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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,

Janet

Sources:
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.

 

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by | July 9, 2019 · 7:30 pm

Exercise and diabetes

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If you have been told your blood sugar (glucose) is too high, you probably have also been told to exercise.  But why?  Knowing how exercise helps lower blood sugar levels is a key for staying motivated to exercise regularly.  Let’s take a look at the inside story of exercise and blood sugars. 

Sticky Blood: When sugar gets wet, it gets sticky.  One of the biggest problems with having high blood sugars is that sugar makes blood “sticky”.   When sugar is at higher levels in your blood for too long, it is concerning because that “sticky” blood is now traveling to every part of your body.   This is why diabetes puts you at risk for so many different medical issues.  Nearly every part of the body is strained when blood sugars are high; your kidneys, your nerves, your eyes, etc.

Natural blood sugar management: Two of the most important ways your body is designed to move sugar out of your blood after you eat is (1) the movement system (2) the insulin system.  The movement system is meant to be the main system for keeping blood sugar from getting too high. The insulin system is designed to be your back up system, for use when you are not moving.

When you move:

  • your body uses the sugar in your blood to help fuel moving muscles
  • your body is able to use its own insulin more efficiently.  After exercise, your body is more sensitive to its own insulin, making this back up system work better for hours after exercise.

When you don’t move often:

  • your main (movement) system for managing blood sugars is not available
  • your body needs to use the back up (insulin) system to bring sugar into cells to be stored as fat
  • over time your back up (insulin) system gets overused and can ‘wear out’

When you have type II diabetes, your body is resistant to insulin, causing sugar and insulin build up in your blood.   When you move your body, you activate the main natural system for lowing your blood sugar.   Exercise then, temporarily reverses the cause of type II diabetes.

Not all movement is created equal.  However, if you move all day for your job or for child care, your movement system could be counteracted by another system – the stress system.  When you are moving but stressed, your body releases more sugar into your blood.  That means the movement system cannot do its job as effectively.  This is what sets exercise apart from your every day physical activities.  Exercise is when you are moving for the purpose of self-care. When movement reduces, rather than increases stress, it is able to do its job of lower blood sugars. 

Plus, exercise has GREAT side effects. The bonus is, exercise also helps you manage diabetes in other ways too:

  • Think clearly:  Moving your body can help your brain function better, giving you a better mood, focus and ability to make healthy choices
  • Health protection:  Regular exercisers have a lower risk of heart disease, cancer and stroke.  When you have diabetes you are at greater risk for health concerns, so the extra protection from exercise comes in very handy.
  • Weight managementExercise (specifically strength training) counteracts the metabolism lowering effect of dieting by keeping your muscles strong and functioning well while losing weight.
  • Improved sleep: When sleep deprived, the stress response in the body is triggered, raising blood sugar and making weight loss more difficult.  Using exercise to improve sleep has a ripple effect to many other parts of your life.
  • Reduce Arthritis pain: stronger muscles around joints can decrease arthritis pain and make moving easier.  Less pain means you can move more and moving more helps keep blood sugar in check.
  • Reduce Back Pain:  The job of the core is to protect the spine from wear and tear. Exercises that teach the core muscles to do their job in a functional way can reduce back pain.  Plus, stretching in a way that helps to improve tolerance of things like bending and lifting and helps the body recover from strains of daily life can reduce back pain flare ups. Again, less pain, more movement, better blood sugar control.
  • Counteracts depression, anxiety, and improves mood and focus:  Exercise, when used properly, has been shown to be very effective as part of a treatment plan for depression, anxiety, ADHD, and other areas of mental health.  Living with a disease like diabetes can be overwhelming at times and can affect mood.  Exercise can help boost your ability to cope with the stress and pressures of having diabetes

Bottom line:  Moving your body, in a way that reduces stress, activates the natural blood sugar management system in your body.  Keep moving to keep this system working for you and your health.

Keep Moving, Be Well,

Janet

 

 

 

 

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by | May 28, 2019 · 8:55 pm

Who can you inspire to move?

Who can you inspire to move_

My whole team is doing the stretches as part of our morning huddle.  We don’t have pain during the day and have more energy at the end of the day!

This week a patient shared with me an inspiring story.

She is a dental hygienist and she would always get pain her her neck and shoulders from being in that position all day long. That pain drained her energy too.  In her first visit, we did some stretches that she could incorporate into her day to see if they help with this energy draining discomfort.

They really worked for her.  So she showed the stretches to her co-workers one day at morning huddle.   Now they all don’t have that pain any more and they have more energy at the end of the day too.  They decided to make it part of their morning routine.

Kudos to you for inspiring others to move and feel better!

Who could you inspire today to keep moving and be well?

Share your story!

Janet

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by | May 22, 2019 · 4:44 pm

Exercise and high blood pressure

Exercise in the age of distraction(1)

High blood pressure has been called a silent disease because there are often no symptoms. This medical condition could be undetected for years if you don’t have your blood pressure measured regularly.  But what is the big deal about high blood pressure and why is exercise an important part of the treatment?

What is it?  Blood pressure is the pressure of blood on your blood vessel walls.  Two parts of your cardiovascular system effect blood pressure:

1. Your Heart:  The force with which blood is pumped from your heart puts pressure on blood vessel walls.  This varies depending on the strength of your heart as well as if you are moving or still. When you are moving, your heart not only pumps faster, it pumps stronger.     Think of an untied balloon filled with air.  The more air you put in the balloon, the more forcefully it will fly around the room when you let it go.   The more of your body that is moving, the more blood that is circulated back to the heart and pumped out again.  The more blood that fills the heart with each beat,  the more forcefully it contracts, the more pressure that blood puts on the blood vessel walls.

2. Your blood vessels:  Blood vessels can tighten and relax to help control where blood is sent in your body.   When you move,  blood vessels relax, especially in moving muscles to allow for more blood flow to bring  oxygen and fuel to moving muscles. In fact, when you exercise your body releases Nitric Oxide. This chemical helps blood vessels relax to compensate for the higher pressure from the stronger heart beat (described above).  This way your blood pressure does not go as high when you exercise.

Your blood pressure goes up during times of stress because the blood vessels are more stiff than elastic when you are stressed.  This causes higher pressure on the walls of your blood vessels. Over time this pressure on the walls can wear down the smooth, slippery lining in your blood vessels, increasing the chances plaque with stick to the walls.  This process is called atherosclerosis and is what can lead to heart attack or stroke.

When you exercise  your blood pressure goes up, but it is because your heart is pumping stronger (and getting stronger in the process), while your blood vessels are relaxing.  This raise in your blood pressure does not cause the wear and tear on your vessel walls because at the same time the walls are more elastic, not stiff like when you are under stress.  This combination helps prevent, rather than lead to the build up of ‘stuff’ on the walls of your blood vessels.

That’s in part because the effects of the Nitric Oxide lasts for up to 22 hours after one single bout of exercise!  Long after you stop exercising, your blood vessels stay a bit more relaxed. This helps to reduce the wearing down of your artery walls because your blood vessels are more relaxed, helping you manage high blood pressure for a whole day after one single bout of exercise.

Bonus: Exercise also helps to reduce the fats and sugars that are in your blood that could stick to vessel walls.  More on that in another blog.

When it comes to your blood pressure though, exercise is one of the great ways to keep your blood pressure lower and reduce the effects of high blood pressure, naturally.

Keep Moving, Be Well,
Janet

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by | May 15, 2019 · 7:14 pm

Exercise in the age of distraction

Exercise in the age of distraction

There is no denying we are living in an age of distraction.  So many ‘bright and shiny’ things to capture our brains attention, its a amazing we get anything done.  It takes extra brain energy to shift attention, and when your brain has to do it all day long, it can really drain your energy and dampen your ability to get things done.

You probably have heard the term Executive Function. It is a way to describe how your brain helps you get things done.  If your energy and time are limited by your life, or a medical issue or a medication, boosting your executive function could make life a bit easier.

There are mixed results on the various methods for improving executive function.  There is however,  one research-backed method that seems to work with great consistently in people of all ages.   Yes, you guessed it, exercise!

 “ample evidence indicates that regular engagement in aerobic exercise can provide a simple means for healthy people to optimize a range of executive functions.”

What do you notice about how exercise helps your brain function?  If you are a regular exerciser, you may not notice any benefits until you don’t exercise and you feel a bit more distractable and less effective.  If you have not yet found that exercise helps your brain, here are three things to consider that may help:

  • Aerobic exercise (AKA Cardio):  This is when you move continuously using a majority of your muscles (IE: Walking, dancing, swimming, seated aerobics, biking) at a level that your breathing is moderate to a comfortable challenge.  Studies show as little as 10-15 minutes of cardio can improve executive function.
  • Use it as a tool:   Studies show the brain benefits are immediate; the brain functions better after one bout of aerobic exercise.  Exercise can be a tool for functioning better each day.  It can also be a way to ensure you are at the top of your game before a test, important meeting, or doing any task requiring focus and organization. Try a 10 minute bout of aerobic exercise before reaching food or caffeine when your energy is low and see if it works just as well (or even better?)
  • Your enjoyable time-out:   If exercise is stress-producing, it will not have as much brain (or health) benefit as when it is stress-reducing.  Exercise is your time-out from the strains of everyday life.  Make it enjoyable and your brain (and body) will thank you for it.

In this age of distraction, how can you make exercise one of your best tools to help make the most of every day?  Be your own investigator. Try different types and timing of exercise to see what works best for your brain.

Keep moving, be well,

Janet

 

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by | May 7, 2019 · 4:57 pm

How to get the most from sitting less

how to lose ten pounds of gym guilt(2)

Like other health recommendations, the research on the risks of sitting for too long is a bit conflicting.  No matter what the latest research says, it is pretty much common sense that prolonged sitting is just not what our body is designed for and its a good idea to avoid it.

But is it enough to just get up and move during the day? Does a standing desk erase all that worry? How about wearing an activity monitor? Lets look at some of the research and see if we can come up with a way to know you are doing what you can to counteract the effects of the sedentary activities in your life.

This study published this month in the Journal of the American College of Cardiology found the following:

For people who sat a lot (6-8 hours a day or more), replacing sitting with vigorous physical activity was better than replacing it with moderate activity; and replacing sitting with moderate activity or walking was better than replacing it with standing.

What does that mean?

Replacing sitting with standing?  In this study, replacing sitting with standing did not reduce the risks.  This study even found that people with occupations that required long periods of standing actually had a greater risk of heart disease then those who sat or those who did mixed activities.  Every study has its limits but the bottom line is, standing and working is not necessarily better.  If you fought for a standing desk at work, don’t ditch it yet.  If changing your position while you work helps you feel better while working, that is a great thing. If standing and working just does not work for you, don’t feel guilty for sitting. There are other, more powerful options.

Do vigorous physical activity?  The word vigorous can sometimes be mistaken for exercise that makes you feel tired, sweaty and sore. but that is not what vigorous physical activity means.    The actual definition used in research is any activity that is six or more times the amount of effort as it takes to sit and rest.  Examples would be running, walking up hill, fast cycling, aerobic dance or other activities of similar intensity level.  The thing is, it’s all relative.  These may feel more moderate for one person and impossible for someone else.  Instead, if you want to add more vigorous activities, choose the level of an activity that challenges your breathing and your body at a challenging but still enjoyable level that you can sustain.

Do moderate physical activity? This study shows that moderate activity works to reduce risks. Moderate level activities are ones that are three to six times the amount of work for your body to sit and rest.  They include walking, housecleaning, dancing, gardening.  Again,  it’s relative to how your body feels when you do that activity.  Choose a level that takes your breathing to level where you notice your breathing,  it but feels comfortable enough you could continue the activity for a while without stopping.

So how to you know if you are doing enough?  Know that even if you can only do a few minutes of an activity to break up your stillness times, and do it consistently, you will probably counteract the effects of prolonged stillness.

But don’t take the advice from research or even my word for it.  What does your body tell you when you have been still for an extended period of time?  How much and what kind of movement makes it feel better?  Chances are your body is telling you what it needs.

Keep moving, be well,

Janet

 

 

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by | April 24, 2019 · 6:47 pm

“Exercise is Medicine for a Good Day”

consistency is the holy grail of exercise(1)

This is the patient quote of the week. I could not have said it better myself.  Design your exercise time, no matter how long or short it is, to be your medicine for a good day.  Enjoy!

Keep Moving, Be Well,

Janet

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by | April 10, 2019 · 6:45 pm