Food
YOUR
and Drug AdministraHEALTH
tion in 2012 as a
daily medication to
protect against acquiring HIV, the virus that causes
AIDS. The drug is commonly called
PrEP, or preexposure prophylaxis.
About 50,000 people a year in the
U.S. become infected with HIV, according to the Centers for Disease
Control and Prevention.
Still, fewer than 22,000 people
are estimated to have taken PrEP
for prevention, according to an
analysis this year in the journal
Current Opinion in HIV and AIDS.
AIDS remains a significant cause
of death in certain populations although treatments have made living with the syndrome a reality for
many.
The CDC in November released
Some AIDS groups lobby
against expanded use of
the drug, called PrEP,
despite its effectiveness.
a report suggesting some 1.2 million U.S. adults who are at substantial risk for acquiring HIV
could benefit from PrEP. Among
those are one in four gay and bisexual men; one in five people who
inject drugs; and one in 200 sexually active heterosexuals.
Taking PrEP reduces the risk of
HIV infection through sexual
transmission by as much as 92%
and by about 70% in people who
inject drugs, the CDC says. Still,
one in three primary care doctors
haven’t heard of the medication,
according to a 2015 CDC survey.
The agency has issued clinical
guidelines with charts and checklists to assist health-care providers
during patient evaluations, and offers a telephone hotline for people
to get free expert clinical advice
on PrEP. “As with any new health
intervention, it will take time for
people to learn about and become
comfortable with PrEP,” a CDC
spokeswoman said.
“More high-risk individuals
Please see HIV page D4
Down on the Sit-Up
The sit-up has been a staple
of military fitness tests,
including one performed by
the Navy in 2010 in
Yokosuka, Japan, top. Some
experts say plank pose, seen
here done by Colorado-based
personal trainer Jessica
Crandall, above, works more
muscles and is easier on the
back. The Canadian Armed
Forces recently ditched situps in favor of more realworld tasks, like lifting a 44pound sandbag, right, in
overhauling its fitness test.
New Views on Long-Term Risks of Frequent Drinking
Here’s a sobering thought for
the holidays: Chronic heavy drinking can cause insidious damage to
the brain, even in people who
never seem intoxicated or obviously addicted.
Experts say alcohol-related
brain damage is underdiagnosed
and often confused with Alzheimer’s disease, other forms of dementia or just getting older.
Now, brain imagHEALTH
ing is revealing how
JOURNAL long-term alcohol
abuse can change the
structure of the
brain, shrinking gray-matter cells
in areas that govern learning,
memory, decision-making and social behavior, as well as damaging
white-matter fibers that connect
one part of the brain with others.
“As we get older, we all lose a
little gray-matter volume and
white-matter integrity, but in alcoholics, those areas break down
more quickly. It looks like accelerated aging,” says Edith Sullivan, a
professor of psychiatry and behavioral science at Stanford University, who has studied alcohol’s effects for years.
Long-term alcohol abuse also
changes how the brain regulates
emotion and anxiety and disrupts
sleep systems, creating wide-ranging effects on the body.
Increasingly, clinicians are diag-
nosing “alcohol-induced neurocognitive disorder” and “alcohol-related dementia.”
How much is too much and
over what period of time? Researchers are reluctant to say, because alcohol’s effects are highly
individual and based on genetics,
age, sex, patterns of consumption
and general health.
The National Institute of Alcohol Abuse and Alcoholism (NIAAA)
says the probability of serious
health issues is low for men who
have no more than 14 drinks a
week, or 4 on a single day, and
women who have no more than 7
drinks a week or 3 on a single day.
Some people, though, experience
severe effects at lower levels.
Meanwhile, some studies show
that people who drink moderately
(generally defined as 1 drink a day
for women, 2 for men) have a
lower risk of cardiovascular disease, depression and some cognitive issues than those who don’t
drink at all. The risks of harm
rises the more alcohol consumed.
Also unclear is whether heavy
drinking during a person’s teens
and 20s, when important brain
connections are still forming, has a
lasting effect on brain function in
later life.
Some researchers are bracing
for a wave of cognitive problems
as baby boomers age. “Sad to say,
we think their increased exposure
in the 1960s has put them at sub-
stantially higher risk for alcoholrelated mortality and morbidity
than the generation before them,”
says Gary Kennedy, chief of geriatric psychiatry at Montefiore Medical Center in Bronx, N.Y.
While long-term heavy drinking
affects the entire brain, the greatest damage occurs in the frontal
lobe that controls executive function, which includes planning, controlling impulses and modifying
behavior, according to imaging
studies.
“The very part of the brain that
you need to change your alcoholic
intake may be most impacted by
drinking,“ says Catherine Fortier,
an assistant professor at Harvard
Medical School and researcher at
the VA Boston Healthcare System,
who has led imaging studies.
Many of alcohol’s effects on the
brain and behavior are similar to
cerebral-vascular dementia, the
second most common form of dementia, which reduces blood flow
to the brain and affects thinking
and reasoning more than memory,
as Alzheimer’s disease does.
That’s important for families to
keep in mind, says Dr. Kennedy. “A
person may have only minor impairments in memory, so families
can’t understand why they aren’t
taking care of themselves, can’t
manage a checkbook, can’t get out
of the house or stay on a task.”
Such damage to executive funcPlease see DRINKS page D3
The Good, the Bad, the Dangerous
GETTY IMAGES
BY MELINDA BECK
‘MODERATE’ DRINKING
(Up to 1 drink a day for women, 2 for men)
Observational studies show it can lower the risk of cardiovascular
disease and depression, and help maintain cognitive function, perhaps bykeeping people socially active.
‘LOW RISK’ DRINKING
(Up to 3 a day/7 a week for women; 4 a day/14 a week for men)
Staying within both limits has a low risk of short- and long-term
health issues. But certain people, including pregnant women and
people under age 21, should abstain.
HEAVY OR ‘HIGH RISK’ DRINKING
(More than 3 drinks a day/7 a week for women;
and 4 a day/14 a week for men)
Regularly exceeding these levels raises the risk of: long-term
cognitive damage; memory loss, depression; cirrhosis of the liver;
high blood pressure; stroke; Type 2 diabetes; cancer of the throat,
esophagus, breast and colon; as well as drowning, falling and motor
vehicle accidents.
Source: National Institute on Alcohol Abuse and Alcoholism, U.S. Dietary Guidelines