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Philadelphia Eagles quarterback Jalen Hurts is expected to miss the remainder of the 2026 NFL season after being diagnosed with deep vein thrombosis and bilateral pulmonary emboli (blood clots in both lungs). Unfortunately, despite being a professional athlete in exceptional health, Jalen Hurts was a victim of a “perfect storm.” In week four of the NFL season, he suffered trauma to his calf (a muscle with a generous blood supply). He developed a hematoma (a localized collection of blood outside the blood vessels, often resulting in a localized “black and blue” mark). Then, he developed a superficial blood clot (not in the deep vein). He flew 7+ hours to London, played a football game and flew home. The clot moved from his leg, into the deep vein system and traveled to his lungs. This problem, especially when associated with flying (that alone is a risk factor for a DVT) does not only occur in athletes, but the public as well. But, with a little planning, you can minimize the risk!

Air Travel

Have you noticed that being in a car or on an airplane for more than three hours leads to soreness, stiffness and swelling in your legs and neck and back pain?  With a little planning, preventing or limiting these problems on long trips is possible. Also, as people age and/or develop other health problems, they are more vulnerable to developing a more serious problem associated with long trips; deep vein thrombosis (DVT) or blood clots. But problems with long-distance travel can be avoided. The following tips, based on research and personal experience, can prevent neck, back, leg pain, stiffness and DVT.

Deep Vein Thrombosis  (DVT)

A DVT is a blood clot that forms in a deep vein. The deep veins pass through the muscles and cannot be seen like the veins just under your skin. While it may occur in your arms, it is much more common in the legs, especially the calf muscle when traveling. When a blood clot forms in a leg vein it usually sticks to the vein wall. Often, pain and swelling lead you to the doctor and treatment is rendered before serious complications develop. However, there are two possible complications. One, a pulmonary embolus occurs when a part of the clot lodged in your deep vein of the calf breaks off and gets lodged in the lung. This is a very serious problem that can be fatal. Two, post-thrombotic syndrome, occurs when you have pain and swelling in your calf after a DVT.

Risk Factors for Travel Related DVT?

The following risk factors for DVT significantly increase the potential for problems when traveling on long trips by air, more than 5 hours. Trains, cars and buses also create a risk, but air travel creates a greater risk for the following reasons: reduced cabin pressure, reduced cabin oxygen levels, dehydration and alcoholic drinks, which may increase dehydration and immobility.

Prevention of Travel Related DVT and Leg Pain/Stiffness

Prevention of Travel Related Neck and Back Pain

Airplane seats are “C” shaped and force you to round your neck and back forwards. These exercises are designed to stretch and extend your back in the opposite direction. Please perform slowly, hold for 3-5 seconds and repeat 10 times each hour.

Sitting: When sitting in an airplane seat, take the neck pillow in the overhead compartment and place it in the small of your lower back. While sitting or standing up, perform postural exercises every 30-45 minutes.

Visit your doctor regularly and listen to your body.    

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part II of II

Wednesday, November 11, 2026 is Veteran’s Day. In 1918, on the 11th hour of the 11th day of the 11th month of the year, an armistice, or temporary cessation of hostilities, was declared between the Allied nations and Germany in World War I. This date became a federal holiday in the United States in 1938, a day set aside to remember with gratitude, those veterans who sacrificed for our freedom.

It is well known that many Veterans have suffered greatly, mentally and physically from their service. Sleep disorders, often associated with other mental and physical problems, are among them. In fact, 2 in 5 (40%) veterans report problems with sleep compared to 30% of adults in the US.

According to recently released CDC data, nearly 13% of American adults used some type of sleep aid most days or every day in the past month. That includes prescription medications, over-the-counter medications and supplements, and marijuana or CBD products.

Despite being completely exhausted, your body hurts, your eyes are heavy, you finally get into bed, and suddenly your brain has decided that now is the appropriate time to think about everything. Tomorrow. Something you forgot to do. Something you said five years ago. The grocery list. That one weird noise in the house. Unfortunately, sleep is not always as simple as being tired.

Sleep is Important

Sleep is important to overall mental and physical health and well-being. While we sleep, the body is still working. Sleep supports memory, immune function, metabolism and recovery. Researchers are also continuing to learn more about how sleep may help the brain clear metabolic waste products. A recent review in Physiology looked at the relationship between sleep and the brain's glymphatic clearance system, which is involved in moving metabolic waste out of brain tissue. Sleep, particularly deeper stages of sleep, appears to play an important role in this process. Your brain does not just shut off for the night. It changes gears.

New research in the area of sleep is encouraging. Dr. Richard Miller is working with veterans and active-duty military personnel practicing Integrative Restoration, or iRest, a modern adaptation of the ancient practice of Yoga Nidra. His work has been studied in military and veterans, including people experiencing symptoms related to post-traumatic stress. In one feasibility study, veterans with combat-related PTSD participated in iRest and described improvements in areas including relaxation and well-being, although larger studies are still needed.

10 Steps of iRest

The beauty of iRest is that it does not ask you to force yourself to sleep. It asks you to lie down and rest. Yoga Nidra is often translated as "yogic sleep," but it is not meant to replace actual sleep. Think of it more as guided deep relaxation which incorporates some of the principles of Progressive Muscle Relaxation (PMR). You lie comfortably, usually with your eyes closed, and listen to someone guide your attention through different areas of your body. 10 steps from the iRest Institute:

iRest 36 min guided meditation link:

Varying lengths iRest guided meditation link: https://shop.irest.org/pages/try-irest-n

SOURCES: National Institutes of Health, National Center for Health Statistics,Transforming trauma: a qualitative feasibility study of integrative restoration (iRest), Yoga Nidra on combat-related post-traumatic stress disorder.

Guest Columnist: Shelby Yeakel is a Physical Therapist Assistant and Doctor of Physical Therapy Student at Mackarey Physical Therapy. She is a certified yoga instructor and proudly served our country as a United States Marine from 2014 to 2017.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part I of II

Wednesday, November 11, 2026 is Veteran’s Day. In 1918, on the 11th hour of the 11th day of the 11th month of the year, an armistice, or temporary cessation of hostilities, was declared between the Allied nations and Germany in World War I. This date became a federal holiday in the United States in 1938, a day set aside to remember with gratitude, those who sacrificed to our freedom.

It is well known that many Veterans have suffered greatly, mentally and physically from their service. Sleep disorders, often associated with other mental and physical problems, are among them. In fact, 2 in 5 (40%) veterans report problems with sleep compared to 30% of adults in the US.

According to recently released CDC data, nearly 13% of American adults used some type of sleep aid most days or every day in the past month. That includes prescription medications, over-the-counter medications and supplements, and marijuana or CBD products.

Despite being completely exhausted, your body hurts, your eyes are heavy, you finally get into bed, and suddenly your brain has decided that now is the appropriate time to think about everything. Tomorrow. Something you forgot to do. Something you said five years ago. The grocery list. That one weird noise in the house. Unfortunately, sleep is not always as simple as being tired.

Sleep is Important

Sleep is important to overall mental and physical health and well-being. While we sleep, the body is still working. Sleep supports memory, immune function, metabolism and recovery. Researchers are also continuing to learn more about how sleep may help the brain clear metabolic waste products. A recent review in Physiology looked at the relationship between sleep and the brain's glymphatic clearance system, which is involved in moving metabolic waste out of brain tissue. Sleep, particularly deeper stages of sleep, appears to play an important role in this process. Your brain does not just shut off for the night. It changes gears.

New research in the area of sleep is encouraging. Dr. Richard Miller is working with veterans and active-duty military personnel practicing Integrative Restoration, or iRest, a modern adaptation of the ancient practice of Yoga Nidra. His work has been studied in military and veteran populations, including people experiencing symptoms related to post-traumatic stress. In one feasibility study, veterans with combat-related PTSD participated in iRest and described improvements in areas including relaxation and well-being, although larger studies are still needed.

How it Works

The beauty of iRest is that it does not ask you to force yourself to sleep. It asks you to lie down and rest. Yoga Nidra is often translated as "yogic sleep," but it is not meant to replace actual sleep. Think of it more as guided deep relaxation which incorporates some of the principles of Progressive Muscle Relaxation (PMR). You lie comfortably, usually with your eyes closed, and listen to someone guide your attention through different areas of your body. If your mind is already racing, trying to guide yourself through relaxation can feel like one more thing you have to do correctly. An audible voice gives your mind something gentle to follow. You might begin at your toes and simply notice them, letting them soften.

Move into the feet and ankles, slowly up the shins, over the knees and through the thighs. Let your hips settle, your pelvis, your abdomen rise and fall with each breath. There is nothing you need to hold in right now. Let your shoulders sink into whatever is holding you—the bed, the floor, or the couch. Allow your neck to lengthen as it rests. Notice the back of your head, your chin and your jaw. Feel the space around your shoulder blades, then move your attention over your ears, temples and forehead.

And then slowly, almost without trying, release through the eyelids, let your tongue release from the top of your mouth, allowing your lips to gently part. Maybe you will fall asleep. Maybe you don't. Either way, your body has had an opportunity to stop bracing for a minute. Yoga Nidra and iRest are not replacements for sleep, medical care or treatment for PTSD.

Meditating may not be comfortable for everyone, particularly some people with trauma. But as a non-drug approach to relaxation, guided meditation may be another option worth exploring for people who struggle to settle down at night. We spend a lot of time trying to make ourselves sleep. Maybe sometimes the better place to start is smaller; practice resting. Begin with your toes. And see what happens next.

iRest 36 min guided meditation link:

Varying lengths iRest guided meditation link: https://shop.irest.org/pages/try-irest-n

SOURCES: National Institutes of Health, National Center for Health Statistics,Transforming trauma: a qualitative feasibility study of integrative restoration (iRest), Yoga Nidra on combat-related post-traumatic stress disorder.

Guest Columnist: Shelby Yeakel is a Physical Therapist Assistant and Doctor of Physical Therapy Student at Mackarey Physical Therapy. She is a certified yoga instructor and proudly served our country as a United States Marine from 2014 to 2017.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

It has been challenging and disappointing to be an Eagles fan so far this season! Losing two star players to hamstring injuries has not helped! Both Saquon Barkley and DeVonta Smith have been sidelined with hamstring injuries for weeks. One of the most common injuries associated with physical activity, especially after a sedentary winter or change in temperature is a “pulled hamstring.” This painful injury is not only for the weekend warrior. Well-trained, healthy and fit professional athletes often have their season interrupted for weeks and months due to a hamstring injury. What is the hamstring?  How is it injured? What is the best treatment?

Hamstring Strain

A hamstring strain is a tear of the muscle fibers of the muscle group in the back of the thigh called the hamstring. The hamstring muscle is a group of three muscles that run from the back of the hip (lower pelvis), crossing the back of the knee and attaches to the knee bone (tibia). The hamstring muscles work to extend the hip and bend the knee during running and walking activities. They are very active when an athlete changes direction, especially forwards and backwards or decelerating.

This injury, like others muscle strains, varies in intensity. Severe hamstring strain occurs when many muscle fibers are torn. The athlete may experience a sudden onset of severe pain in the back of the thigh and occasionally report a popping sensation. Pain, swelling and black and blue skin from tissue damage and bleeding is often reported. Also, pain is reproduced when attempting to bend the knee. In very severe cases, the boney attachment can be pulled so strongly that a small fracture can occur. Healing time can be as short as a few days or as long as weeks or even months.

The Most Common Causes of a Hamstring Strain

Diagnosis

Your family physician will examine the back of your leg to determine if you have hamstring strain. Sometimes, pain in the buttocks and back of the leg can be referred from your lower back if the sciatic nerve is inflamed. In more advanced cases, you may be referred to an orthopedic surgeon for further examination and treatment. An X-ray, MRI or bone scan will show the extent of the tear and if the bone is involved. The diagnosis will determine if your problem is minor, moderate or severe.

Treatment

There are many conservative options. Your family physician or orthopedic surgeon will help you decide which choices are best.

Prevention

Recent studies have determined that a training program specifically designed to prevent hamstring injuries is effective, especially for the competitive athlete. This program includes:

SOURCES: Journal of Physical Medicine & Rehabilitation and American Academy of Orthopaedic Surgeons

Visit your doctor regularly and listen to your body.    

 

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

It seems like every time you scroll through social media wellness or fitness posts, there is a new “fad “or “craze” promising to enhance fitness and weight loss. Weighted vests seem to be the new favorite of social media influencers and fitness fanatics. A weighted vest is a form-fitting garment loaded with extra weight. The vest is worn over the torso during exercise or daily activities to increase resistance. However, like most fads, there is a gap between testimonials and scientific research. But, before you hit the trails with extra weight on your back, know the benefits and risks of using a weighted vest.

Weighted Vests (WV)

According to the American College of Sports Medicine (ACSM), weighted vests are an effective way to increase the calories burned while walking. When tested on untrained subjects, (ages 18-55 years) it was found that walking 2.5 mph while wearing a weighted vest of 15% of their body weight increased energy expenditure approximately 12% as compared to those not wearing a vest. Those subjects wearing 20% of their body weight while walking 3.0 mph expended 13% energy. Please note, however, that the recommended vest weight is 5-10% of body weight.

Potential Benefits of Using a WV– according to the current scientific literature

Potential Side Effects/Risks of Using a WV

Some of the more obvious side effects of wearing a WV are; blisters, chafing, and muscle soreness and the risks of wearing a WV may require medical clearance from your physician or physical therapist if you have the following conditions:

Types of WV’s:

WV’s can be found online or in stores like Dick’s Sporting Goods, Target and Walmart.

Choosing the Best WV:

Like most things, there is not one size and style that is best for everyone. WV’s vary in size, cost, durability, flexibility and adjustability.

How to Begin Using a WV:

In Conclusion:

What the Science Says – Using a WV can be an effective way to increase the calories burned while walking or performing other non-impact activities. WV can also improve bone density, cardiovascular fitness, and functional strength. However, for those with the aforementioned risks, medical clearance is advised.

SOURCES: American College of Sports Medicine; NIH; prevention.com

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Congratulations to more than 1,000 courageous runners who finished the 29th Annual Steamtown Marathon today. Most, if not all of you, will wake up tomorrow morning with a little less jump in your step than you had yesterday as your body begins it's recovery.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom. Based on science, to encourage you to adequately rest and allow your body to recover.

GREAT EXAMPLE OF REST AND RECOVERY:

With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks. While an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident. Following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.      

RESPECT THE DAMAGE TO YOUR BODY:

The Effects of Running 26.2 Miles on the Body: (RunNow.com - Jim Peskett)

3 MYTHS THAT PREVENT REST AND RECOVERY IN RUNNERS:

  1. If I don’t have pain, then I did not damage my body. I can run again soon after the marathon.
    • FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
  2. Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
    • FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
  3. If I don’t run, I will lose all of my conditioning in one week.
    • FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! 

Expedite Your Recovery:

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Provisional Bag/First Aide Kit

It is one week away from the 29th Steamtown Marathon. This column is dedicated to all the runners preparing for the big day. One small piece of advice; start slowly, avoid the first mile adrenaline sprint downhill, and enjoy the journey! Remember, only one Olympic marathon winner (Juan Zabala, Argentina, 1932) was in the lead at the 5 mile mark. Lesson: The last miles matter more than the first!

Today, I hope to address some common questions for the novice marathon runner or for those coming from other locations to run in the race. What should you pack? How should I dress? What supplies will I need?

Elite runners are so experienced that they know exactly what to pack in preparation for the big day. However, those, running in marathon for the first or second time usually have lots of questions. First, what you need and what you can bring will depend on your support team. If you are running alone and will not have family or friends meeting you along the way, then you are limited to a fanny pack and a few supplies. If you have a support team, then they can carry a bag with supplies, meet you along the course and you can have a sense of security.

Remember; do not do anything different on race day. Try out special clothing, water with supplements and snacks on a practice run. Also, experiment with your best pre-race meal. You will be getting up at 5-6:00am to catch the bus from Scranton to Forest City. You may want to pack breakfast to eat in the high school gym such as; bagel, peanut butter, jelly, banana and coffee or Gatorade. Moving your bowels before the race is a must.

Marathon Musts:

Don’t Forget: Map and directions to the bus or starting line, course map, race number, and get your timing chip.

Enjoy! Enjoy! Smell the roses, take in the fall foliage and chat with a fellow racer. Savor the marathon moment and enjoy the day…you are doing something very special!

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Weight Training and Aerobic Exercise for GLP-1 Users

The popularity of glucagon-like peptide-1 (GLP-1) medications, such as semaglutide (Ozempic, Wegovy, Mounjaro) for weight loss, have increased exponentially over the past few years. Many medical experts predict that it is only the beginning. Medicare recently announced that it will begin a pilot program for those who qualify for GLP-1. If approved and covered by Medicare, GLP-1 use will become widespread. While the potential benefits of these weight-loss drugs exceed the risk for those suffering from obesity, it is not without some risk and side effects such as gastrointestinal problems and loss of muscle mass. Following a healthy diet and engaging in an exercise program to maximize the benefits and minimize the side effects from GLP-1 medications is necessary.

GLP-1

Glucagon-like peptide-1 (GLP-1) medications, when used for weight loss, reduce food cravings, increase fullness, slow digestion and control blood glucose. However, gastrointestinal (GI) side effects and maintaining muscle mass and energy levels are common concerns. These medications are designed to mimic the action of a natural hormone GLP-1, which is produced in the intestines after eating. This hormone regulates appetite, blood sugar levels and digestion. Ultimately, by slowing digestion, GLP-1 users feel fuller for longer periods of time.

A recent study published in Journal of the American Medical Association (JAMA) strongly recommends that people using GLP-1 medications eat more protein, consume smaller meals and snacks, avoid certain foods to reduce constipation, nausea and heartburn, stay hydrated, and engage in regular exercise including aerobic exercise and strength training to minimize muscle and bone loss.

Benefits of a Well-Designed Weight Training Program for GLP Users

Risks From Poorly Designed or Unsupervised Program

How to Begin A Weight Training Program for GLP Users

**STOP:

SOURCES: Journal of the American Medical Association, Trimrx.com, National Institutes of Health 

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part 1 of 2

The popularity of glucagon-like peptide-1 (GLP-1) medications, such as semaglutide (Ozempic, Wegovy, Mounjaro) for weight loss, have increased exponentially over the past few years. Many medical experts predict that it is only the beginning. Medicare recently announced that it will begin a pilot program for those who qualify for GLP-1. If approved and covered by Medicare, GLP-1 use will become widespread. While the potential benefits of these weight-loss drugs exceed the risk for those suffering from obesity, it is not without some risk and side effects such as gastrointestinal problems and loss of muscle mass. Following a healthy diet and engaging in an exercise program to maximize the benefits and minimize the side effects from GLP-1 medications is necessary.

GLP-1

Glucagon-like peptide-1 (GLP-1) medications, when used for weight loss, reduce food cravings, increase fullness, slow digestion and control blood glucose. However, gastrointestinal (GI) side effects and maintaining muscle mass and energy levels are common concerns. These medications are designed to mimic the action of a natural hormone GLP-1, which is produced in the intestines after eating. This hormone regulates appetite, blood sugar levels and digestion. Ultimately, by slowing digestion, GLP-1 users feel fuller for longer periods of time. A recent study published in Journal of the American Medical Association (JAMA) strongly recommends that people using GLP-1 medications eat more protein, consume smaller meals and snacks, avoid certain foods to reduce constipation, nausea and heartburn, stay hydrated, and engage in regular exercise including aerobic exercise and strength training to minimize muscle and bone loss.

Diet and Nutrition Considerations for GLP-1 Users

FOOD TO AVOID

  1. High-Fat Foods
    • High-fat foods can increase nausea and bloating.
    • Fried foods: French fries, fried chicken, and doughnuts.
    • Fatty Meats: Bacon, sausage and fatty meats
    • Creamy Sauces and Dressings
  2. Sugary Foods and Beverages
    • Foods with high sugar content can spike blood sugar levels which counteracts the benefits of GLP-1 medications without significant nutritional value. Some include candy, sweets, pastries, desserts, sodas, sweet teas, fruit juices which can also contribute to GI issues.
  3. Starchy Vegetables and Fruits
    • Some starchy vegetables and fruits have a high glycemic index which causes spikes in blood sugar. However, due to the nutritional value that this food group provides, moderation, not elimination, is the best approach when eating potatoes, corn, and peas. High sugar fruits such as very ripe bananas, mangos, and grapes must be consumed prudently.
  4. Highly Processed Foods
    • Highly processed foods are never a healthy choice and more so for GLP-1’s. They often contain unhealthy fats, sugars and preservatives that can contribute to side effects. Some examples are; fast foods, prepackaged snacks (chips, cookies), and instant meals.
  5. Alcohol
    • Overuse of alcohol can contribute to GLP-1 side effects…so drink in moderation and discuss it further with your physician.

Alternative Food Choices for GLP-1 Users

While it is important to eliminate unhealthy foods from your diet as previously discussed, it is equally important to include a diet rich in nutritious and wholesome foods to prevent the loss of muscle mass associated with GLP-1 use.

  1. Lean Proteins
    • Chicken, fish, and plant-based proteins such as lentils, chickpeas, and tofu.         
  2. Non-Starchy Vegetables (low in carbohydrates and calories)
    • Leafy Greens (spinach, kale, Swiss chard)
    • Cruciferous Vegetables (broccoli, cauliflower, Brussels sprouts)
    •  Colorful Vegetables (bell peppers, tomatoes, zucchini)
  3. Whole Grains
    • Brown rice, quinoa, oats
  4. Healthy Fats (good for your health and long-lasting satiety)
    • Avocados, nuts and seeds, olive oil
  5. Hydration
    • Water is the first and best option for hydration in GLP-1 users. Other options include; herbal teas, infused water with fruits and herbs.

Tips for Maintaining a Balanced Diet for GLP-1 Users

  1. Portion Control – GLP-1 medications reduce hunger. Eat smaller, balanced meals.
  2. Be Mindful - Listen to your body - stay focused and listen to your body…don’t eat if you’re not hungry. GLP-1’s will make you feel full if you are paying attention.
  3. Regular Meal Times – try to eat meals at consistent times to avoid blood sugar spikes.
  4. Consult with a Dietitian – get professional advice from a registered dietitian to tailor a plan for your specific needs.

SOURCES: Journal of the American Medical Association, Trimrx.com, National Institutes of Health

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

NEXT WEEK: Part II of II “Diet & Exercise Considerations for GLP-1 Users”

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

PART III OF III

This is the third of three columns dedicated to healthcare for college students. Please find these “10 Tips to Keep Yourself Healthy in College” helpful. However, no discussion regarding the health and wellness of college students would be complete and thorough without addressing what health care and university experts consider the two most dangerous behaviors on college campuses across the nation: binge drinking and unprotected sexual activity.

While it is not my intent to offend the religious and moral values of any reader, it is my purpose to provoke direct and meaningful conversation between parents, religious leaders and students. To prevent serious health problems in college, parents must share their experience and discuss their values regarding sexual activity and alcohol consumption with children before they leave home to live independently in college. If you are unable to have a direct conversation about these issues, consider doing what several readers have done; mail a copy of this column to your child!

10 Tips to Keep Yourself Healthy in College: (American Academy of Pediatrics)

SOURCES: American Academy of Pediatrics

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly.

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy

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 orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!