Guest Columnist: Janet Caputo, PT, OCS
In support of the Race for the Cure this upcoming weekend, this two part series on exercise and cancer is intended to raise the level of awareness and attempt to empower people to make their illness an opportunity for wellness.
In the past, people being treated for a chronic illness, like cancer, were often told by their doctors to rest, conserve their energy and reduce their physical activity. Recent research has shown that exercise is not only safe and possible during cancer treatment but it can improve your function and quality of life.
Fatigue, one of the most frequent side effects of cancer treatment, affects up to 70% of patients receiving chemotherapy and radiation therapy. Treatment-related fatigue is severe and imposes limitations on daily activities. To reduce fatigue, patients may avoid physical exertion and down-grade their level of activity. The resulting physical inactivity causes muscle atrophy and weakness, reduced endurance, and loss of function. Current studies show that people recovering from cancer treatment should increase their physical activity to reduce fatigue and improve physical performance.
Cancer, as well as cancer treatments can increase the risk of blood clots. You are at high risk for a blood clot if you have undergone surgery for malignancy. If you are less active because of treatment-related fatigue, this would also increase your risk! Physical activity and graded exercise improve blood flow and lower the risk of blood clots.
Steroids, which are often given with chemotherapy and radiation therapy can increase the risk of developing osteoporosis. Osteoporosis weakens bones and places them at a high risk for breaking. Weight-bearing exercises, such as walking and resistive exercises using weights, help keep your bones strong and healthy. You can break a bone if you fall, especially if you have osteoporosis. Balance training, a form of weight bearing exercise, can prevent falling by improving your balance which would lower your risk of breaking a bone. Also, steroids can also cause muscle weakness called steroid-induced myopathy. This muscle weakness, increased by the physical inactivity from your chronic fatigue, can further impair your balance responses which would increase your risk for a broken bone from a fall. The harmful side effects of steroids can be delayed or reduced by weight bearing exercise such as walking and strength training using weights or resistive bands.
Many people will gain weight from the steroids and from physical inactivity due to chronic fatigue. This weight gain can further reduce your physical abilities especially if you are already experiencing muscle weakness and fatigue. Regular exercise can reduce your risk for gaining weight by increasing caloric expenditure with aerobic exercise and increasing lean muscle mass with strength training.
Nausea can be a problem with some cancer treatments. Not eating properly because of nausea can contribute to your muscle weakness, bone loss, and fatigue. Your physical performance can further diminish making you dependent on others for help during normal daily activities. Physical activity and exercise can lessen nausea and improve your appetite. Eating better will not only provide the nutrients that are necessary for strong bones and healthy muscles but also the energy for physical activity and exercise that are vital for life.
Cancer and chemotherapy can suppress your immune system which would increase your risk for developing infections and possibly other cancers! Exercise can enhance your body’s natural defense mechanisms to prevent illness. Although there are very few absolute guidelines for exercise prescription, moderate exercise and physical activity has been shown to enhance immune function and reduce your susceptibility to disease.
When you live with a chronic illness like cancer you may develop anxiety, depression, and sleep disturbances. Regular physical activity and exercise can not only reduce your symptoms of anxiety and depression but also improve your ability to sleep. Although the exact mechanism is unknown, researchers hypothesize that these benefits are experienced because exercise releases endorphins, reduces levels of cotisol, and increases sensitivity of serotonin receptors. Overall, you experience improved mood, sense of control, and self-esteem. When you feel better about yourself, you will want to socialize. Interacting with friends will enhance your physical activity which will further improve your mental and physical well-being!
Before initiating any exercise program, consult your doctor! Exercise cautiously when you feel extremely fatigued. Keep your exercise program fun and fresh! Consult a medical professional, like a physical therapist, to tailor a program that can precisely suit your needs!
Read Part 2 of this series, about exercise and cancer prevention.
SOURCES: American Cancer Society; Friedenreich, CM, Orenstein MR. Journal of Nutrition
CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.
MEDICAL EXPERT REVIEWER: Christopher A. Peters MD, Oncologist, Radiation Oncologist, Northeast Regional Oncology Centers (NROC), Dunmore, PA. Dr. Peters is a clinical associate professor of medicine at the Commonwealth Medical College.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Each year, as students prepare to return to school from summer vacation, the subject of backpacks arises. The good news is, when compared to purses, messenger bags, or shoulder bags, backpacks are the best option to prevent lower back pain (LBP). The bad news is, most of the 40 million students in the USA using backpacks, are doing so incorrectly.
A recent study conducted at Simmons College Physical Therapy Department in Boston found more than 33% of children had LBP that caused them to miss school, visit a doctor, or abstain from activity. Also, 55% of children surveyed carried backpacks heavier than the 10-15% of their bodyweight, which is the maximum weight recommended by experts. Additionally, the study noted that early onset of LBP leads to greater likelihood of recurrent or chronic problems. Backpacks that are too heavy are particularly harmful to the development of the musculoskeletal system of growing youngsters. It can lead to poor posture that may lead to chronic problems.
The following information on backpack safely is based, in part, by guidelines from The American Physical Therapy Association. Parents and teachers would be wise to observe the following warning signs of an overloaded and unsafe backpack:
Consider the following suggestions to promote backpack safely and prevent back injury.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Since my column on the prevention of heat stroke in football practice ran two weeks ago, I have received several calls and emails requesting more information about safety tips in youth football. In response, this column is written to raise the level of consciousness and to educate coaches, players and parents about the importance of injury prevention in young players. While most high school programs have certified athletic trainers on staff, I am more concerned with the youth football programs. Often, these players are coached by a well-intended, but not well-informed parent without access to trainers or other medical personal at practices and games.
According to the Consumer Product Safety Commission, each year more than 3.5 million sports related injuries in youngster under 15 required medical treatment at a hospital or clinic. One million of those injuries are from football and basketball alone. The American Academy of Pediatrics and the American Academy of Orthopedic Surgeons offers medical information regarding the young athlete (15 and under) and recommendations for injury prevention. High school football is different. Coaches are subject to state regulation (PIAA) and medical personal and athletic trainers are present. However, youth football players may be more vulnerable.
“RICE” Rest, Ice, Compression, Elevation is the best treatment for most minor injuries to provide comfort and prevent further injury until a medical professional is seen.
If the following signs are present, timely medical attention is imperative:
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Recently, a reader wrote to ask for advice to ensure safe practices while working out in a hotel gym without supervision while traveling. Interestingly enough, another reader asked the same question a few months ago. Last year, in the wake of corruption charges against Luzerne County Judges, Magisterial District Judge James Gibbons was appointed to The Interbranch Commission on Juvenile Justice and found himself in hotels across the state on a regular basis. He used the hotel fitness centers for exercise and stress release; however, he stated that he was not sure how to properly and safely implement a program.
This column will address the needs of the frequent traveler who does not exercise regularly (3-5 days per week of aerobic and strength training). Business travelers often find themselves with more free time in the evenings after a full day of meetings than when they are at home. While the hotel fitness room is convenient, it rarely has an attendant. The traveler has several questions. What is the best method to begin a fitness program? Which exercises are best for the inconsistent novice? How do I interpret the data on the aerobic equipment and apply it to a program? Are there safe guidelines?
Before you begin, discuss your intention to exercise at a hotel gym with your primary care physician. Get medical clearance to make sure you can exercise safely.
While a 60 minute workout would be the long term goal, begin slowly at 20-30 minutes and add a few minutes each week. Make time to warm up and cool down.
Begin with light weights and increase repetitions
First, determine your resting heart rate by taking your HR (pulse) using your index finger on the thumb side of your wrist for 30 seconds and multiply it by two. 80 beats per minute is considered a normal HR but it varies. This is a good baseline to use as a goal to return to upon completion of your workout. For example, your HR may increase to 150 during exercise, but you want to return to your pre exercise HR (80) within 3-5 minutes after you complete the workout.
For those who are healthy, calculating your target heart rate (HR) is an easy and useful tool to monitor exercise intensity.
MET=Energy Cost of Physical Exercise. This is a measurement for those concerned about calories expended during exercise. NOTE: Keep the level at a light/moderate level for the first two to three weeks and advance to the moderate/heavy at week four. The Very Heavy Level is for those who have a reasonable fitness level and exercise 4-5 days per week.
This is a good unit of measure for the cardiac patient on beta blockers.
Always secure physician approval before engaging in an exercise program. If the patient is on beta blockers (Atenolol, Bisoprolol, etc), it is important to use the Borg Rating of Perceived Exertion Scale (RPE) scale to determine safe exercise stress since exercise will not increase HR as expected:
NOTE: Keep the RPE at 2-3 the first week and advance to 3-4 week two. Levels 5-6-7 are for those with a reasonable fitness level and exercise 4-5 days per week. The advanced levels should not be attained until 2-3 months of exercise.
CONTRIBUTING AUTHOR: Brittany Lunney, SPT, is a physical therapy graduate student at the University of the Sciences in Philadelphia, PA.
MEDICAL REVIEWER: David FitzPatrick, MD, is a cardiologist at Great Valley Cardiology in Scranton, PA.
Last week, while driving home from work on a hot summer evening, I saw a scary sight – kids playing football in helmets and shoulder pads. According to the PIAA, August 16th is the 1st day of full uniform and contact football practice sessions in Pennsylvania. Several parents have urged me to write a column on the prevention of heatstroke. Although I have addressed this column in the past, I feel it is a critical issue and worthy topic to repeat regularly to raise the level of consciousness and prevent injury or death.
Heat stroke one of the most serious heat-related illnesses. It is the result of long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible. It can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heatstroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or backyard activities. The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations:
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”
GET THE HECK OUTSIDE! Research shows that spending time outdoors has many positive effects on your health. While there are many year round activity options, in Northeastern Pennsylvania our short-lived summer is the inspiration to “suck the marrow out of a sunny day!” Summer in NEPA is enjoyed in many ways such as; walking, running, hiking, biking, horseback riding, boating, kayaking, and swimming. Studies show that even less vigorous activities such as; fishing, picnicking camping, barbequing or reading a good book on the porch are healthier than being indoors.
It is reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, ticks, wind, mosquitoes and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors. Please consider the following benefits of spending time outdoors.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
The purpose of this column is to present an alternative to traditional running that will allow training on more interesting and less stressful surfaces such as those used when hiking, mountain biking and horse riding trails in the beautiful woods of Northeast Pennsylvania.
A few weeks ago, when the temperatures soared above 90, my family and I went kayaking at Lackawanna State Park. However, as a typical runner, after a few hours of relaxation on the lake, I needed to do something different. Of course, I had my running gear in the car (just in case) and went for a run. As I set out on State Road 348, the sun was beating down on me. I happened to see a sign that read, “Orchard Trail, Bull Hill Trail, Tree Line Trail.” I thought it might be a good idea to find some shade and decided to run on this path normally used for hiking, mountain biking and horseback riding. It turned out to be a great decision. While I was forced to run 25% slower due to the uneven terrain, I was able to practice “light running” techniques by running with short strides on the balls of my feet. I felt much more refreshed as I avoided the direct sunlight under the cover of the trees. Furthermore, I enjoyed the up close view of nature as I ran by cool streams and wet mossy rocks. I saw beautiful flowers, rhododendron, and mountain laurel. I observed deer, chipmunks and birds. In my quest to avoid the hot sun, I discovered the beautiful underworld of “trail running” – a growing trend in today’s running community. If you, like me, have been running for many years, trail running can help you rediscover why you love to run. It is beautiful, peaceful, natural and unique. It is fun to get in touch with your inner child as you run in the woods and get muddy. Trail running makes running fun!
The trail running community purports that trail running is popular because it satisfies a primal need for man to move through nature, derived from hunter/gatherer days. Others who promote trail running feel the popularity is due to the many advantages it offers. One, trail running prevents impact injuries due to soft surfaces. Two, the training style of running with shorter strides on the ball of the foot, lessens impact. Three, this type of running will develop stronger ankles and trunk core muscles while improving balance, coordination and proprioception from running on uneven surfaces. Lastly, the ability to release copious amounts of endorphins while breathing fresh air instead of roadside fumes is invaluable.
Sources: American Trail Running Association, Trailspace.com
Visit your doctor regularly and listen to your body.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Guest Columnist: Janet M. Caputo, PT, OCS
Last of Three Columns Dedicated to Dehydration
Because of the possibility of the life-threatening, and at best life-altering, consequences of dehydration, prevention is best defense against dehydration. We must take a proactive approach to ensure and/or encourage adequate fluid intake. Consider some of the following practical tips to promote optimal hydration.
Review your medications and note if any have the potential to reduce your body fluid levels or alter your electrolyte balance. Diuretics, hypnotics, and laxatives are some examples of medications that have the potential to contribute to dehydration. Avoid beverages that contain caffeine or alcohol since both have dehydrating properties. Keep a check on your urine. As a general guide to hydration, urine should be plentiful, pale in color, and odorless. Dark, scanty, and strong-smelling urine may be the signal of dehydration.
Remember that simply breathing in and out uses more than a pint of water a day. On an average day, try to drink about two liters of water. You will need to hydrate more of you are experiencing vomiting, diarrhea, or an infection that causes fever. If you are exercising, drink slowly and frequently, especially in hot weather.
Some elderly individuals fear frequent nightly urination. To prevent this occurrence, begin your fluid consumption early and not later then 6 o’clock at night. Eliminate the need to “think” about drinking more fluids. Carry a water bottle around with you or at least keep a glass filled with your favorite, healthy beverage within your reach or at least within your view! Having fluids nearby and easily accessible will help to remind you to drink!
Plan and provide “opportunities to drink.” Individuals typically consume more fluids in a social setting. I witnessed this first-hand. My mother, who was recently hospitalized, constantly complained about how bad the coffee tasted. One day after lunch, my mom, her roommate, and I were having a nice conversation. As our social visit jumped from one topic to another, I noticed that my mother was taking an occasional sip from her coffee cup. Not long thereafter her cup was empty! Another idea is to have a “taste-test”. Gather a group of friends at your home and have fun guessing the flavor of various juices or soft drinks. Invite some companions to meet at a local restaurant for an afternoon “tea” (or other preferred healthy beverage). One last suggestion is to schedule a happy hour before your evening meal and serve liquid appetizers (e.g. tomato juice, orange juice, V-8 juice) or non-alcoholic drinks such as a virgin Bloody Mary.
We must admit that we are all human and tend to judge a book by its cover. With that in mind, do not overlook the appearance of the beverage you offer! Fluids with appealing colors (e.g. pink lemonade) served in attractive bottles, glasses, or stemware are more alluring to the senses and more likely to be sampled. Use a blender to mix cocktail combinations: kiwi-strawberry, vanilla and root beer soda, ginger ale and cranberry juice, and orange and pineapple juice. Garnishing a simple glass of water with a wedge of lemon or a frozen strawberry may be the stimulus that some people need to take their first taste. Adding sprigs of fresh mint or lemon verbena can make a fresh-tasting drink with an appetizing aroma.
In addition to appearance, texture is an important factor to consider when encouraging fluid consumption. Create frozen liquids such as lemon ice, popsicles, gelatin desserts, Italian ices, and snow cones. These delicious drink ideas not only provide healthy hydration but also are a treat to eat.
Fluid substances are not the only way to prevent dehydration. Many types of solid foods contain a substantial amount of water. If an individual has difficulty swallowing liquids or is on a fluid-restricted diet, it may be possible to maintain adequate hydration by increasing the amount of moisture consumed in foods. Fruits and vegetables are great examples because they contain 80% to 90% water.
Knowledge of the symptoms of and the prevention of dehydration can reduce unnecessary hospitalizations and maximize health and well-being for the elderly individual.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
If you missed the earlier parts of this series, read Part 1 on dehydration and the elderly, and Part 2, about the benefits of adequate hydration.
Janet M. Caputo, PT, OCS – guest columnist is an associate and clinic director at Mackarey Physical Therapy where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept.
Guest Columnist: Janet M. Caputo, PT, OCS
Water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluid loss also contributes and complicates many health issues. If you are elderly or care for the elderly, understand that this may be one problem that you can often control. It is important for you to understand the many conditions complicated by dehydration.
Good hydration prevents the development of the following ailments:
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
Janet M. Caputo, PT, OCS – guest columnist is an associate and clinic director at Mackarey Physical Therapy where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.
If you missed it, read Part 1 of 3 about dehydration and the elderly. Or, go on to read Part 3 of 3, “Prevention of Dehydration.”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Guest Columnist: Janet M. Caputo, PT, OCS
Summer heat is here and the risk of dehydration continues for one specific group, the elderly. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round.
Next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.
In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.
Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.
Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. The elderly often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly persons may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.
Elders may suffer headaches, fainting, disorientation, nausea, a seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.
Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms:
Plain old tap water is a good way to replenish fluid loss. Some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed form the stomach. Consuming alcoholic and caffeinated beverages actually has an opposite, diuretic effect!
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly, and live long and well!
Janet M. Caputo, PT, OCS – guest columnist is an associate and clinic director at Mackarey Physical Therapy where she specializes in outpatient orthopedic and neurologic rehab. She is presently working on her doctorate in physical therapy from the University of Scranton.
Read Part 2, “The Benefits of Good Hydration,” and Part 3, "Prevention of Dehydration."
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of Scranton, PT Dept
