A little bit of exercise makes a big difference - USATODAY.com

For you couch potatoes out there, or for those who think you should be doing maybe just a little bit more exercise......read on below. This article offers some good practical advice for exercise. Plus, as we all know, we can ask our local PT!

A little bit of exercise makes a big difference - USATODAY.com

A Good Walking Program!

Thinking about beginning a walking program to help recover from an injury or condition, or just to get in better shape? Here is a good place to start with some good guidelines from the American Academy of Orthopedic Surgeons (AAOS).

We also advocate including mobility and strengthening work into your exercise program, but walking is an excellent place to start for beginners if you're trying to improve your physical condition. And as always, a good physical therapist can help you get started if you're not sure what to do!

COURTESY OF THE AAOS

Exercise Walking

The average person walks between 2,500 and 5,000 steps each day. Although this may seem like a lot, you may want to add more steps to your daily routine with an exercise walking program. Consider the benefits to your physical and mental health:

• A brisk walk increases your intake of oxygen, strengthens your heart to pump more blood, improves circulation, and lowers blood pressure.
• Walking also slows development of arthritis, slows loss of bone mass in osteoporosis, and tones your muscles gently.
• Walking reduces stress, helps you keep a positive outlook, can make you feel (and look) younger, and can help you sleep more deeply and restfully.

If you are recovering from a recent injury or surgery or have a chronic condition, you may want to see your doctor before beginning a walking program. You may be able to withstand the low-stress effort of walking without aggravating your condition. Walking has helped many people find relief from arthritis and back pain.

You can walk alone or with friends, almost anywhere and anytime it is convenient for you. The only equipment you need is a good pair of shoes, which should be comfortable and supportive and not cause blisters or calluses. Choose shoes that support the arch and elevate the heel slightly. There should be stiff material surrounding the heel (the heel counter) that keeps your heel from turning in or out or wobbling. The toe box should be roomy but not too long.

Starting Your Program

When you start your exercise program, warm up by walking as you normally would for 5 minutes, then pick up the pace to whatever speed gets your heart beating faster and your lungs breathing deeper. Keep up the faster pace for about 15 minutes. While you walk:

• Swing your arms
• Keep your head up, back straight, and abdomen flat
• Point your toes straight ahead
• Take long strides, but do not strain

Cool down by walking at your warm-up speed again for 5 more minutes. Do gentle stretching exercises when you are done.

Establish a Routine

Repeat the above routine 3 or 4 days a week with days for rest in between. After 2 weeks, add 5 minutes to the strenuous part of your walk. Keep adding 5 minutes every 2 weeks as you gradually build strength and endurance.

Another way to build fitness with a walking program is to use walking sticks or poles. Using a stick in each hand gives your upper body a better workout and provides your lower body with more stability.

Proper Hydration

During exercise, be sure to keep a water bottle handy to prevent dehydration. Drink 1 pint of water 15 minutes before you start walking, and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise.

Commit to Physical Activity

When you start an exercise walking program, you are making a commitment to yourself to be more physically active. This should be a lifetime pursuit, as the major health benefits of exercise walking take place over time.

Keep track of your progress as you become more physically fit and increase the intensity of your workouts. You might consider getting a pedometer (available at most sporting goods stores) that clips on your belt and automatically records every step you take. In addition to your exercise walking routine, consider ways you can build more steps into each day, such as taking stairs instead of elevators or parking your car at the far end of parking lots.

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.

Staying Fit as We Age: Some Practical Advice and Thoughts

Nice video below from Move Forward PT discussing the importance of "keeping moving" as we get older.

It's Hot - Stay Hydrated!

Especially if you're working outside in this heat, don't forget to drink plenty of water. We recommend you drink at least half of your body weight in ounces each day - more if you are active/exercising. For example, if you weigh 200lbs., you would want to drink at least 100oz. of water daily. So carry that water bottle with you, and get out and have fun.

Good, short article below about heat injury and how to prevent it.

http://www.stopsportsinjuries.org/heat-illness.aspx

Study Links Excessive Weight, Lack of Exercise, To Pain

NEW YORK (Reuters Health) - It may not be surprising, but people who exercise at least one hour per week have a lower risk of troublesome back, neck, and shoulder pain, a new study shows.

The new evidence supports the possibility that obesity and physical inactivity play a role in a person's risk of developing chronic pain in those areas, said study co-author Dr. Paul Mork, of Norwegian University of Science and Technology in an email to Reuters Health.

Mork and colleagues followed more than 30,000 adults who participated in a large Norwegian health study. They recorded participants' body mass index (BMI) - a measure of weight related to height - at the start of the study, as well as how often they exercised, and then tracked them over the next 11 years.

The authors divided the participants into four categories based on how often they exercised, and four categories based on their BMI. They also looked at how many people in each category developed chronic neck, shoulder, and lower back pain.

Overall, 1 of every 10 people in the study developed lower back pain, and nearly 2 of every 10 developed shoulder or neck pain.

After taking into account participants' age, BMI, whether or not they smoked, and whether they did manual labor at work, the research team found that men who were exercising 2 hours or more per week at the start of the study were 25 percent less likely to have lower back pain 11 years later, and 20 percent less like to have neck or shoulder pain, compared men who didn't exercise at all. And women who exercised at least 2 hours per week were 8 percent less likely to develop lower back pain than women who were inactive, and 9 percent less likely to develop neck and shoulder pain.

Weight, not surprisingly, also affected the risk of chronic pain later on. Obese men were almost 21 percent more likely to develop chronic lower back pain than men of normal weight, and 22 percent more likely to develop neck or shoulder pain. Obese women were also 21 percent more likely to develop lower back pain than women of normal weight, and 19 percent more likely to develop neck and shoulder pain.

Based on the results, Mork believes that even moderate physical exercise - just one hour or more per week - "can, to some extent, compensate for the adverse effect of being overweight and obese on future risk of chronic pain."

"Chronic neck and back pain are important to public health due to their substantial influence on quality of life, disability, and health care resources," Dr. Adam Goode from Duke University in Durham, North Carolina told Reuters Health by email. Goode, a physical therapist, was not involved in the study by Mork's group.

Back in the mid-1990s, a study from the Netherlands estimated that low back pain cost that country nearly 2 percent of its gross national product. In their new paper Mork and colleagues write that "just a small reduction in the incidence of chronic lower back pain would have a profound economic impact."

Because of the way it was designed, the Norwegian study can't prove that lack of exercise and being overweight actually caused people's chronic pain, or that regular exercise and a more healthy weight prevented it. It could be that the people who did or didn't have chronic pain are different in ways the study did not measure.

However, given the known benefits of exercise and maintaining a healthy weight, Mork believes that "community based measures aimed at reducing the incidence of chronic pain...should aim at promoting regular physical exercise and the maintenance of normal body weight."

Staying Fit As We Age (Great Video)

Click below to see a great video (3:24) about how we can stay fit as we get older (and yes, Paul chose this because they talk about the squat (or sit to stand exercise - everyone's favorite!).

Surprise, Surprise....Exercise Helps Your Brain As Well As Your Body

Exercise and Brain function: Start Early and Do It Often

(Courtesy of Evidence in Motion)

A nice summary of some interesting preliminary evidence that the benefits of exercise begin early in life.

The conclusion and take-away are clear: Young people need more aerobic exercise, and I would argue so do our patients.
Interestingly, according to an unpublished study from his lab which compared the cognitive impact in young people of 20 minutes of running on a treadmill with 20 minutes of playing sports-style video games at a similar intensity, running improved test scores immediately afterward. Playing video games did not. Message: get kids moving and preferably away from their Wiis. Old-school rules here……move more.

It's Drugs, Surgery, or Us

A great post from Evidence In Motion below. Would love to hear your thoughts.........

Ever get the feeling that the more things change the more they stay the same? The links below to two recent medical headlines remind me of the fact that despite our health care system being bro ken (and the Affordable Health Care for America Act has not and will not fix it), the following tune within the culture seems to only grow stronger: a. More surgery (at ever younger ages, more extensive procedures, and for increasingly “elective” reasons and b. More drugs.

In the first case, total joint replacement and resurfacing procedures have transitioned from being the last intervention option after all other means of relief have been exhausted to becoming a primary option for getting folks back to kite-boarding and basketball (make sure to view the video link on that page to hear a real expert interpret and explain things for us). In the second case, what could be better than a drug (Cymbalta) that works for not only one condition (depression in this case) but for two!! Everyone loves a two’fer, right? (in this case, make sure to read the important safety information posted at the top……does that apply when taking this for chronic MSK pain or only when I am taking it for depression?).

No question that total joint replacements and medication for selected conditions have their place, but when it comes to musculoskeletal pain should surgery and drugs be the primary interventions of choice? The answer to that rhetorical question is an obvious “NO”, but too few seem to be getting it or getting that message out. Besides common and fiscal sense, there has been a voluminous increase in the volume and quality of evidence that non-operative interventions provided by physical therapists can reduce pain, disability, and increase function. Oh yea, there is also evidence that these same non-operative interventions (a combination of education, manual therapies, and exercise in most cases) can also reduce depression, anxiety and fear in patients suffering from these conditions (the article by Main and George is a good place to begin with getting up to speed with what has been termed “psychologically informed practice”).

It’s been said before and I will say it again. When broken down into the simplest terms, a patient’s basic intervention choices when suffering from musculoskeletal conditions are: Drugs, Surgery or Us. We need more than evidence at this point to stop the Madness that has, in many cases, become what we know as health care. I am not sure what those “somethings” are (no silver bullet for sure), but it will involve a change in behavior of all parties involved, including the consumer.

Diabetes and Carbohydrates: What should I know?

Diabetes, which is a disease characerized by raised blood sugar levels (blood glucose), affects 25-26 million people in the U.S. Diet and exercise are very important components of controlling the effects of diabetes. This post discusses carbohydrates specifically, how they affect your blood sugar levels, and why it's a good idea to limit processed/refined starches and sugars in our diets (whether we have diabetes or not). If this post relates to you and you'd like more guidance on your specific diet, ask your physician or dietician.



(COURTESY OF http://www.diabetes.org/)

Nowadays, we hear about carbohydrate all the time.
Foods that contain carbohydrate raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. You may also be interested in our book, Diabetes Carbohydrate and Fat Gram Guide, 3rd Edition.

Did you know there are three main types of carbohydrate? There are

• Starches (also known as complex carbohydrates)
• Sugars
• Fiber

You'll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains, and whole grains.
No wonder knowing what kind and how much carbohydrate to eat can be confusing!

On the nutrition label, the term "total carbohydrate" includes all three types of carbohydrates. This is the number you should pay attention to if you are carbohydrate counting.

Starch

Foods high in starch include:

• Starchy vegetables like peas, corn, lima beans, and potatoes
• Dried beans, lentils, and peas such as pinto beans, kidney beans, black eyed peas, and split peas
• Grains like oats, barley, and rice. (The majority of grain products in the US are made from wheat flour. These include pasta, bread, and crackers but the variety is expanding to include other grains as well.)

The grain group can be broken down even further into whole grain or refined grain.
A grain, let's take wheat for example, contains three parts:

• bran
• germ
• endosperm

The bran is the outer hard shell of the grain. It is the part of the grain that provides the most fiber and most of the B vitamins and minerals.
The germ is the next layer and is packed with nutrients including essential fatty acids and vitamin E.
The endosperm is the soft part in the center of the grain. It contains the starch. Whole grain means that the entire grain kernel is in the food.
If you eat a whole grain food, it contains the bran, germ, and endosperm so you get all of the nutrients that whole grains have to offer. If you eat a refined grain food, it contains only the endosperm or the starchy part so you miss out on a lot of vitamins and minerals. Because whole grains contain the entire grain, they are much more nutritious than refined grains.

Sugar

Sugar is another type of carbohydrate. You may also hear sugar referred to as simple or fast-acting carbohydrate. There are two main types of sugar:

• naturally occurring sugars such as those in milk or fruit
• added sugars such as those added during processing such as fruit canned in heavy syrup or sugar added to make a cookie

On the nutrition facts label, the number of sugar grams includes both added and natural sugars.
There are many different names for sugar. Examples of common names are table sugar, brown sugar, molasses, honey, beet sugar, cane sugar, confectioner's sugar, powdered sugar, raw sugar, turbinado, maple syrup, high-fructose corn syrup, agave nectar, and sugar cane syrup.
You may also see table sugar listed by its chemical name, sucrose. Fruit sugar is also known as fructose and the sugar in milk is called lactose. You can recognize other sugars on labels because their chemical names also end in "-ose." For example glucose (also called dextrose), fructose (also called levulose), lactose, and maltose.
If you are looking for information about artificial sweeteners, try this section.

Fiber

Fiber comes from plant foods so there is no fiber in animal products such as milk, eggs, meat, poultry, and fish.
Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts, and legumes. When you consume dietary fiber, most of it passes through the intestines and is not digested.
For good health, adults need to try to eat 25 to 30 grams of fiber each day. Most Americans do not consume nearly enough fiber in their diet, so while it is wise to aim for this goal, any increase in fiber in your diet can be beneficial. Most of us only get about ½ what is recommended.
Fiber contributes to digestive health, helps to keep you regular and helps to make you feel full and satisfied after eating. Additional health benefits, of a diet high in fiber — such as a reduction in cholesterol levels — have been suggested by some so may be an additional benefit.
Good sources of dietary fiber include:

• Beans and legumes. Think black beans, kidney beans, pintos, chick peas (garbanzos), white beans, and lentils.
• Fruits and vegetables, especially those with edible skin (for example, apples, corn and beans) and those with edible seeds (for example, berries).
• Whole grains such as:
• Whole wheat pasta
• Whole grain cereals (Look for those with three grams of dietary fiber or more per serving, including those made from whole wheat, wheat bran, and oats.)
• Whole grain breads (To be a good source of fiber, one slice of bread should have at least three grams of fiber. Another good indication: look for breads where the first ingredient is a whole grain. For example, whole whe+at or oats.) Many grain products now have "double fiber" with extra fiber added.
• Nuts — try different kinds. Peanuts, walnuts and almonds are a good source of fiber and healthy fat, but watch portion sizes, because they also contain a lot of calories in a small amount.

In general, an excellent source of fiber contains five grams or more per serving, while a good source of fiber contains 2.5 - 4.9 grams per serving.
It is best to get your fiber from food rather than taking a supplement. In addition to the fiber, these foods have a wealth of nutrition, containing many important vitamins and minerals. In fact, they may contain nutrients that haven't even been discovered yet!
It is also important that you increase your fiber intake gradually, to prevent stomach irritation, and that you increase your intake of water and other liquids, to prevent constipation.
Because fiber is not digested like other carbohydrates, for carbohydrate counting purposes, if a serving of a food contains more than or equal to 5 grams of dietary fiber, you can subtract half the grams of dietary fiber from the total carbohydrate serving of that food.

More About Sitting and our Health

Work should be about optimizing your productivity and health

by Jay Parkinson, MD (Courtesy of KevinMD.com)

Do you spend 8 hours in front of a screen at work? Do you then spend your free time watching TV or poking around the internet when you get home? How much time are you spending cooking healthy meals to eat with friends and family? How much time are you doing physical activities that make you happy?
A recent study in the Journal of the American College of Cardiology entitled, Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events, found that,

recreational sitting, as reflected by television/screen viewing time, is related to raised mortality and CVD risk regardless of physical activity participation. Inflammatory and metabolic risk factors partly explain this relationship.

Essentially, we’re starting to understand health in terms of how much time you spend being sedentary, not about how much physical activity you get.


About six months ago, I purchased a standing desk. It took a few weeks to get used to standing all day, but now, for the rest of my life, I will never sit and work at a computer again. My time is now actively spent using my leg and core muscles rather than being almost 100% passive while sitting. I’m burning calories while working. However, there’s only one problem. I’m not using my arms.
Many years ago, Apple patented the concept of a touch screen iMac.

From what I hear, the problem with this type of computer interface is that people simply become exhausted using their hands all day interacting with a touchscreen mounted in front of them. It makes sense. Try and hold your hands in front of your body for a few minutes and you’ll understand. However, you would burn some significant calories. Imagine standing and waving your hands all day in front of a screen. You would surely get tired, and yes, that would be the point. You would be tired and work would be good for you. For the past 600,000 years, our bodies evolved to physically work and be tired. It’s in our genes.
But the problem just needs to be reframed. Working at a screen shouldn’t be all about comfort. That’s how we’ve always viewed working at computers — just look at these beautiful and “healthy” chairs!

Work should be reframed. It should be about optimizing your productivity, your health, and your life. To do this, we need to reframe how we should spend our time. We should do everything we can to minimize passive time and maximize active time.

I’d love to see Apple Health release a screen to fit into a work environment that makes me work. It wouldn’t be for everyone, but a significant portion of the population actually cares about their health.
Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.