Studies have shown a recent escalation of joint replacements in a much younger and more active group than previously noted…the baby boomer! While the end result is mostly physical, the cause is often psychological. We all know the personality type: type A, hyperactive, goal-oriented, driven, possessed and highly organized – almost at all costs! Many of you have seen fitness enthusiasts running through the streets at 5:30 AM for 5-10-15 miles each day. Moreover, many of these runners have more activities planned later in the day: golf, tennis, ski, swim, play sports with their kids. Well, after 20 years of this behavior, many of these enthusiasts are now suffering the effects of long term multiple micro traumas. They are suffering from what orthopedic surgeons at the University of Pennsylvania call “Boomeritis! Boomeritis is inflammation of the baby boomer from overuse. Lower back pain, hip, groin, and knee pain is almost a daily event.

As baby boomers continue to enjoy sports with the same vigor and intensity as when they were younger, they are finding that their older bodies just can’t keep up. While these individuals often succeed in finding the balance of fitness and craziness, they have had times when they took it too far. Furthermore, nearly all compulsive exercisers suffer from over training syndrome. When take too far compulsive behavior is rationalized by insisting that if they didn’t work to extreme then their performance would suffer.

10 Warning Signs of a Compulsive Exerciser (E. Quinn):

• You force yourself to exercise even if you don’t feel well
• You almost never exercise for fun
• Every time you exercise, you go as fast & hard as you can
• You experience severe stress & anxiety if you miss a workout
• You miss family obligations because you have to exercise
• You calculate how much to exercise based on how much you eat
• You would rather exercise than get together with friends
• You can’t relax because you think you are not burning calories
• You worry that you’ll gain weight if you skip exercising for one day
• Rain, sleet, or hail would not prevent you from exercising

*Each sign is worth 1 point:

• 1-3 Points    = Normal compliance & disciplined behavior
• 3-5 Points     = Caution but OK
• 5-7 Points     = Reexamine goals
• 7-10 Points   = Get Help

10 Warning Signs of Overtraining (E. Quinn):

• Mild leg soreness & general achiness
• Pain in muscles & joints
• Washed-out feeling, tired, drained & lack of energy
• Sudden drop in ability to run “normal” distance or times
• Insomnia
• Headaches
• Inability relax, twitchy, fidgety
• Insatiable thirst, dehydration
• Lower resistance to common illnesses: colds, sore throat etc.
• Exercise starts to feel like a job

Managing Overtraining

If you have two or more of the warning sings, consult your family physician to rule out potentially serious problems.

• Stop and rest. Taking several days off is the best treatment.
  • 3-5 days off if overtraining for 3-4 weeks and 3-5 weeks if severe and prolonged overtraining.
• Drink plenty of fluids.
• Alter you diet by eating health carbs (fruit, veggies, pasta)
• Alternate your routine to prevent stagnation. Cross training will use different muscles (lift: arms Mon & Wed, legs Tues & Thur, Aerobic: run Mon & Wed and bike Tues & Thur).
• Try a massage to mobilize built up lactic acid in your muscles.
• Use RICE (rest, ice, compression elevation) for acute injuries (strains, muscle/tendon soreness) associated with exercise.
• Have Fun! Mix in fun sports and activities to break the monotony by adding fun activities such as golf (walk 5-7 miles and carry a light bag), swim, bike, ski, hike and play tennis. Remember, overtraining problems occur in single sport athletes.
• Limit Intensity – only work out intensely 2-3 times out of 5 days per week.

TIPS TO AVOID EARLY JOINT DEGENERATION

Avoid weight bearing exercises two days in a row. Run one day, walk, swim or bike the next.

Use the elliptical instead of the treadmill.    

Avoid squatting…deep squatting is bad for your hips and knees. Even when gardening, use a kneeling pad instead of bending down and squatting.

Visit your family 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 orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

For all of Dr. Mackarey's articles, visit our exercise forum!

Fall is here, cross-country running season has begun and the 26^th Steamtown Marathon is only a few weeks away! With that in mind, running injuries, some very specific to women, are on the increase…

While driving to or from work have you noticed more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.

With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.

A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.

According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”

The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.

They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.

The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.

What is BMI?

Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.

BMI = (weight in pounds / height in inches squared) X 703)

Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8

Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7

Underweight      < 18.5%

Normal weight      18.5 to 24.9%

Overweight      25 to 29.9%

Obesity            30 and over

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk for stress fractures?

FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.           

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Other Causes of Stress Fractures

• Overuse, Overload, Over training – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
• Inadequate Fitness Level – or activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program to quickly for cross-country in August/September.
• Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
• Recent Change in Training Schedule – sudden increased intensity or speed
• Recent Change in Running Surface – sudden change to a hard or soft surface
• Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
• Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
• Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
• History of Stress Fractures – makes the athlete two times as likely to have another

Prevention & Treatment

• Maintain Ideal BMI – 24 for female runners
• If Overweight – gradual exercise with diet, not too much too quickly - Mix run & walk every 10 minutes
• If Underweight – improve diet maintain healthy body fat%
• Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
• Perform lower body weight training – to strengthen the muscles of the lower body, thighs, knees, ankles, feet.
• Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
• Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
• Gradual Change in Training Schedule
• Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
• Gradual Change in Foot ware – walk in new shoes first, then run 1-2 miles
• Consult Family Physician/Orthopedic Physical Therapist/Nutritionist

Source: Ohio State University, Science Daily

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

Fall in NEPA is one of my favorite times of year. For outdoor enthusiasts, there is nothing more refreshing than activities in the bright sunshine and crisp, clean air. The hot humid summer weather can be a deterrent to outdoor activities and this time of year provides an opportunity to get fit by beginning a walking program. For many who have not maintained an active lifestyle or have health issues, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program too aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.

WALKING FOR HEALTH

There is probably nothing more natural to human beings than walking. Ever since Australopithecus, an early hominin (human ancestor) who evolved in Southern and Eastern Africa between 4 and 2 million years ago, that our ancestors took their first steps as committed bipeds. With free hands, humans advanced in hunting, gathering, making tools etc. while modern man uses walking as, not only a form of locomotion, but also as a form of exercise and fitness. It is natural, easy and free...no equipment or fitness club membership required!

BENEFITS OF WALKING

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.” According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

• Improve blood pressure and blood sugar levels
• Help maintain a healthy body weight and lower the risk of obesity
• Enhance mental well-being
• Reduce the risk of osteoporosis
• Improve muscle and joint health
• Improve circulation
• Improve sleep

PLAN AHEAD

• Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption are also recommended for walking. Wear weather appropriate dry tech clothing with bright, reflective visible colors. Bring a cell phone in case of emergency…but try not to use it to talk or text because it will ruin the vibe!
• Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
• Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
• Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
• Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.
• Trekking Poles. Consider using trekking poles, especially if you have a balance issue or lower back, hip, knee or ankle/foot problems.
• Hydrate. If you build up to more than 45 to 60 minutes or if the temperatures soar, bring a water bottle and be sure to hydrate.

SET REALISTIC GOALS

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can't set aside that much time, try several short sessions of activity throughout the day (3 ten or 2 fifteen minute sessions). Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.

Remember it's OK to start slowly — especially if you haven't been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week. Once you are ready for a challenge, add hills, increase speed and distance.

TRACK YOUR PROGRESS

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a smart watch, pedometer or fitness tracker to calculate steps and distance.

MARK YOUR CALENDAR

Make walking part of your daily routine. Pick a time that works best for you. Some prefer early morning, others lunchtime or after work. Enter it in your smart phone with a reminder and get to it!

FIND A WALKING PARTNER

 Studies show that compliance with an exercise program is significantly improved when an exercise buddy is part of the equation. It is hard to let someone down or break plans when you commit to someone. Keep in mind that your exercise buddy can also include your dog!

USE EFFICIENT WALKING TECHNIQUE

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here's how you'll look when you're walking:

• Head up, look forward – glance at the ground but don’t stare down.
• Relax your neck, shoulders and back – avoid a rigid upright posture.
• Swing your arms freely with a slight bend in your elbows.
• Keep your stomach muscles slightly tightened (work the core) with a straight back.
• Walking smoothly - rolling your foot from heel to toe.

Visit your doctor regularly and listen to your body.     

Sources : Sapiens.org; WebMD; Mayo Clinic 

NEXT MONDAY BLOG and in print in THE SUNDAY TIMES TRIBUNE – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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 associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Paul Mackarey's articles, check out our exercise forum!

This column is repeated every year at this time with the intent of raising the level of awareness to prevent death or serious illness from heat stroke in athletes and other active people in hot, humid weather.

It is August and summer is rapidly passing! So, get outdoors and have fun in the sun. However, please be mindful of how your body reacts to high humidity and heat and take appropriate precautions. Athletes are particularly vulnerable this time of year due to daytime practice sessions. (August 7, 2023, first day of acclimatization and August 14, 2023, first day of practice for fall sports according to PIAA). Visit www.piaa.org for more information. Keep in mind, you don’t have to be running a marathon or playing football in full uniform to suffer from heat stroke.

Heat stroke, one of the most serious heat-related illnesses, 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 and it can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heat stroke 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.

Hot Temps and Exercise

Some “old school” folks think that wearing extra clothing and “breaking a good sweat” is an optimal goal for exercise. However, it may be potentially very dangerous in hot and humid conditions. When exercising in hot weather, the body is under additional stress.  As the activity and the hot air increases your core temperature your body will to deliver more blood to your skin to cool it down. In doing so, your heart rate is increased and less blood is available for your muscles, which leads to cramping and other more serious problems. In humid conditions, problems are magnified as sweat cannot be evaporated from the skin to assist in cooling the body.

The American Academy of Pediatrics and The American College of Sports Medicine has the following recommendations which are appropriate for both the competitive athlete and weekend warrior:

Treatment of Heat Stroke:

• Heat Exhaustion – can be a precursor to heat stroke
  • Signs: cramps, weakness, fatigue, nausea
  • Treatment: rest in shade, cool down with cool (not cold) towels, and drink plenty of fluids.
• Core Body Temperature above 105 degrees Fahrenheit
• Hot, dry skin – flushed but not sweaty
• Lack of sweating *
  • *NOTE: athletes often have external heat stroke and they can sweat even with an increase core temperature
• Very rapid pulse
• Mental confusion, disorientation or hallucinations
• Physical clumsiness, sluggishness or fatigue
• Seizure
• Dizziness

Treatment of Heat Stroke:

• CALL 911 – Remember this may be life-threatening
• Relocate  – to a cool shady place or air-conditioned indoors and lie down with slight elevation of feet
• Undress – Remove outer garments and roll onto side to expose as much skin as possible to the air
• Cool Down – spray or sponge with cool water (not cold) and fan the skin
• Ice – place ice packs to the groin, neck and armpits to cool down large blood vessels. No ice bath.
• Core Temperature – is the only accurate measurement so medical personnel may take rectal temp if necessary. Must get core temp to 102 degrees Fahrenheit ASAP.
• Begin CPR – if breathing stops
• No Aspirin or Acetaminophen – to decrease temp
• Administer Fluids – if person is alert enough to swallow give 32 to 64 oz over 1-2 hours

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

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 in downtown Scranton and is an associate professor of clinical medicine Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, check out our exercise forum!

STAY ACTIVE & HAVE FUN IN THE SUN!

Can you believe that the 4^th of July holiday was more than one month ago? Do not despair! There is still plenty of time to be outdoors in NEPA and experience so many activities such as: biking, hiking, running, walking, swimming, boating, golfing, and playing tennis to name a few. Late summer and early fall tend to be beautiful and is also a wonderful opportunity to discover your inner child, mix it up and try something new! Below are some new and exciting ways to stay active and have fun in the sun:

Spending time on any of the beautiful lakes in NEPA is time well spent. From an exercise standpoint, rowing, canoeing and kayaking offer a very special experience. Most kayaks are light weight, easy to use and maneuverable on a lake. Sitting low on the water offers a unique perspective as you feel yourself gliding across the lake. The Countryside Conservancy, in partnership with Lackawanna State Park, sponsors moonlight kayak events on the lake at the park. With a bright full moon, you can begin at 8 pm and return at 10 pm. Bring bug spray and headlights to enjoy the sunset and moon rise on the lake. You will feel like a kid breaking the rules of the park by being on the water after dark!

NOTE: Try kayaking in the daytime first and then advance to sunset trips before staying on the water for the moonlight. Rentals are available at the park.

Gear:

• Clothing – a DryTec type material for shirt and pants…bring along a light long sleeve in case the wind picks up or the bugs are out.
• Shoes – Aqua shoes are best…old sneakers will work
• Water – handheld water bottle or a water proof bag for money, keys, ID, and a granola bar.
• Insect Repellent - a must
• Headlamp – to see and be seen on the water and packing up.
• Change of Clothes – towel and change of clothes in your car…just in case

Website: www.countrysideconservancy.org; www.dcnr.state.pa.us/stateparks.org  

Stand up paddle boarding (SUP) is becoming a fast-growing sport among water enthusiasts. It is a fun way to exercise your core, improve balance, and tone your upper body. It requires minimal equipment; a board that is essentially a long and wide surfboard and a long paddle to use while standing on the board. It can be done in the ocean surf, bay, lakes, or rivers; however, beginners would be wise to stay in calm water. Rentals are available at most beaches.

Check out the video for more information: REI paddleboard basics

Elliptical Peddle Boarding

What is it? Imagine a standup paddle board with a handlebar and pedals like a exercise stepper machine. Instead of using a paddle, you step up and down on the pedals and fins under the board propel you through the water.  Check it out…Hobie Mirage Eclipse Stand Up Peddle Board; Dick’s Sporting Goods

Aqua Zumba

Zumba is a very popular form of dance aerobics spiced up with Latin music. When adding water and sun to this already cool activity, you are assured to have fun while exercising. As with any aquatic exercise, the added resistance from the water gives arm rows and leg kicks more challenge. Female participants report an additional benefit; they are uninhibited to “shake that thing” to the music under the cover of the water. So, beat the heat, let loose and get some fun in the sun while you exercise.

NOTE: Consider trying regular Zumba first to get the hang of it. Amy Sekol is a local certified Zumba instructor and also offers Aqua Zumba. (amys.zumba.com)

Website: www.zumba.com

Elliptical Biking

I love this idea…why didn’t I think of it first! In the gym I enjoy the elliptical machine because it simulates running without the impact on my joints but of course, I would rather be outdoors. Well, this is the answer to my prayers…an elliptical machine that is attached to a bike with handle bars and brakes included. I think it will probably be difficult on steep hills but it is something I MUST TRY!

Website: www.elliptigo.com;  www.mywingflyer.com

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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 associate professor of clinical medicine at GCSOM.

For all of Dr. Mackarey's Articles, check out our exercise forum!

 

The sunny warm weather is conducive to outdoor sports and activities. Countless adults and more especially students out of school for the summer are participating in tennis, soccer, cross country running, gymnastics, and other sports. These student athletes and others who engage in recreational sports and exercise can be vulnerable to excessive training for all the right and wrong reasons. Parents, family members, coaches, teachers, athletic trainers, friends and health providers must be aware of potential for exercise abuse…as part of the “fitspiration” movement.

It takes only a cursory glance through social media to become aware of the “fitspiration” movement. This catchy term may accompany posts of workout videos, pictures depicting physical activity, or pictures of individuals showing off the muscular bodies they obtained through dedication to rigorous exercise regimens. In a sense, exercise and fitness have become trendy in our society, with more strenuous exercise routines being perceived as more impressive. Cars boast bumper stickers with numbers such as “13.1,” “26.2,” or even “50,” referring to the distances so proudly conquered by runners. When we hear a friend has decided to commit to a rigid training schedule to complete a marathon, we are often in awe of their self-control and motivation, wishing we were that dedicated. But can exercise be a bad thing? The answer is complicated. Exercise is one of the best things we can do for our health. I have heard physicians say that if all the benefits of exercise could be bottled up into a pill; pharmaceutical companies would be fighting for the chance to sell it. However, it can get complicated when one’s reasons for exercising stem from a potentially destructive place, rather than a pursuit of health.

Exercise Bulimia/Anorexia Nervosa

Exercise bulimia is a term used to refer to the excessive use of exercise to burn calories or try to keep a low body weight. It is not a medical diagnosis in and of itself, but the notion of using exercise to make up for excessive calorie consumption or maintain an unhealthily low body weight can occur in both anorexia nervosa and bulimia nervosa. Moreover, when excessive exercise occurs in combination with a significantly low body weight, an intense fear of gaining weight, a disturbed body image, undue influence of body shape on self-worth, or a failure to recognize the seriousness of the condition, an individual would meet the criteria for anorexia nervosa.

Anorexia nervosa can cause serious complications in all body systems. Some examples include disrupted functioning of the heart, reduced lung capacity, hormonal imbalance, amenorrhea, (loss of the menstrual period in women), changes in brain structure, and in severe cases, difficulty with memory. The hormonal changes associated with amenorrhea, especially when coupled with extreme exercise, can lead to reduced bone density and can put women at high risk of stress fractures. Stress fractures are breaks in the bone that occur from overuse through large amounts of exercise rather than the traumatic bone breaks we typically think of where an obvious event results in a broken bone.

Warning Signs

Because exercise bulimia can be a part of an eating disorder with potentially life-threatening consequences, it is important to be aware of the warning signs that someone’s exercise routine might be part of an eating disorder. Signs of exercise bulimia may include:

• Exercising in excessive amounts
• Refusing to take days off from exercise
• Being overly concerned with tracking how many calories one burns
• Becoming defensive if someone suggests the person is exercising too much
• Being very anxious if the person is not able to do his or her usual form of exercise
• Sticking to a rigid exercise routine at the expense of missing social activities, work or school
• Feeling guilty when unable to exercise
• Refusing to eat if unable to exercise
• Having exercise performance significantly tied to self-worth

Not Clear Cut

While the definition of exercise bulimia implies a voluntary engagement in excessive exercise for weight loss, my experience from being on female track and cross country teams in high school and college has shown me that anorexia nervosa does not always fit the mental picture we may have of someone who refuses to eat at all or even of exercise bulimia where an individual compulsively engages in excessive exercise. During cross country, the mileage we ran likely would have been considered excessive by the average person. Our team often trained 7 days a week with run-length ranging from 5-12 miles. Most runs were at least 7 miles, and some of my teammates had long runs in excess of 12 miles. The men on our team ran even farther. In hindsight, one of my teammates may have met the criteria for a diagnosis of anorexia nervosa. Her weight was significantly below normal, she feared weight gain, did not eat sufficient calories to replenish what she burned on runs, and despite knowing she was thin, did not fully recognize the potential health consequences due to her low weight. However, it was not a clear cut problem. She was not an obvious candidate for an eating disorder because she was not pursuing the excessive exercise; she was simply following her coach’s training plan. If she did not exercise to the extent she did, the amount of food she ate would have been considered normal, so seeing her eating habits alone did not trigger any red flags. Finally, cross country runners are known for being lean, often even emaciated; it was a common side effect of the sport often not given a second thought. Thankfully, this runner never fell victim to the dangerous downward spiral that is sometimes seen in patients with anorexia nervosa. However, it is important to be aware of the unsuspecting ways in which an eating disorder can sometimes present.

Treatment

Treatment of eating disorders typically involves a multi-pronged approach with nutritional counseling, psychotherapy, and general medical care playing a role. The nutritional counseling aims to help the patient restore a healthy diet to attain a healthy weight, the psychotherapy aims at getting to the root of the issues that may have contributed to the onset of the eating disorder, and general medical care may be necessary to manage any complications from the eating disorder depending on its seriousness. Educational programs about eating disorders and risk factors have also been shown to be successful in helping to prevent eating disorders.

It can sometimes be a fine line between a healthy passion for exercising and eating well and the start of an eating disorder. Especially in athletes where extreme exercise is part of the sport and putting in extra training is rewarded, it is valuable to be aware of the signs and symptoms of exercise bulimia to help prevent a loved one from crossing over that line. Though serious health consequences are possible in the setting of an eating disorder, treatment and recovery are very possible.

GCSOM Guest Author: Mary Pelkowski, Geisinger Commonwealth School of Medicine MD Class of 2022.

For More Information: www.nationaleatingdisorders.org

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, exercise regularly, and live long and well!

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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 associate professor of clinical medicine at GCSOM.

For all of Dr. Paul's articles, check out our exercise forum!

Have Fun and Get in Shape!

Memorial Day is the unofficial kickoff to summer…outdoor furniture is out, the grill is fired up and the pool is open! This summer try to think of your pleasure puddle in different light…a health spa! It may very well be the exercise of choice for many people. Many have discovered the benefits of moving their limbs in the warm water of a home pool following knee or shoulder surgery. Also, long distance runners who often look for cross training methods without joint compression and arthritis sufferers who are often limited in exercise choices by joint pain from compressive forces when bearing weight, can enjoy the buoyancy effects of  water. These are good examples of the benefits or water exercise…aerobic and resistive exercise without joint compression.  

Exercise and Arthritis

Most doctors recommend some form of exercise with arthritis. Pain and fatigue are the most limiting factors for the person with arthritis. Pool exercise may be the answer. With proper technique, adequate rest periods, appropriate resistance and repetitions, water exercise can be very effective.

Benefits

The following are some of the benefits of water exercise:

• Decreased Risk of Cardiovascular Disease
• Improved Endurance
• Improved Strength – with resistance of water to exercise muscles
• Improved Flexibility and Range of Motion – with less pain
• Improved Function in Daily Activities
• Maintain Mobility
• Improved Balance
• Slow Down Osteoporosis
• Weight Control – which leads to less stress on joints
• Improved Mood and Attitude – release of endorphins and serotonin
• Improved Circulation – especially in warm water
• Decreased Muscle Spasm and Tension – especially in warm water
• Decreased Stress on Joints – Buoyancy effect of water

Getting Started

• Medical Clearance – see your family physician for clearance especially if you have a cardiac history or joint replacements. Do not use pool if you have surgical sutures or an open wound.
• Warm Pool -  83-88 degrees Fahrenheit
• Water Walking Exercise– begin in shallow end
• Water Running Exercise– with buoyancy vest in deep end
• Water Aerobics Exercise– using arms and legs as in regular aerobic exercise but in the water
• Strength & Flexibility Exercise – just as on land but in water

1. Start Slowly – Don’t Overdo it
   • 5-10 minutes and repetitions first time and add 2-3 minutes/repetitions each week
   • Long Term Goal: 20 – 40 minutes per session - 3-4 times per week
2. Submerge The Body Part - That you want to exercise into the water and move it slowly
3. Complete The Range of Motion - Initially 5 times, then 10-15-20-30 times
4. Assess - Determine if you have pain 3-4 hours after you exercise or into the next day. If so you overdid it and make adjustments next time by decreasing repetitions, speed, amount and intensity of exercise.
5. Warm-Up - Make sure you warm up slowly before the exercise with slow and easy Movements
6. Advance Slowly - By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
7. Exercises – standing in shallow end of pool
   • Heel Raises - push toes down and heel up
   • Toe Raises – lift toes up and heel down
   • Leg Kicks – extend leg up and down
   • Hip Hike – raise knee up 4-6 inches and down
   • Leg Squeeze – squeeze knees together and apart
   • Leg Curl – bend knee
   • Torso Twist – slowly turn arms/torso to right, then to left
   • Shoulder Forward and Backward – like paddling a boat
   • Shoulder Out and In – like a bird flying
   • Bend Elbow Up and Down

Visit your doctor regularly and listen to your body.     

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

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 associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our Health and Exercise Forum!

We are more than one month into the New Year and many people are still talking about their health and fitness goals. As you probably know, losing weight and getting fit are the most popular resolutions, however, for many who have not maintained an active lifestyle in years, it is challenging to know where to begin. Moreover, beginning without a good plan can lead to injury and leave you discouraged. For example, those overweight and de-conditioned should not start a walking program to aggressively. Walking at a fast pace and long distance without gradually weaning into it will most likely lead to problems.

WALKING FOR HEALTH

There is probably nothing more natural to human beings than walking. Ever since Australopithecus, an early hominin (human ancestor) who evolved in Southern and Eastern Africa between 4 and 2 million years ago, that our ancestors took their first steps as committed bipeds. With free hands, humans advanced in hunting, gathering, making tools etc. while modern man uses walking as, not only a form of locomotion, but also as a form of exercise and fitness. It is natural, easy and free...no equipment or fitness club membership required!

BENEFITS OF WALKING

“There’s no question that increasing exercise, even moderately, reduces the risks of many diseases, including coronary heart disease, breast and colon cancer, and Type 2 diabetes,” said Dr. Jennifer Joyce, MD, professor of family medicine at GCSOM. “Research has even shown that you could gain two hours of life for each hour that you exercise regularly.”

According to the American Heart Association, walking as little as 30 minutes a day can provide the following benefits:

• Improve blood pressure and blood sugar levels
• Help maintain a healthy body weight and lower the risk of obesity
• Enhance mental well-being
• Reduce the risk of osteoporosis
• Improve muscle and joint health
• Improve circulation
• Improve sleep

PLAN AHEAD

• Gear Up – but don’t go overboard. Good running shoes with proper arch support and shock absorption are also recommended for walking. Wear weather appropriate dry tech clothing with bright, reflective visible colors. Bring a cell phone in case of emergency…but try not to use it to talk or text because it will ruin the vibe!
• Select the Best Path – begin on level surfaces like a “rails to trails.” In inclement weather consider walking in a shopping mall.
• Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.
• Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.
• Stretch. After you cool down, gently stretch your muscles. If you want to stretch before you walk, remember to warm up first.
• Trekking Poles. Consider using trekking poles, especially if you have a balance issue or lower back, hip, knee or ankle/foot problems.
• Hydrate. If you build up to more than 45 to 60 minutes or if the temperatures soar, bring a water bottle and be sure to hydrate.

SET REALISTIC GOALS

Anything is better than nothing! However, for most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity, or an equivalent combination of moderate and vigorous aerobic activity. The guidelines suggest that you spread out this exercise during the course of a week. Also aim to do strength training exercises of all major muscle groups at least two times a week.

As a general goal, aim for at least 30 minutes of physical activity a day. If you can't set aside that much time, try several short sessions of activity throughout the day (3 ten or 2 fifteen minute sessions). Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.

Remember it's OK to start slowly — especially if you haven't been exercising regularly. You might start with five minutes a day the first week, and then increase your time by five minutes each week until you reach at least 30 minutes.

For even more health benefits, aim for at least 60 minutes of physical activity most days of the week. Once you are ready for a challenge, add hills, increase speed and distance.

TRACK YOUR PROGRESS

Keeping a record of how many steps you take, the distance you walk and how long it takes can help you see where you started from and serve as a source of inspiration. Record these numbers in a walking journal or log them in a spreadsheet or a physical activity app. Another option is to use an electronic device such as a smart watch, pedometer or fitness tracker to calculate steps and distance.

MARK YOUR CALENDAR

Make walking part of your daily routine. Pick a time that works best for you. Some prefer early morning, others lunchtime or after work. Enter it in your smart phone with a reminder and get to it!

FIND A WALKING PARTNER

Studies show that compliance with an exercise program is significantly improved when an exercise buddy is part of the equation. It is hard to let someone down or break plans when you commit to someone. Keep in mind that your exercise buddy can also include your dog!

USE EFFICIENT WALKING TECHNIQUE

Like everything, there is a right way of doing something, even walking. For efficiency and safety, walking with proper stride is important. A fitness stride requires good posture and purposeful movements. Ideally, here's how you'll look when you're walking:

• Head up, look forward – glance at the ground but don’t stare down.
• Relax your neck, shoulders and back – avoid a rigid upright posture.
• Swing your arms freely with a slight bend in your elbows.
• Keep your stomach muscles slightly tightened (work the core) with a straight back.
• Walking smoothly - rolling your foot from heel to toe.

Sources : Sapiens.org; WebMD; Mayo Clinic

* Visit your doctor regularly and listen to your body.     

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

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 associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

For all of Dr. Mackarey's articles: Visit our Healthcare Forum!

Human beings were designed to move…walk, run, climb, lift, hunt, and gather. Contemporary man has suffered greatly from a technologically driven inactive and sedentary lifestyle. Moreover, many people continue to work or school from home and studies have found that these people are sitting more with less activity during the day. Inactivity is associated with many health problems; obesity, adult-onset diabetes, high blood pressure to name a few. The problems associated with lack of movement are many.

Constipation

The more you move your body, the more you colon moves!  A regular and consistent exercise and activity regime, results in a more consistent bowel schedule, especially with age. Healthy muscle tone in your abdominal muscles and diaphragm is also key to moving waste through your digestive tract.

Stiff Joints

Osteoarthritis, rheumatoid arthritis and many inflammatory or auto-immune diseases can cause achy, and stiff joints. However, even healthy joints can also stiffen when you don’t use them enough. Put them to work so they get tight and cause pain.

Shortness of Breath

All muscles get weak from lack of use, including the muscles that help your lungs expand and contract as you breathe if you don’t work them out regularly. The less exercise or activity you do, the more you experience shortness of breath, even during easy daily tasks.

Depression/Moody

Physical problems are not the only complication of inactivity. A lack of movement can also increase feelings of anxiety and depression. Aerobic exercises like walking, biking, swimming, or running, have been proven to stimulate endorphins to boost and steady your mood, and even improve your self-esteem.

Low Energy

Many studies have found that regular movement improves energy. Exercise helps deliver oxygen and nutrients to your tissues. When you sit or are inactive, tissues are not getting the same amount of fuel they need to keep you going.

Slow Metabolism

Movement stimulates your metabolism. Hyperactive people burn more calories…just by fidgeting! Even if you are not hyperactive, the more active you are, the more calories you burn each time you move.

Sleeplessness

One of the first recommendations sleep doctors make to their patients suffering from insomnia is exercise. When you keep a regular exercise routine, you fall asleep faster, and you sleep deeper once you drift off.

Lack of Mental Clarity

Exercise stimulates the release of oxygen carrying blood and chemicals in your brain to improve function. The more blood that gets to your brain, the better you can think, remember, and make decisions.

High Blood Pressure

Sedentary people have a higher incidence of high blood pressure and heart disease. Spending most of your time sitting raises your risk of heart disease. High cholesterol, high blood pressure, obesity, all related to inactivity, are major risk factors for heart issues like coronary artery disease and heart attack.

Pre-Diabetes

Inactivity and high blood glucose levels are closely associated. Regular exercise is essential to keep your blood glucose under control. Stable blood sugar levels helps you avoid type 2 diabetes danger zone.

Low Back Pain

A strong core is can prevent lower back pain. A weak core, associated with inactivity core muscles and lack of use, makes you more vulnerable to lower back pain from tweaking your back muscles during everyday movements like standing or reaching. Pilates, yoga, and other exercises that use stretching are good for building a stronger back.

Increased Appetite

While some people report an increase in appetite with exercise, research shows that aerobic exercise like biking, swimming, walking, and running can actually decrease your appetite because it changes the levels of certain “hunger hormones” in your body.

Frequent Cold and Flu

Studies show the more moderate activity you get, the lower your chance of catching a cold or other germs. When you make exercise a habit, your immune system gets stronger.

Dull or Washed Out Skin

If your skin looks duller than usual, a lack of movement may be to blame. Some studies show that moderate exercise boosts your circulation and your immune system, which helps your skin keep that youthful glow.

Source: WebMD

Read “Health & Exercise Forum” – Every Monday Next Week Part II of II: Tips to Select a Good Cervical Pillow For You.  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.

For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.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 in downtown Scranton, PA and is an associate professor of clinical medicine at GCSOM.

November is also Native American Heritage Month!

Happy Thanksgiving! Like most of you, I am most thankful for the love and support of my family and friends. I am also very thankful for health and wellness. But this year, the year of the global pandemic which has limited my access to the warm hugs and smiles of those I love, I am more grateful than ever for simple things…the beauty of nature and the great outdoors in NEPA!

With this in mind, I am also grateful to the first environmentalists in the Americas…Native Americans! Long before John Muir and the Sierra Club, Native Americans were stewards of the planet. Native Americans feel that everything in nature has a soul… living creatures, trees, mountains, rocks and even water! Therefore, they believe that all of nature must be treated with respect and honor.  Today, when being outdoors in nature is more important than ever, we are the beneficiaries of their stewardship. Now it is our turn to enjoy, respect and protect nature for future generations!

GET THE HECK OUTSIDE!

Research shows that spending time outdoors has many positive effects on your health. With a little imagination, one can find many year round activity options in Northeastern Pennsylvania. While swimming, boating, kayaking, biking and golfing may be winding down, consider other options this winter. With proper equipment and clothing, walking, running, hiking, fat-tire biking, snowshoeing, cross-country and downhill skiing can be enjoyed. Studies show that even less vigorous activities such as barbequing or reading a good book on the porch are healthier than being indoors... so bundle up next to a good fire pit or outdoor propane heater and get outdoors!

Even before the pandemic, it was 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, heat, ticks, wind, cold, 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.

• Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight. It seems that health concerns of ultraviolet light, sun burn and skin cancer have created an overreaction to the point of Vitamin D deficiency in many. Balance and common sense go a long way. One can attain normal levels of Vitamin D by being outdoors in the sun and exposing their arms and legs for 10 -15 minutes a few times per week. Additional time in the sun warrants sunscreen and Vitamin D supplements can be used if necessary.

• Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children. Some studies show that children in the United States spend an average of 6 ½ hours per day with electronic devices such as computers, video games and television. It is also reported that a child’s activity level more than doubles when they are outdoors. So, get out of the office, house and gym as often as possible. Consider weight training at the gym and doing cardio by walking, biking or running outdoors.    

• Improved Mental Health – It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health. Furthermore, studies show that exercising outdoors in the presence of nature, even for as little as 5- 10 minutes has additional mental health benefits. For those less active, read or listen to music outdoors next to a fire.

• Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors. Furthermore, it was discovered that these children scored higher on concentration tests following a walk in the park than they did after a walk in their residential neighborhoods or downtown areas, showing the benefit of the “green outdoors.”

• Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light. Next time you’re recovering from an illness, discuss this with your physician.
• Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. In spite of this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside. Many pulmonologists believe people with pulmonary problems would benefit from outdoor activities such as a 10-15 minute walk because they are prone to osteoporosis and Vitamin D deficiency.  Local pulmonologist, Dr. Gregory Cali, DO, agrees and also adds that studies do not show that high humidity is dangerous for respiratory patients but it may be uncomfortable. In cold temperatures, those with pulmonary problems must avoid directly breathing cold air by covering up their mouths when walking outdoors. Overall, the benefits far outweigh the risks.

Read “Health & Exercise Forum” – Every Monday.  

OR access ALL of Dr. Mackarey's content at https://mackareyphysicaltherapy.com/forum/

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 associate professor of clinical medicine at GCSOM.