Tag Archives: exercise

Stepping out to help others

Many of our patients find it rewarding to be able to do a fundraising walk for a cause that is close to their heart.  The ability to participate in these is an added bonus of ‘getting your life back’ after weight loss surgery.


If you are a UMass Memorial Weight Center patient, you know about the diversity and dedication of our team.  What you may not know is how each member of our team makes exercise a part of their lives as well.  Like our patients, many members enjoy using their fitness to benefit others too.

Dr. Mitch Gitkind is one of them.  This past weekend he and his wife completed the Boston Marathon Jimmy Fund Walk. Together they raised $1000 in memory of a young woman in their town who passed away a few weeks ago at the age of 18.

Gitkind steps

To be able to do 50,000 steps at age 60, raise money to help others, and come in to work with a smile the next day is the reward of someone who is a regular exerciser.  His daily routine keeps him healthy and young.  The ability to enjoy being part of this and other incredible fundraising events during the year is an added bonus to the many ways exercise adds to his enjoyment of life.

Studies show that our health improves when we help others.  We know exercising regularly improves to health too. When you add this kind of meaning to your every day exercise routine, your  health benefits from exercise are multiplied.  You don’t need to walk 50,000 steps to do it either.  The amount of steps you do, nor the money raised don’t matter. It is the fact that you are adding a broader level of purpose to your exercise time.

Has your regular exercise routine enabled you to complete a fundraising event lately?  Share your story in the comments below.

Keep moving,  Be Well,



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by | September 23, 2019 · 5:51 pm

Is it your body or your mind holding you back?

Why exercise for diabetes_(12)

The header at the top of this page is a collection of pictures of people who are on a weight loss journey. They are all at various stages on that journey, most are not at their goal weight yet.  However, each of them are now doing things they could not do before losing weight.  It is quite inspiring to see these smiling faces enjoying life while on the journey. How did they overcome their body and get so fit?  It took changing their mind so their body didn’t get in the way.

 The brain is a reality simulator.  What you imagine can seem very real.  Just think of how you feel when waking up from a dream.  The feelings can stay with you for a while, even though it was all in your head.

When your body is carrying extra weight, it can hold you back from exercising and doing many other activities you once easily enjoyed.  It can seem like you cannot exericse and it would be better to wait until you lost some weight to get started.  What you are feeling in your body is very real.  Just like a dream however, what your brain believes about how much is enough exercise may not be the reality.  Your expectations could be based on your memories of what you used to be able to do and what you want to be able to do now.  They could also be based on recommended amounts, which are really general guidelines.    Just like your dream, your mind can hold beliefs about what your body should be able to do, even when your body is telling you that it cannot do it.

This can feel like your body is getting in the way, holding you back from exercising.  However it is really your ideas about what it means to exercise that is holding you back.  Your body does not know the recommendations.  It only knows what it can do now, in this moment.  Your body does not know how many calories you want it to burn, it only knows what it will burn based upon what will be keep you healthy and well.  Your body does not know the numbers displayed on the weight machine or the treadmill or your activity monitor.  It only knows if it can tolerate what you are asking it to do.

If it cannot tolerate it, your body will let you know through pain and fatigue. Pain and fatigue are a sign of too  much too soon. Contrary to popular beliefs, pain is not a sign of progress (nope, not even muscle soreness). If you body has what it needs to do what you are asking it to do, it will let you know instantly through more energy, greater freedom of movement, more focus and a better mood.  Basically, your body is smarter than your brain when it comes to exercise. Your body and brain work best when they work together, that means your brain observes your body rather than dictates what it should be able to do.

So the next time you start thinking your body is working against you, ask what it is trying to tell you.  The answers may not be clear right away, and usually it is not telling you to stop exercise completely.  It is usually telling you it needs less for a while until it has time to adapt. You will know you have found the just right level and type of exercise by how you feel during and after exercise.  Your body  will tell you if and when it is ready for more. Until then, keep the peace between your brain and your body, by trusting you body to tell your brain how much is enough exercise right now.

Keep Moving Be Well,


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by | September 18, 2019 · 6:44 pm

Depression and Exercise

Why exercise for diabetes_(11)

Some solutions sound so great on paper, but putting them into practice is another story. It could not be more true when it comes to exercise, especially when using exercise to help treat depression.

There are plenty of studies backing up the recommendation for people with depression to exercise as part of their treatment for depression.  But, when you are feeling low, getting up and moving is just not that easy, no matter how much you know you should.  Let’s look at how to find your way to use movement to feel better.

This article is the conclusion from 25 studies, 1487 adults with depression.  Importantly, they included only studies that were actual exercise studies, not information from self report surveys about general physical activity.  Why is this important?

First because people tend to overestimate the amount of physical activity they do. Second, physical activity is not exercise. Physical activity is any movement.  Surveys that ask folks about their levels of physical activity ask about thinks like housecleaning, and yard work. This type of movement are the things you need to do.  They are tasks and can be stress producing.   When you exercise, your attention is on your body, moving for the purpose of taking care of yourself, which is stress reducing.  This has a very different effect on your brain and your body.

So what did they conclude? “exercise has a large and significant antidepressant effect”

This is great! On paper anyway.  But if you are feeling depressed you know there are two big problems with taking that great news and putting it into action:

First, depression is not a stand alone disease.  The disease itself, plus the medications that treat it leads to many other health concerns, like weight gain, which can lead to diabetes, joint pain, and cancers.  When you feel depressed, getting up and moving is the furthest thing from your mind. Add to that extra weight, elevated blood sugars, joint pain and the side effects of other diseases and their treatments, and putting this amazing tool into practice is far from easy.

Second, our brain is set up to avoid things that make us feel worse.  With the ‘no pain no gain’ mentality of so many exercise programs, why would a brain, that is not feeling great, tell a body that is not feeling great to get up and exercise, just to make it feel worse?  Motivation to exercise comes when it makes you feel better. When it makes you feel worse, your brain will come up with some pretty creative excuses why you cannot exercise.

What is the answer to this conundrum? Part of the answer is right in the research. Moderate intensity exercise for as little as ten minutes is enough. You don’t need to run a marathon, you don’t even need to run. You don’t need to be at the gym for an hour, you don’t even need to be at a gym.  You don’t need to be sore, because that is just a sign you did too much too soon anyway (yes soreness does not mean progress). You don’t need to do high intensity training, just moderate, comfortable level for your body.

When you choose what you do, where you exercise, who you exercise with (or without), and how you exercise so you feel better right away, you are getting the antidepressant effects and your brain will help you stay motivated.

The thing is, only you can tell what type, where and how much is enough to make you feel better.  The trick is, not doing too much on that first time out, so your body and brain both actually feel better right away.   Then your brain will tell you to do it again, because it felt good.

Bottom Line:  The only one who knows the right amount and type of exercise that makes your brain function better is you.  The only one who can administer this medication is you.  Just like any new medication, start with the smallest dose and see how your body and brain respond. Exercise works best for depression when it is used with the just right type and dosage for you right now.

Keep Moving Be Well,



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by | September 10, 2019 · 1:54 pm

Stress and exercise

Why exercise for diabetes_(10)

All you have to do is watch the news, and stress level begins to rise.  Then there are the usual stressors of work and family, plus the bigger stressors that pop up and you have a mind and body that are working overtime.   These mental stressors are part of life, but they can also lead to weight struggles.

Within seconds of a stress response, chemicals (catecholamines) change every system in your body;  Your heart rate increases, blood vessels constrict in your digestive system and your skin, your liver pumps glucose into your blood, your brain narrows its attention to deal with the ‘problem’.

The catecholamines also signal your body to release cortisol.  This chemical suppresses appetite immediately but after some time it then stimulates appetite and the preference for food that is rich in fat and sugar (ie: comfort food).  Cortisol is also known to cause fat to be deposited around the abdomen. Cortisol also increases your body’s insulin resistance, making it more likely those sugars will stay in your blood system.  This chemical also also changes cells in organs in a way that can lead to asthma and eczema as well as pain, gastrointestinal symptoms and panic attacks.

When the stress response is prolonged, it can lead to conditions like: anxiety, depression, type 2 diabetes, fibromyalgia, loss of muscle mass, osteoporosis, high cholesterol, hypertension, and heart disease.

When you are carrying extra body weight there are additional factors that can lead to chronic stress too.  Experiencing weight discrimination, having more health concerns and symptoms such as pain and sleep apnea all keep cortisol levels high.

Add to that other factors such as smoking, excessive alcohol use, and some medications like antidepressants and steroids also increase cortisol levels.

This can create a spiral where higher cortisol increases weight and weight gain increases cortisol.  When we think of weight loss as simply moving more and eating less, we miss this major hidden factor that is contributing to weight – stress.   Then, when going on a diet and exercising are stressful, it can speed up this cycle rather than reversing it.

While all of this may seem overwhelming, the way out is closer than we think.   It is found in understanding why your body does all of those changes in response to stress.

When you are in a stress response your body is preparing to protect you by preparing you to move; to run away from or fight a stressor.  We all have heard the stress response called the ‘fight or flight’, and that the problem is that our modern day stressors are not solved by fighting or fleeing the ‘danger’.  The bigger problem is that we have made exercise stressful, reducing the chances it will be able to take you from the stress response back to the state your body can heal and repair.

The answer is found not in more exercise, but instead carefully designing movement time so it is stress reducing by:

  • Focusing on what you are doing, not multitasking to just get it done
  • Moving the way your body was designed (hint: it was not designed to do sit ups)
  • Doing just the right amount for your body now,  not exercising to a point of pain or exhaustion

The fact is, only you know if exercise is stress producing or stress reducing.    It starts with knowing how your body is designed to move, staying away from marketing based exercise programs.   Then listening to your body so you know how it moves well now, at your current shape and size.

It’s not only possible for exercise to reduce stress, it is essential if exercise is going to lead to weight loss and improved health and well-being.

The bottom line is that exercise is the antidote to stress. It is what your body needs when you are stressed in this modern society.  Take time to move in ways that help your body lower your cortisol levels now, and it will thank you by getting back to its job to keep you healthy and well.

Keep Moving, Be Well,



Stress and Obesity: Are There More Susceptible Individuals? Eline S. van der Valk et al. Current Obesity Reports(2018)




by | September 4, 2019 · 7:11 pm

Exercise and Osteoarthritis

Why exercise for diabetes_(5).png

What is Osteoarthritis?

In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In osteoarthritis or OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes develop that further damage the cartilage. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain.  Arthritis Foundation Website

How does exercise help?

Exercise is considered the most effective non-drug treatment for reducing pain and improving movement in osteoarthritis. Arthrtis.org

Movement in general can reduce inflammation, the cause of pain in arthritis.   Your lymph system relies on movement to keep this fluid part of your blood moving so your body can lower inflammation.  All three types of exercise work well for osteoarthritis:

  • Stretching reduces stiffness that makes movement more difficult.  Simply moving a joint through its full range of motion a few times several times a day can be very beneficial in reducing stiffness and movement limitations from OA
  • Strength training helps your muscles, ligaments and tendons support arthritic joints. Strength training has been shown to reduce arthritis pain.  The key is knowing how to do strength training with proper alignment so your joints work there best and you minimize strain.  In your exercise visit, we practice this to ensure strength training is not painful so your body can gain strength without strain.
  • Cardio can reduce pain, but there are several factors to consider.  If the activity is weight bearing (such as walking), your joints probably won’t tolerate it for as long. However, since walking is a type of activity needed for daily life, it is important to incorporate if at all possible.  Use a cane or walker if it helps you walk with less pain.   Walk in several short bouts for the duration that does not increase pain.  Supplement with a form of cardio that is non-weight bearing and allows you to move for a longer period of time,  such as an exercise bike or seated aerobics. The key is doing the amount and type that decreases, not increases pain and then repeat that more frequently to make up for the lower duration.

The key to each of these  is listening to your body.   When movement decreases pain, it is lowering inflammation.  When pain increases, so does inflammation.  So doing small bouts throughout the day, doing the types of exercise that reduce pain and stiffness is the way to use exercise as the most effective non-drug treatment for reducing pain and improving movement in OA.

One last thing to consider is stress.  If exercise or physical activity is stressful, it will increase inflammation.  Choose types of movement you enjoy, that leaves you feeling good about yourself, and do it in a way that it does not increase your pain, and you will be using exercise in the way that it can make it easier to live with osteoarthritis.

In the next blog, I will address why exercise is important if you are having  joint replacement surgery.

Keep moving, be well,


Exercise in the management of knee and hip osteoarthritis. Elizabeth Wellsandt and Yvonne Golightly. Current Opinion in Rheumatology. 30(2):151–159, MAR 2018
Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. C.Gay, A.Chabaud, E.Guille, E.Coudeyre.  Annals of Physical and Rehabilitation Medicine.  June 2016, Pages 174-183


Please share these posts with anyone you know interested in losing weight with or without weight loss surgery.  Click here to learn more about the UMass Memorial Weight Center

These weekly blogs are general guidelines. These guidelines apply to patients who are cleared by a physician for the type of exercise described. Please contact your physician with any concerns or questions. Always report any symptoms associated with exercise, such as pain, irregular heartbeats, and dizziness or fainting, to your physician.



by | July 9, 2019 · 7:30 pm

Exercise and Sleep Apnea


Obstructive Sleep Apnea or OSA is an involuntary cessation of breathing that occurs while a person is asleep.  Left untreated, sleep apnea can lead to health concerns such as high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments. Typical symptoms of sleep apnea include heavy snoring, excessive daytime sleepiness or fatigue, difficulty with concentration or memory, and waking during the night feeling short of breath. (Sleepapnea.org )

There is growing evidence that exercise is an effective part of treatment for OSA.  Although it used to be thought that exercise was helpful only when a person lost weight, study’s show that exercise helps sleep apnea even before losing weight. 

According to one meta-analysis, for every 1 unit increase in the level of sleep apnea (Apnea/Hyponea Index or AHI), there is a 6% increased risk of stroke  in people with mild to moderate sleep apnea.  Exercise alone (without weight loss) can reduce the level of sleep apnea between 2 and 17 units showing that it can lower the risks of sleep apnea even before you lose weight. In other studies, people with sleep apnea who exercise have fewer symptoms such as daytime sleepiness and low energy.

In these studies, exercise worked within a wide range of types, amounts and frequency of exercise.  Cardiovascular exercise is most commonly used. However,  future studies are looking at strength training and mind/body exercise programs as well. 

While all that sounds great, the fatigue from sleep apnea is a major challenge when it comes to finding the motivation to exercise. So when using exercise to help withe sleep apnea, we need to be realistic if it is going to work.  Keep these tips in mind as you plan exercise when you have sleep apnea:

  • Think of exercise as small focused bouts of movement you do frequently rather than one long session you do a few times a week (i.e: 5-15 minutes of exercise or more a day)
  • Plan one bout at the time of day  you have the most energy
  • Choose types of exercise that have an inherently lower risk of injury.  Your balance, reaction time and coordination are likely effected by the lower quality sleep. 
  • Try different types of exercise and assess what types give you energy at different times of day and what types help you sleep better at night.
  • When you think you are too tired to exercise, try just a few minutes to see if it helps.  If it does, keep going. If it doesn’t, stop exercise and try another type of a different time of day. 

If you have sleep apnea, know that exercise is part of the treatment plan.  However, set yourself up for success by adjusting your expectations until your symptoms are under control.

Keep Moving, Be Well,




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by | July 3, 2019 · 6:53 pm

Exercise and asthma


Asthma is a medical condition where parts of your airway tightens making it difficult to breathe.  There are many triggers and exercise can be one of them.  For this reason, many people with asthma avoid exercise. This is unfortunate because exercise, when done right, can actually help give you more days free of asthma symptoms.

Along with all the other benefits,

regular exercise has been shown to improve asthma control

What makes exercise a trigger for asthma?

  • Exercise induced asthma seems to be caused by dehydration of the airways.  When you breathe heavier, the airways are more likely to dry leading to a series of events that causes asthma symptoms
  • When water loss is prevented, by breathing warm humid air, exercise does not provoke an attack of asthma

What are the benefits of exercise for people with asthma?

  • More symptom free days
  • Reduces risks of asthma exacerbation
  • Improved exercise capacity
  • Improved quality of life
  • Improved pulmonary function

How can I prevent an asthma episode with exercise?

  • Exercise regularly
  • Do a pre-exercise warm up
  • Cover your mouth with a scarf or mask while exercising in cold temps
  • Avoid exercising in
    • High pollution areas
    • Periods of high allergen levels
    • Extreme temperatures
  • Avoid exercising when asthma is exacerbated or during a respiratory tract infection
  • Ask your doctor about using a fast acting asthma medication 10-15 minutes before exercise can help you avoid or minimize an asthma episode during exercise.
  • Use all of your asthma medications as directed
  • Treat other medical conditions that can worsen asthma symptoms, such as gastric reflux


Keep Moving, Be Well,


Please share these posts with anyone you know interested in losing weight with or without weight loss surgery.  Click here to learn more about the UMass Memorial Weight Center

These weekly blogs are general guidelines. These guidelines apply to patients who are cleared by a physician for the type of exercise described. Please contact your physician with any concerns or questions. Always report any symptoms associated with exercise, such as pain, irregular heartbeats, and dizziness or fainting, to your physician.


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by | June 26, 2019 · 6:50 pm