s a visitor or patient at the Hirslanden Clinic, you have more in common with a Formula 1 driver than you think. An F1 driver who spends 7 hours in the car (and another 7 hours in meetings) needs maximum endurance, strength and the best reaction time to repeatedly cross the finish line safely and quickly. Executives with 90 Key Performance Indicators or seniors at the age of 75 want to improve or maintain their performance in a different context, whether it is a corporate project or hiking with the grandkids. To take it to an "F1 level in life", you have to look at the body holistically and consider muscle strength as one of the most important measures of prevention and rehabilitation. Whether it is in motorsport, in business or in everyday life. In medicine, we speak of primary and secondary prevention.
"We are not slaves to our genes. We shall not take our health for granted, and there is a lot we can do to optimize it in everyday life."
For F1 drivers, special attention is dedicated to physical as well as mental endurance, strength, focus, reaction time and prevention of musculoskeletal problems. But the same applies for everybody else leading their ordinary lives. Whether you drive Red Bull, McLaren, Mercedes or ride a bike, you consult an expert having one goal: to either optimize performance or prevent illness or injury. At different times, we prioritize one goal or the other. Unfortunately, we all get sick or injured at some point. For physicians, this means applying the measures of preventive medicine intelligently. What does it mean concretely?
Preventive medicine is about avoiding illness and injury by eliminating health risks such as a lack of sleep, stress, smoking, obesity, a lack of exercise, poor stress levels, overuse of alcohol and medications(primary prevention) and optimizing health, resilience and performance(secondary prevention). In addition to rehabilitation, secondary prevention plays an essential role in the long term, because one wants to maintain well-being and performance at all times. In the following, I highlight what to pay attention to in order to increase performance and well-being in everyday life.
All too often with exceptional performance in sports or as we age, we hear "this is genetically predisposed." But we are not slaves to our genes. It is well known that strong and healthy muscles, as well as strength and endurance training, have a positive influence on the heart, circulation, lungs, gastrointestinal tract, metabolism, hormones and the brain. Conversely, the health of muscles and connective tissue is strongly influenced by lifestyle, circulation and metabolism. Strengthening muscles and connective tissue means strengthening the entire system and vice versa.
The loss of muscle mass begins on average at the age of 30 and amounts up to one percent per year. Medically, muscle loss can be quantified using computer tomography and can also be detected by urea nitrogen in the urine. However, we can counteract it well with a healthy diet and training, even at the age of 60, 70, or 80+. This is not only about building muscle through strength training, but also about promoting muscle elasticity and healthy bones, ligaments and tendons.
A healthy lifestyle and adequate training can also prevent injury - which is important because bed rest or immobilization in case of an injury lead to rapid muscle loss or atrophy. Muscle atrophy is also promoted by malnutrition in cases such as anorexia nervosa or when the protein intake is too low due to malnutrition. Especially in the evening it is important to take protein (also vegetarian sources like nuts, soy milk, oatmeal, lentils) to reduce muscle breakdown during the catabolic phase of sleep. It is also worth mentioning that seniors at the age of 65 and older have an increased protein requirement and need at least 1.0 gram of protein per kilogram of their body weight, both for muscles and bones and for a strong immune system.
Hormones also have an impact on musculo-skeletal health. It is well known that female hormones such as estrogen and progesterone affect the properties of the connective tissue and that the risk for anterior cruciate ligament rupture (tear) is much higher in women than in men. In addition, the risk of rupture is significantly higher in the first half of the menstrual cycle. Meta-analyses show that oral contraceptives can reduce the risk of rupture by up to 20%. Thus, when creating a training program for female athletes, menstrual cycle influence can be considered, and oral contraceptives can be used as protection. Therefore, every woman shall be aware that not only her performance level is much lower at the beginning of the cycle, but the risk of injury is also higher.
For optimal performance in life and in sports, rest and sleep are highly significant. Without super compensation, i.e. resting and replenishing glycogen stores between training sessions, we cannot increase our performance and in the worst case even deteriorate it. During sleep, waste products in the brain are transported away and energy reserves are built up for the next day. Studies show that the universal energy carrier ATP is built up in the brain during deep sleep so that we can focus again during the day and function optimally, as well as perform mentally and physically. It is estimated that a quarter of all traffic injuries happen due to lack of sleep and thus lack of concentration as well as reduced analytical ability. Sleep and sleep quality are multifactorial, but diet plays a role here as well. A protein-rich dinner not only improves sore muscles, but also sleep quality. Carbohydrates and fat may shorten sleep.
Eccentric training which feels like resisting in strength training, better exploits the potential of the muscle. It increases muscle growth, increases strength (studies even show an increase of the maximum strength up to 10% within a few weeks), trains explosiveness, connective tissue, tendons and joints (which can thus take more strain and push performance even further) and improves rehabilitation after injuries and breaks in training. Therefore, strength exercises are so important to treat osteoarthritis and cartilage degeneration and help maintain mobility and joint flexibility and to combat pain. In addition, chondroitin sulfate can also make cartilage resistant to pressure and stress.
Strength and endurance exercises are also important for improving the course of chronic diseases. For example, it is well known that building muscle mass reduces insulin requirements in type 2 diabetics and improves insulin resistance. Unfortunately, poorly controlled diabetes negatively affects the muscles and body, promotes inflammatory and harmful processes in the body and accelerates muscle breakdown. So, on the one hand it is important for diabetics to do strength and endurance sports to improve the prognosis of the disease, and on the other hand, blood sugar should be well controlled by medication to protect the muscles from degeneration and inflammation.
"Strong is great" but more exercise is not necessarily better. Rather, it is about exercising properly and taking care of both the mind and body holistically.
On the hormonal end, besides insulin, estrogen and testosterone also affect muscles and connective tissue. In the case of estrogen deficiency due to menopause or RED-S (Relative Energy Deficiency in Sports, formerly Female Athlete's Triad), bone weakness occurs relatively quickly, which can later lead to osteoporosis and fractures. Based on the experience gained by NASA astronauts in space and what other studies demonstrate is that a significant increase in bone mineral density can be achieved through a properly implemented strength training program, see the reference below. Especially in case of fatigue fractures, it is also important to build bone health and strength. Then, it is necessary to ensure an adequate supply of calcium and vitamin D3 as well as sufficient protein and calorie intake. Some studies also show that vitaminK2 can play a role in prevention.
"With the increase of muscle mass, other organs in our body increase their performance. This is also why it is important to build muscle mass."
Whether one's goal is to cross the finish line first in sports or to perform and feel good in everyday life, it is essential to take a holistic approach and strengthen the whole system. The health of muscles and connective tissue play a vital role and are strongly influenced by lifestyle, cardiovascular system and metabolism. In addition to internal organs such as the heart, lungs and gastrointestinal tract, also musculoskeletal components such as tendons, ligaments and bones must be cared for and rehabilitated when injured. The goal should always be to strengthen the whole system and this regardless of whether you are 25 or 75 years old, whether you want to win a race, or just enjoy the day.
References:
Smith, M.F. et. al. (2012). Benefits for bone from resistanceexercise and nutrition in long‐duration spaceflight: Evidence from biochemistryand densitometry. Journal of Bone andMineral Research, 27(9).
Miller, T. L., & Best, T. M. (2016).Taking a holistic approach to managing difficult stress fractures. Journal of Orthopaedic Surgery and Research,11(1), 98.
Dr. med. Dr. phil. Anna Erat is chief physician at the Hirslanden Check-up Center. After several years of research at Harvard Medical School, she specialized in internal medicine, sports medicine and prevention. She cares for top athletes in her role as a national team physician at Swiss Ice Hockey and also Formula 1 drivers for Hintsa Performance, among others. She publishes regularly in scientific journals and teaches medicine students in Zurich.
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