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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

How to lose ten pounds of gym guilt

how to lose ten pounds of gym guilt(1)

The trend in affordable gyms has made it so much easier for many people to exercise year round.

It has also expanded the problem many people have with a gym membership  – gym guilt!

In trying to get more exercise, you might be tempted to join a gym because it’s only $10 a month.    As you may have discovered, your exercise motivation depends on A LOT of factors so getting to that gym might be not so easy.   You may be busy right now and just cannot fit it in.    Often, when trying to lose weight, walking into the gym feels like a spotlight is shining on your extra weight. It’s just too embarrassing to go right now.   You might wait until you feel better about your body and then you will start.

The bigger problem with these low cost memberships is that they are not expensive enough to make you end the membership if you are not going.  When things calm down a bit, or when you lose some weight, you will go, so why cancel it?     In the meantime, that membership fee on your credit card statement each month is a constant ‘weight’ on your mind. Its a constant reminder that you are not exercisign the way you ‘should’.

(No, I am not reading your mind, you are just not alone in this. I see it all the time!)

Lets talk about how to lose the weight of that gym guilt.  Here are some questions to ask yourself so you can finally make peace with using, or losing your gym membership.

  • Is it the commute? Does it take more time to get to and from the gym than its worth?  If your time is limited, no matter how inexpensive the membership, you probably will not to choose to spend your time on a gym commute on a consistent basis.
  • Is it the environment? When you walk into the gym, how do you feel?  Happy to be there or counting the minutes until you can leave? That initial instinct about the gym is so subtle, you may not realize it is the reason your brain finds excuses not to go.  Either find a way to make it more comfortable for you or find a new place to exercise.
  • Is it the people?  There is a definite vibe in each gym.  Some are welcoming and friendly in a very authentic way.  Some are ‘friendly’ in a “my boss told me to say hello when members walk in so I am going to flash a fake smile and say a cool hello” kind of way.  Some gyms are meant for people with very definite exercise goals. If they are not the same as yours, you may feel unwelcome, no matter what you do.  Either give yourself a pep talk reminder that the attitude of others is not your concern or find a more welcoming place to exercise.
  • Is it equipment overload?  It seems that the less expensive the gym, the larger and more daunting it can be.    If you feel overwhelmed by the equipment choices in the gym, know that much of that equipment is not useful anyway.  Find the machines right for you and  stay focused on that.  You don’t need to do everything that is in the gym.  Get a comfortable routine going and do what you enjoy most. (well OK more than the sauna and massage chairs!) When you are ready for a change, learn only one new machine at a time to stay out of overwhelm.
  • Is it too crowded when you go?  Rush hour times at the gym are about as much fun as rush hour time on the highway.  If the crowds are getting in the way of efficiently enjoying your gym time, and you cannot go at another time, seek alternate routes to exercise.
  • Is your body not ready yet?   Some types of exercise are not great for starters.  The elliptical for instance starts at a higher intensity. If you are just starting out you are likely to feel like a failure in about two minutes flat.  Group exercise classes can be motivating but they also are more likely to make you do too much too soon. Gain skills in listening to your body before joining a group. Choose the types that feel best for your body to start and gain some stamina, strength and body knowledge before expanding to other more challenging forms.
  • Is it lack of know-how?  There is no time in adult life that we learn how to exercise correctly.  If you don’t know how to exercise, you are not lacking some skill that everyone else has.  There is a lot of useless exercise information available out there, much of it based on what is marketable, not how your body is designed.  If it does not feel good, it is not good for you.  If you are a UMassMemorial Weight Center patient, contact me to chat about how to strengthen your exercise know-how

Some times the healthiest decision is to let go of the gym membership and exercise at home or someplace else.  Most importantly, lose the gym guilt, it’s is not helpful for your mind or your body.  There are plenty of other options out there and exercising at a gym is not right for everyone.   Find a way to make it work or let it go.

Keep Moving, Be Well,

Janet

 

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by | April 17, 2019 · 7:13 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

Exercise motivation from an unlikely source

How calorie burning makes it harder to lose weight(12)

This article gives a surprising yet research backed perspective about will-power and making changes that stick.  It is pretty clear that our old way of  making exercise a habit works against us.    If you think exercise has to be hard, and you just need more self control to make yourself do it until it becomes a habit, there is a much more effective way.

We’re using tools that aren’t only weak; they’re also potentially harmful. If using willpower to keep your nose to the grindstone feels like a struggle, that’s because it is.

It turns out too, this way also puts a drain on our health

Those who were better at using self-control did have more success when it came to resisting temptations, but at a cost to their health. Their bodies suffered not only from increased stress responses, but also from premature aging of their immune cells.

What is this unlikely source that is better for our motivation and our health than good old fashion self control?   Fostering emotions like gratitude, compassion and awareness of your own strengths has a better track record for both sustaining motivation and for promoting health.

This is one of the most challenging mindsets to change about exercise.  From my experience the belief in grit, willpower and self discipline comes from the place many of us learned about exercise – through sports.  Think about it, athletes make up the majority of our images and messages about exercise in our culture.    They have amazing self control and discipline and achieve amazing levels of fitness.  How could that model steer us wrong?

An athlete has plenty of reasons to push through and stay disciplined – the competition, team mates, coaches, records – all of these external motivators drive willpower.   We ‘regular folks’ don’t have all of those, so we replace them with other external motivators –  weight goals, challenges, competitions, social media, and accountability partners.

The research is pretty clear though.  Trying to make yourself have more discipline and willpower is stressful and not built to last.   That stress strains health and energy.  It works, but it is just not sustainable, nor is it helping with exercising for long term health.

The easier and more lasting way to motivation for exercise is to  practice the skills of gratitude, compassion and pride (awareness of your personal inner strengths).

If your New Years Resolutions have faded, it may be time to dust them off and look at them through the lens of our updated understanding of lasting motivation.  You could:

  • Keep a gratitude journal, writing down one thing each day that you are grateful for about how your body moved that day
  • Practice a brief self-compassion meditation a few days a week, so you are practiced up on your skill of self compassion for those times you might use self criticism to make you motivated to exercise.
  • Do a Strength Survey to raise your awareness of your inner strengths and how you can use them to keep you motivated to exercise when life tries to get in the way.

How to you use these tools already to keep yourself motivated?  What else could you do to move away from trying to have more willpower to applying these positive emotions to help you keep moving and stay well?

Keep Moving, Be Well,
Janet

 

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by | April 2, 2019 · 6:04 pm

The why’s and how’s of warming up

How calorie burning makes it harder to lose weight(10)

Warming up before exercise is one of those things that many people see as optional.  For your body however,  warming up is non-negotiable.  It can change your whole exercise experience, which can either drain or boost your motivation.   It’s worth taking a moment to know the why’s and how’s of warming up.

Let’s start with why warm up.

  • Body temperature rises:  Yep, the term warm up literally means, warming up.  Why is this important?  Because as blood temperature goes up, oxygen is released from blood easier, which means it is more available to muscles.  See our blog series on heart rate to know why the oxygen availability is so important for cardiovascular exercise.
  • Blood flow shifts:  If you are sitting and resting while you read this, about 80% your blood flow is going to your digestive system, your brain and other essential organs.  Only 20% is sent to your skeletal muscles.  When you exercise this flips;  about 80% is set to the moving muscles and 20% is sent to essential organs.  This shift takes time. Skipping the warm up means your muscles have less of what they need as you start and are more likely to fatigue faster.
  • Brain/body connection: This is called ‘neuromuscular” warming up.  When you warm up with movements you are using during exercise, it helps your brain and body communicate more effectively by waking up the nerve pathways the create smooth coordinated movement. This is most important during types of exercise where the movements involves  coordination and agility such as strength training, sports, or dance.   During sports doing the movements slower with full focus helps the body prepare for doing them wit more strength and power.
  • More mobility:  Mobility is freedom of movement.  Just like a gummy worm, when it is cold it would be less elastic.  When warm, more flexible.  Raising your body temp helps you have more freedom of movement.

So some pretty important things happen in those few minutes.  Here is how to make the most of your warm up time:

  • Mimic the moves:  Do the movements you will be doing during exercise, just at a lighter, slower level.  For strength training, do the first set at a light level and practice using core stability, proper breathing and whole-body awareness will help each  more challenging set(s) be more effective and less straining for your body.
  • Light breathing:  Start moving at a level that feels light for your breathing on cardiovascular exercise.  On some types of exercise that might mean just walking around before getting on a machine.
  • Listen to your body: Pay attention to your body temperature.  Notice when you start to feel warmer.  Your body will tell you when you are ready to increase the intensity of exercise.

Enjoy the warm up time to mentally check in on how you are feeling.  Using mindfulness will allow you to adjust what you are doing for exercise each time to match just what your body needs. The warm up time gives you a chance to figure that out before you dive into exercise.

Your body and your brain will thank you because exercise will be more enjoyable and thus more motivating to come back again!

Keep moving, Be Well,
Janet

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by | March 20, 2019 · 6:00 pm

Why all the hype about heart rate? Part 3

How calorie burning makes it harder to lose weight(8)

This is the last part of our series on heart rate.  Check out blog #1 and blog #2 for the full story. 

We have been looking beyond heart rate to see what is really going on in your body with cardio.  This ‘behind the scenes’ look is important because it lets you take charge of self-monitoring your cardio, so it feels right for your body.  When you know what is happening during cardio, it is clear that your breathing level, not your heart rate, is your best guide to getting good cardio exercise for weight loss, health and well-being.

When exercise feels light to moderate, your muscles are able to use oxygen to produce enough fuel. However when exercise starts to feel more and more challenging, it means your body is no longer able to produce energy using oxygen and needs to use other ways to produce energy.  This source of energy production is not as long lasting, so unless you slow down, fatigue will soon make you need to stop moving to let your body catch up.  

The more oxygen your body can use, the easier it is for you to keep moving without getting out of breath or tired and needing to stop or slow down.

The purpose of cardiovascular exercise is to build stamina in your whole cardiovascular system,  so you can move for longer periods of time without stopping.

When the level of an activity reaches a point where your body can no longer use oxygen to produce energy to fuel muscles, it has to go back to creating more energy through the process that does not need oxygen. The downside of using this non-oxygen requiring system is that it produces carbon dioxide. If levels of carbon dioxide get too high, your body starts to shut down, so getting rid of that carbon dioxide is really important. .

When you feel uncomfortably short of breath with exercise, it is because your body is getting rid of carbon dioxide, not because your body is trying to get in more oxygen. When you feel that uncomfortable shortness of breath, it means your body is producing energy in a way that is not sustainable. Its a sign you are not going to last very long at that level of movement. You either need to slow down, so your body is not using so much energy to fuel muscles, or stop so your system can catch up.

How do you build stamina so your body can use more of the long lasting oxygen using system for fueling muscles?  Simply getting your heart rate up will not make that happen.  Moving your body at a level that your breathing is at a moderate to comfortable challenge for an extended period of time, and repeating that on a regular basis will improve stamina. 

You could do this in three 10-minute bouts a day, two fifteen minutes a day, or three thirty-minute sessions a week. The key is consistently challenging your whole cardiovascular system to help your body build the equipment needed to provide fuel for your muscles in a sustainable way.  After about three days, your body starts to lose what it has started building, so do some cardio at least every three days.  

In the end, that consistently with sustained movement at a moderate breathing level will make  everyday activities are easier for your body so you have more energy left over for the activities you enjoy!

Keep Moving, Be Well,

Janet


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.

Leave a comment

by | March 12, 2019 · 7:50 pm