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Exercise and Osteoarthritis

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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 Sleep Apnea

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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,

Janet

 

 

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by | July 3, 2019 · 6:53 pm

Exercise and asthma

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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,

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 | June 26, 2019 · 6:50 pm

Exercise for heart health

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You probably hear all the time that exercise is good for your heart health, but what does that mean?   In a past blog I highlighted how your fitness level seems to be more strongly connected to your risk of heart disease than your weight. Let’s take a closer look at how exercise helps to prevent heart disease.    There are many types of heart disease.  Here we will talk specifically about exercise for preventing coronary artery disease, the kind that can lead to a heart attack.

What leads to a heart attack?  A heart attack (or MI – myocardial infarction) is when one of the arteries of the heart is blocked. Since the job of arteries in the heart is to deliver oxygen and other nutrients to the different parts of the heart muscle, blockage means that part heart muscle is damaged from lack of oxygen.

There are many reasons why a blockage can occur.  Generally it is the gradual accumulation of fats, sugars and on the walls of arteries.  The risk factors for heart disease increase the chances of these deposits forming:

  • High blood pressure:  Normally the inside lining of arteries is smooth.  But high blood pressure over time wears down the walls of arteries so substances like fat and sugar in the blood are more likely to stick to the walls building up and leading to a blockage
  • Diabetes: The higher amount of sugar that stays in the blood with diabetes means there is more substances to stick to the walls of the arteries
  • High cholesterol:  The higher the amount of fats floating in blood, the more chance it has to stick to the walls of arteries
  • Smoking: Smoking increases the risk of  blood clots which can block an artery in the heart (or anywhere in the body).   Smoking also doubles the level of risk of developing other risk factors for heart disease.
  • Stress:  When your body is in a stress response, it increases the amount of fats and sugars in your blood, constricts your blood vessels, and increases clotting in your blood (in case you are injured).  All of these increase the chance that your arteries become damaged and blocked.

When you exercise, several things happen right away that directly improve these conditions and thus helping to prevent a blockage in your arteries.

  • Your body releases nitric oxide, a natural blood vessel relaxer.  This counteracts the effects of high blood pressure and stress to reduce the chances of damage to the walls of your arteries from these conditions. Nitric oxide remains in your system for up to 22 hours after one 30 moderate intensity bout of exercise.
  • Your body uses fats and sugars in your blood to fuel moving muscles.  This way they are not hanging around in your arteries ready to attach to the walls and create a blockage. Depending on the type and intensity of exercise, this higher usage of fats and sugars in the blood can last up to 72 hours after one single exercise bout.
  • Your body shifts to a relaxation response IF exercise is not stressful.  Since stress prepares your body for movement, exercise that is not stress producing gives your body what it has prepared for in the stress response, allowing your nervous system to shift back to the job of healing and repair.
  • Brain chemicals for a calmer body.  When you exercise your brain releases chemicals that help you stay calm, think clearer, and focus better for hours after. It also lowers chemicals that increase inflammation (like cortisol) that can exacerbate a blockage.    Even just ten minutes has been shown to release these chemicals.   Improved brain function means a better mood and less stress.

Over time with consistent exercise, your body changes in ways that help to give it even further protection from heart disease.

  • New blood vessels grow in your heart to provide more blood flow to the heart muscle.  This is called collateral circulation and provides protection if one artery is blocked, these smaller vessels can get blood to that area of the heart, reducing or preventing the damage of a blockage.
  • Muscles become more efficient so every day activities are less strain on your heart.  When you improve your stamina and strength, your heart does not have to work as hard for everyday activities.  Less strain means less demand of oxygen with physical activities, making your heart handle daily activities and stress better.
  • Your heart becomes a more efficient pump.  Your hearts job is to pump blood to the rest of the body.  As you improve your fitness level, your body does not need to beat as fast, because it pumps more blood with every beat.   A stronger pump means it does not need to work as hart do to its job.
  • Better management of other risk factors.   When you exercise regularly, all of the other risk factors that contribute to blockages in your heart improve.  Regular exercise is the all in one treatment for lowering your risk of heart disease.

Exercise directly and indirectly reduces the root causes of heart disease.  Even if you already have heart disease, exercise has been shown to reduce the risk of a second heart event.   There is no other treatment available that does all of this at once.  Exercise truly is medicine!

Keep Moving, Be Well,

Janet

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by | June 18, 2019 · 7:19 pm

Exercise and fibromyalgia

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If you or someone you care about has fibromyalgia, you know it can be one of the most frustrating illnesses around.  The symptoms of widespread pain and tenderness (sensitivity to touch) that tends to come and go and move about the body mean you never know what will hurt next.   The fatigue is compounded by sleep problems, which compounds other problems.  The wide range of symptoms effect every aspect of life and can leave you feeling like your body is the enemy.

Exercise is part of the standard recommended treatment, yet this can often lead to even more frustration when it only leads to more pain and fatigue.  Let’s look at why exercise with fibromyalgia so you know how to make exercise work for you.

Since the cause of fibromyalgia is unclear, we can only use exercise to treat the symptoms rather than the root cause of the illness.  Exercise has the most impact on preventing the secondary symptoms of fibromyalgia, the ones caused by living with pain and fatigue.  Let me explain.

The first secondary symptom is the loss of strength, stamina and mobility the comes when movement is limited by pain and fatigue.   This leads to the spiral of inactivity where you move less because of pain and fatigue, which causes you to lose function, which causes you to move less, and so on. This downward spiral continues so it looks like the disease is progressing when in reality it is the direct result of moving less.

So first and foremost, having regular routines for exercise that includes strength, cardio and stretching will help you recover from a flare up by reclaiming what is lost when you were resting.  Equally as important is having a ‘flare up’ routine you can switch to so you can keep moving but adjust the way you move to help with healing.   This duel approach to exercise gives you the ability to use exercise to help your body get what it needs in each stage; one is about rebuilding, one is about recharging.

That leads to the next important factor in fibromyalgia – mindfulness. Mindfulness, paying attention to what is happening in the present moment has been shown to be helpful with fibromyalgia pain.  When combined with exercise, mindfulness helps you stay out of the frustration of comparing your body to what you used to do or think you should do.  The focus on noticing when you are judging, and shifting to curiosity helps you move in the way your body needs to move now.  The most important ingredient of mindfulness is kindness.  Remembering that you are exercising to take care of your body, rather than trying to overcome it.  Mindfulness during exercise is the mindset that keeps you exercising in the way that helps fibromylagia.

Another side effect of fibromyalgia is depression.  Exercise, done in a way that helps your body feel better, will also help your brain function better.  Just ten minutes of exercise releases a natural balance of brain chemicals that raises mood and calms nerves.  Since stress is a trigger for fibro flare ups, using regular exercise to reduce stress in some way every day in your brain and body can help to lower the frustration of the changing symptoms of fibro.

For all of us to function well in daily life, we need strength, stamina and mobility.  There is no one type of exercise that gives you all three of these.  When you have fibromylagia, finding the balance between these three types of exercise is even more important. It helps you avoid doing too much of one kind and straining your body rather than helping it regain function.

  • Stretching: Helps your connective tissue regain some elasticity, reducing pain and stiffness, and helps your lymph system reduce inflammation. Stretching is the foundation of exercise for fibromyalgia because it can help directly improve the symptoms both in a flare up and between flare ups.
  • Strength training: Helps your muscles and bones and metabolism stay strong and counteract the effects of prolonged times of resting during a flare up.  Do strength training in a way that teaches your body to be strong for movements of daily life.  Stay clear of the athletic type strength training that tends to push your body to do more faster. Also stay clear of the  aesthetic fitness style strength training that is more about changing the look of your body (which is mostly myth and marketing based anyway) than the function of your body.
  • Cardio:  Helps keep your stamina up so that you have more energy for every day activities.   Find a kind of cardio that feels good on your joints and allows you to modify the intensity depending on how you are feeling that day.  Doing shorter bouts, like 5-10 minutes, often feels better and still improves stamina.  Starting with one a day and then gradually adding more bouts during the day makes it easier on your body to adapt well without increasing pain.

Lastly, one sure way to put yourself in a flare up is doing too much too soon.  The fact is,  the body can adapt to a 10% increase in exercise a week.  That is not much.  When you have a medical concern like fibromyalgia, the rule is 5% increase per week. That means if you are doing a 10 minute walk, increase by 30 seconds! That is much less than your brain thinks you should, but is the amount your body can do. By working with your body in this way, you help avoid flare ups and can better use exercise to help you manage fibro well.

Bottom line: When you have fibromyalgia, it is extra important to be sure your brain and body are working together.  When you work with your body, listening to it as your best guide, giving it the right balance of rest and movement, exercise can be a great part of your fibro management toolbox.

Keep Moving, Be Well,

Janet

Sources:
  1. Fibromyalgia:  https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
  2. Mindfulness and Fibromyalgia:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693231/pdf/nihms916892.pdf
  3. Mindful Movement and pain management:  https://med.stanford

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by | June 11, 2019 · 7:14 pm

You are stronger than you know!

Fresh and Organic

When we say you lose strength, you don’t really lose it. It just goes into long term storage. Sort of like the things you don’t use often and store in your attic or basement. Strength training brings your strength back to the level where you can use it every day, to make life easier and allow you to enjoy more activities.

Do strength training to remember you are strong!

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by | June 5, 2019 · 7:24 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