“The core muscles provide stability for the entire body as it moves,” @ClevelandClinic

cleveland evrything starts wit your core

If you’re planning to start an exercise program and wondering where to begin, start with your core first, says physical therapist Brittany Smith, DPT. People often think of the core muscles as being the abdominal muscles, but the core includes the muscles in the abdomen, back and hips, all working together as a group.

“The core muscles provide stability for the entire body as it moves,” says Smith. “These muscles are activated when you stand up, turn, bend, reach, twist, stoop and move in most other ways. Everything starts with your core.”

Strong core muscles help you maintain good posture, while weak ones can lead to slouching and slumping. Poor posture can be a cause of aches and pain, especially in the back.

Getting started with your core

To get your core muscles in shape, you need to exercise.

“Our bodies were made to move, so any physical activity is really important,” says Smith.

She recommends these specific core-strengthening exercises below.

The first one engages the deep muscles in the abdomen, called the transverse abdominis. “These muscles help hold us in a better position to stabilize our core, thereby stabilizing our arms and legs,” says Smith.

“The more you work on these muscles, the more it will become second nature to hold these muscles tight when you’re lifting grocery bags, doing yard work or any other kind of physical activity,” says Smith. This will help support your body.

Other muscles that tend to be weak are the gluteus maximus in the buttocks, and the gluteus medius and gluteus minimus on the side of the hip. The bridge and clamshell exercises can help strengthen these muscles.

Smith emphasizes that getting the proper position of these exercises correct is more important than the number of repetitions you do. “It’s better to take your time, maybe do fewer reps, but with better quality,” she says. For that reason, it can be helpful to have the guidance of a physical therapist to get started.

Move on from the core

Core exercises are the starting point of overall fitness because you need to hold those muscles engaged while you strengthen other muscles, such as the biceps in the arms or the quadriceps in the legs.

Smith suggests setting short-term goals (for about a month) and then more long-term goals. Once you have achieved short-term goals, such as getting around more easily, add other types of weight-training or resistance exercises to build muscle elsewhere.

With any exercise you do, always listen to your body, warns Smith. If you have pain other than muscle burn, take it easy. Reduce the number of repetitions, the weight or the duration of the exercises. Then build up gradually. “You don’t have to be in pain to make gains,” she says.

Beginner exercises for core strength

For each of the following, work up to one to two sets of 10 to 15 repetitions once a day.

Abdominal bracing

Lie on your back with your knees bent and feet flat on the floor. Contract your abdominal muscles, and press the arch of your back down toward the floor, pulling your belly button toward your spine. Hold for 5 to 10 seconds. Make sure your lower back stays flat on the floor. Relax and repeat.


Lie on your back with your knees bent and feet flat on the floor with your arms at your sides. Squeeze your abdominal and buttocks muscles, push your heels into the floor and slowly lift your buttocks and hips off the floor. Keep your back straight. Hold for 5 to 10 seconds.


Lie on your side with knees bent in line with your hips and back, draw up the top knee while keeping contact of your feet together as shown. Don’t let your pelvis roll back during the lifting movement. Hold for 5 seconds.

Planning to Start Exercising? Start with Your Core First

A Strong Core is Your Best Guard Against Back Pain @ClevelandClinic

A group of adults are taking a fitness class together at the gym. They are working out on exercise mats and are holding a high plank.
A group of adults are taking a fitness class together at the gym. They are working out on exercise mats and are holding a high plank.

A physical therapist answers your questions

If you suffer from back pain, you’ve probably heard that strengthening your core can bring you some relief. But is this always true? And if so, how do you do it? We spoke with Cleveland Clinic physical therapist Patti Mariano, DPT, to find out.

Q: What is your core?

When most people think about the core of the body they think of the abdominal or six-pack area just below the ribs. While the abdominal muscles are an important part of the core, we consider other areas important, too.

Your core includes:

  • Front abdominal muscles — the rectus abdominis
  • Muscles along the side of your body — the internal and external obliques
  • A deep muscle that wraps around the front — the transverse abdominis
  • Muscles in your back that are located between your spine bones and run along your spine — the erector spinae and multifidi

Your core also includes the diaphragm and muscles of the pelvic floor. I also consider the gluteal muscles as core muscles.

Q: What is the relationship between core strength and back pain?

Theoretically, if your muscles around the low back are weak, your body will rely more on passive structures, including ligaments — the tissue that connects bone to bone — as well as the spinal bones or discs, which lie between the spinal bones, for stability, which can cause pain.

But some studies have shown that specific core exercises are not any more beneficial than general exercise for low back pain. What we know is that exercise in general can help, and focusing on core muscles may provide some additional benefit.

Q: What are some exercises for the core that can help with back pain?

Here are my top five:

  • Side plank — Sit on the floor with your right hand below your right shoulder and feet stacked. Lift your body, keeping your legs long, abdominals engaged and feet stacked. Hold. Repeat on the other side. You can modify this pose by dropping your bottom knee to the floor for extra support.
  • Plank — Kneel on all fours. Pull in your abdomen and step your feet behind you until your legs are straight. Keep your hands directly under your shoulders and your neck straight. Hold your abdomen and legs tight and avoid letting your lower back sag. Hold and breathe for 30 seconds. You can modify this pose by lowering your knees.
  • Bird dog — Kneel  on all fours. Reach one arm out in front of you, draw in your abdomen, and extend the opposite leg long behind you. Repeat on the other side.
  • Scissors — Lie on your back with your arms at your sides and legs pointed straight into the air above your hips. Press your lower back into the mat and tighten your abdomen. Lower your right leg until it’s a few inches from the floor. Raise your right leg up and begin lowering your left leg the same way. Continue switching right and left.
  • Upward dog — Lie face down with head slightly lifted and hands palm-down under your shoulders. Point your toes. Exhale, then press through your hands and the tops of your feet and raise your body and legs up until your arms are straight and your body and legs are off the ground. Keep your neck relaxed and long and thigh muscles tight as you hold and breathe.

For the plank exercises, start by holding them for 15 seconds to 30 seconds. For bird dog and scissors, try three sets of eight or 10 repetitions. For upward dog, do one set of 10 repetitions.

Q: Can you injure your back by trying to strengthen your core?

Any exercise performed incorrectly, whether it is core-strengthening or otherwise, has the potential to cause discomfort.

Twisting exercises or even incorrectly completing the exercises cited above can cause pain in the low back. But it’s highly unlikely that one repetition of an exercise will seriously harm your body, unless it’s an exercise using a very heavy weight.

The best way to keep your body safe is to listen to body cues such as pain during and immediately after an exercise, and the next day after exercising.

Q: When should you talk to a doctor about your back pain?

If any of the following is going on you should consult with your doctor:

  • Your pain has been going on for longer than a month, despite resting from activities that make it worse.
  • Your pain is getting worse.
  • Your pain wakes you from sleep.
  • Your pain is in your low back but also is going down one or both of your legs.
  • You notice that one leg is becoming weaker than the other.

Q: Where should you turn if you want help in creating a plan to address back pain?

Physical therapists train as musculoskeletal experts — they are the experts on muscles, bones and human movement. These professionals are the most qualified, aside from an orthopedic doctor, to assess back problems.

Since there are many factors that impact low back pain and many types of low back pain, it is a good idea to visit at least one time with a physical therapist for an evaluation and subsequent plan of care. This will give you an individually tailored plan with exercises that progress safely.

The idea of core strengthening, while beneficial, is just one piece of the low back pain puzzle.



Beta-glucan is abundant in oats and barley and has been shown “quite unequivocally” to help maintain healthy cholesterol levels, @American_Heart

American Heart Association


Oats and oatmeal have powers you probably didn’t know about — like nutrients to help lower cholesterol and enough fiber to help you feel fuller longer. They just might be quiet heroes of #BetterBreakfastMonth.

(Arx0nt/Moment via Getty Images)

By Michael Merschel, American Heart Association News

Let’s admit it: Oatmeal is a total nerd. It lacks fashion sense – the color they named after it is somewhere on the drab side of beige. It’s often seen with Sesame Street’s Bert, who also loves bottle caps, paper clips and pigeons.

But when it comes to healthy eating, oatmeal and the oats it comes from can definitely hang with the cool kids at the breakfast table.

“It has many, many good qualities,” said Candida Rebello, director of the nutrition and chronic disease research program at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge.

Extensive studies have associated oats and oatmeal with plenty of heart-healthy benefits, such as lowering cholesterol (both total and “bad” LDL cholesterol) and helping with weight control.

Oatmeal has a host of vitamins and minerals. Two examples: According to the U.S. Department of Agriculture, a one-cup serving of cooked oatmeal has about 1.8 milligrams of vitamin B1, or thiamin. That’s close to 15% of what an adult needs each day. It also has 1.36 mg of manganese, which is 59% of the daily recommendation for men and 76% for women. Manganese has roles in immunity, blood clotting and the way cholesterol and blood sugar are metabolized.

But that’s not what makes oats stand out, Rebello said. That same cup of cooked oatmeal has just 166 calories and nearly 4 grams of dietary fiber.

And the type of fiber is where oats start to distinguish themselves. It’s called beta-glucan. Put that in the conversation, and it’s like the scene in a movie where oatmeal takes off its glasses and everyone realizes just how beautiful it is.

Not literally. It’s a soluble fiber, which means it dissolves in hot water, where it thickens. “When you eat oatmeal, the kind of sliminess that you see – that comes from this viscosity that beta-glucan generates,” Rebello said.

That helps you feel full longer, she said. And it helps undigested food travel farther down your digestive tract, where it feeds the friendly bacteria living there.

Beta-glucan is abundant in oats and barley and has been shown “quite unequivocally” to help maintain healthy cholesterol levels, Rebello said.

Oats also are rich phytonutrients – plant-derived substances that may boost health. One class of such phytonutrients is avenanthramides, which are found only in oats. Avenanthramides may have antioxidant and anti-inflammatory effects, although Rebello said their possible benefits are not as well-researched as those for beta-glucans.

Oats have been linked to heart-health benefits since the 1960s and come in many forms. The differences involve levels of processing.

Oats grow in an inedible casing called a hull. Inside the hull is a seedlike groat. That groat is encased in bran. “In other whole grains, like in wheat, you can remove that bran layer,” Rebello said. “But in oats, this groat is very soft, so that bran layer cannot really be removed.”

That means oats are almost always a whole-grain food, and those are a key part of a healthy eating pattern.

If oats are labeled “steel cut,” it simply means they were processed with a steel cutter, Rebello said. Rolled oats are steamed first, then pressed with a roller. “If the roller crushes it into thinner flake, then you get quick-cooking oats,” she said. “If it is then rolled into an even thinner flake, you get your instant oats.”

Rebello said that nutritionally, there is little difference between steel cut and rolled oats. Instant oats, however, have a higher glycemic index, meaning they raise your blood sugar faster.

When oats are ground to flour, the coarser portion is extracted and called oat bran. The beta-glucans will be concentrated in the flour rather than the bran, she said.

Oat milk is derived from oats and water, but processing may add ingredients such as sugar, salt, oil and more. Oat milk has some dietary fiber, Rebello said – commonly 2 grams per cup – but the amount of beta-glucan is rather small.

Unfortunately, Rebello ruled out sugar-filled oatmeal cookies as a healthy food (although she’s not averse to having one as a treat now and then).

How, then, to embrace oats? “Just eat regular oatmeal,” she said. Half a cup of rolled oats cooks up quickly and will keep you full a long time.

Oatmeal with your favorite fruit can be a sweet way to start the day. Cook it in low-fat milk for creaminess and add unsalted nuts to bolster its heart-health value. If you’re time-pressed in the morning, try a healthy version of overnight oats, which can be prepared the night before.

It’s important to remember that no single food, even oats, can do it all, Rebello said, noting that if you eat a nutritious breakfast but then load up on sugar and fat the rest of the day, “that’s really not going to help you much.”

But you should go ahead and invite oatmeal into your breakfast club, Rebello said. “I definitely recommend eating oats.”

If you have questions or comments about this American Heart Association News story, please email editor@heart.org.

Alcohol has risks. We must all aim to minimise those risks. @Dr.Paddy_Barrett preventative cardiologist @HealthBlackrock

Let’s start with some simple facts.
Alcohol is a toxin.
Alcohol is a factor in1:
30% of suicides
40% of fatal burn injuries
50% of fatal drownings
50% of homicides
65% of fatal falls
29% of fatal road traffic accidents
Globally, alcohol is responsible for 3 million deaths per year; in the United States, it is the third leading cause of preventable death2 3.
It is hard to see the upside when you see these figures.
So let’s go a little deeper.
First off, I drink alcohol. Not a lot. But I do drink.
So any comments made here are not some puritanical position on alcohol but reflections on the data that exist in the literature.
Multiple studies have demonstrated that excess alcohol consumption, usually defined as consuming greater than 2 to 4 drinks per day, is associated with worse outcomes and a greater likelihood of dying when compared to someone who drinks less than 2 to 4 drinks per day4.

Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies. Arch Intern Med.2006

In the study shown above, females start to accrue an increased risk at greater than two drinks per day on average and males at greater than four drinks per day.

These findings shouldn’t come as a surprise to anyone.

Surprisingly, on average, individuals who consume less than two drinks per day appear to have better outcomes than those who do not drink at all. This is where things start to get a little counterintuitive, and the story of alcohol being beneficial for you starts to appear.

This relationship is known as a ‘U’ shaped curve where those in the middle have the best outcomes, and those on the edges have worse outcomes. A kind of ‘Goldilocks’ relationship; “Not too hot. Not too cold. Just right.”

How might we explain this?

Enter the darling of the 1990s, Resveratrol. This compound in red wine spawned the mantra that red wine was ‘good for your heart’. This was based on research that suggested that it might reduce cholesterol levels, among other things.

But to consume the levels of Resveratrol tested in some of the animal studies that demonstrated benefit, you would have to drink 40 litres of wine…… Per day.

Not exactly a feasible strategy. Even with the best will in the world.

Let’s look at a more plausible explanation.

Data on alcohol consumption and outcomes are almost always based on observational data, not randomised controlled trials. This means that other factors or ‘confounders’ may explain the difference between the groups, not the alcohol consumption alone.

When you look at the trials that suggest a benefit of modest alcohol consumption, you will often find that this group tend to exercise more, smoke less, be in a higher socioeconomic bracket etc. This is referred to as a ‘healthy user bias’ and is likely to explain the difference between the groups.

Most trials try to correct or adjust for these confounders, but in truth, it is very hard to do. A recent publication looked at this problem and attempted to (as much as possible) correct for these ‘healthy user’ bias factors and then compare outcomes between alcohol consumption groups. The results were a little more in line with what we might expect.

Those in the lowest alcohol consumption category had the best lifestyle factors overall. When these healthy factors were corrected for, any benefit seen with modest alcohol consumption disappeared. What remained was a linear relationship between alcohol consumption and coronary artery disease5. Much more what you might expect.

Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022

Research like this and other studies is where the more recent media reports of ‘any’ alcohol being bad for you have come.

So, alcohol is a toxin. But, as Paracelsus notes:

“The dose makes the poison.”

Even water consumed to excess can be lethal.

We know that excess alcohol consumption is harmful. But I don’t think there was any great uncertainty around that point.

The key takeaway is that modest alcohol consumption is unlikely to be ‘beneficial’ to you. As much as you loved the idea that red wine was good for your heart, we can say with reasonable confidence that this is not the case.

The real question we need to answer is whether consuming modest amounts of alcohol is considerably worse for you when it comes to heart disease and death from any cause.

Based on the literature to date, it seems that the incremental risk for modest amounts of weekly alcohol consumption is likely to be small. But that doesn’t mean there are no downsides.


One of the main reasons I significantly reduced my alcohol consumption was its effect on my sleep. If I drink more than one drink, I find that the quality of my sleep gets worse. I am much more likely to wake in the middle of the night and feel the effects the following day. But that’s just my personal experience.

Although alcohol is likely to make you fall asleep faster, it impacts your sleep quality6. Additionally, alcohol also reduces the percentage of REM sleep a person gets overnight7.

A workaround for me is to consume any alcohol during the daytime, so my sleep is unlikely to be affected, and if I am going to have a drink, I make sure it is worthwhile. I.e. I am with friends, or it is a high-quality drink. No more drinks on airplanes for me. Mainly because you lose about 30% of your sense of smell and taste in a pressurised cabin and therefore you are less likely to enjoy your drink8. Why do you think they serve you tomato juice and the fact that you think it’s tolerable?!

Humans have been consuming alcohol as far back as the ancient Egyptians, and some evidence suggests the Chinese were consuming alcohol as far back as 7000 B.C. So I don’t see alcohol disappearing any time soon.

The question we all need to ask is:

How much are we realistically drinking on a daily or weekly basis &

Is it likely to be doing us harm?

Only you can answer that question.

The only way to be certain you are doing no harm is to eliminate alcohol entirely. But life is full of risks, some of which we can control, some we cannot.

And some risks are worth taking.

Want to eliminate all road traffic accidents worldwide?


Ban cars.

But at what cost?

The risks of driving are a risk most of us are willing to take.

Alcohol has risks.

We must all aim to minimise those risks.

Whatever that means for you, only you can decide.




Mokdad, A.H.; Marks, J.S.; Stroup, D.F.; and Gerberding, J.L. Actual causes of death in the United States, 2000. JAMA 291(10):1238–1245, 2004. Erratum in JAMA 293(3):298, 2005.


Centers for Disease Control and Prevention (CDC). Alcohol and Public Health: Alcohol-Related Disease Impact (ARDI). Annual Average for United States 2011–2015 Alcohol-Attributable Deaths Due to Excessive Alcohol Use, All Ages.


Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies. Arch Intern Med.2006;166(22):2437–2445. doi:10.1001/archinte.166.22.2437


Biddinger KJ, Emdin CA, Haas ME, et al. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022;5(3):e223849. doi:10.1001/jamanetworkopen.2022.3849


Britton, A., Fat, L.N. & Neligan, A. The association between alcohol consumption and sleep disorders among older people in the general population. Sci Rep 10, 5275 (2020). https://doi.org/10.1038/s41598-020-62227-0


Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013 Apr;37(4):539-49. doi: 10.1111/acer.12006.


Burdack-Freitag, Andrea & Bullinger, Dino & Mayer, Florian & Breuer, Klaus. (2010). Odor and taste perception at normal and low atmospheric pressure in a simulated aircraft cabin. Journal für Verbraucherschutz und Lebensmittelsicherheit. 6. 95-109. 10.1007/s00003-010-0630-y.