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Part I of II

According to the National Institutes of Health, an estimated 19.1% of U.S. adults 18 and older had an anxiety disorder in the past year. Anxiety disorders were higher for females (23.4%) than for males (14.3%). An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives.

There are a wide variety of anxiety disorders and will vary by the objects or situations that induce them. However, the features of excessive anxiety and related behavioral disturbances are similar. Anxiety disorders can interfere with daily activities such as job performance, school work, and relationships. Symptoms include: distress, nausea, shortness of breath, bowel pattern changes, excessive perspiration, frequent laughing or crying, restlessness, and is often associated with depression. While there are many types and degrees of anxiety and there is no substitute for medical and psychological care, there are some simple and basic tools to help manage the problem…daily exercise is one easy, affordable and accessible suggestion for most. 

Multiple studies have discussed the incidence of unhealthy self management of anxiety, including the use of alcohol and recreational drugs. The University of Pittsburgh Medical Center (UPMC) recommends the following healthy tips for coping with anxiety:

Healthy Coping Tips

1. Get Enough Sleep 
Adequate sleep is critical for mental health. Unfortunately, anxiety can lead to sleeping problems and, according to the Anxiety and Depression Association of America (ADAA) inadequate sleep can worsen anxiety.

Seven to nine hours of sleep each night is recommended for most adults. The National Sleep Foundation recommends maintaining a regular schedule that includes going to bed at the same time each night and waking up at the same time each morning.

2. Practice Mindfulness Meditation 
Incorporating meditation into your life can help you cope with anxiety, according to the National Center for Complementary and Integrative Health.

Research shows mindfulness meditation programs are effective in reducing anxiety and depression. UPMC offers a Mindfulness-Based Stress Reduction Course and a Beginners Guide to Meditation that have been proven to be very effective. Another option for reduction of anxiety and stress is Progressive Muscle Relaxation. This mind-body technique can be found in 5, 10, 15 or 20 minute videos.

3. Spend Time in Nature 
How you deal with anxiety should include a walk in the forest or even a tree-lined park. In NEPA we are very fortunate to have access to beautiful walking and biking trails and state parks. Make time to enjoy them.

Research shows that “forest bathing,” long, slow walks in nature for health purposes, can lower blood pressure and relieve anxiety. A review of clinical trials published in the International Journal of Biometeorology found that salivary cortisol levels, biomarkers for stress, were significantly lower in groups who participated in forest bathing versus the control group.

4. Take up Yoga or Tai Chi 
Yoga does more than increase your flexibility. It incorporates exercise, deep breathing, and meditation. Yoga is an all-in-one anti-anxiety activity, as shown in a review of body-centered interventions published in Frontiers in Psychology. Tai chi, a mix of meditation and martial arts, works much the same way.

5. Dance Therapy 
That same research found that dance therapy, also known as movement therapy, reduces anxiety by engaging the body’s nervous system, which regulates how the body reacts to stress. In addition, dance/movement therapy increases production of serotonin, a chemical produced by the cells that’s responsible for mood.

6. Breathe Through It 
When you begin to feel anxiety or a panic attack with symptoms such as: sweating, trembling, dizziness, rapid heartbeat and nausea, start to come on, “take a deep breath.” Research shows that slow deep breaths can calm you down and lower your heart rate while quick, shallow breaths  can induce or worsen anxiety.

One breathing technique shown to reduce anxiety is diaphragmatic breathing. Using your diaphragm for deep breathing requires you to fill your lungs to capacity.

Breathe in slowly through your nose so that your stomach rises. Then, tighten the stomach muscles and exhale slowly through pursed lips. Repeat several times.

7. Limit Caffeine and Alcohol 
Too much caffeine restricts blood vessels, which can increase blood pressure and contribute to anxiety. Coping with anxiety also doesn’t mean masking it with alcohol. Studies show that there is a complex relationship between alcohol and anxiety. While some may use alcohol and recreational drugs to mask the symptoms of anxiety (often leading to substance abuse disorder), some studies show that alcohol can interfere with the neurotransmitters that manage anxiety and prevent you from getting a good night’s sleep. Drinking to cope creates a sort of feedback loop, which makes the anxiety worse and can lead to alcohol dependence.

8. Check Your Medicine 
Certain medicines, such as corticosteroids, asthma drugs, and others, can cause anxiety. Ask your doctor if any medicines you take may be a contributing factor.

9. Eat Healthy Foods 
Keeping the body nourished is essential for all functions of life. New research shows that a healthy diet may affect more than just weight and energy levels. One example is a Mediterranean Diet, with lots of vegetables, fruits, beans, lentils, nuts, whole grains, extra virgin olive oil and a moderate amount of fish (especially those rich in omega-3 fatty acids), with limited use of red meat.

10. Keep a Journal 
Keeping a journal can be a great way to keep track of your progress with anxiety and how your body responds to such situations. Tracing the triggers of anxiety can help you develop the skills to properly respond when put in anxious conditions.

11. Exercise Regularly 
Exercise promotes the release of endorphins. These brain chemicals reduce the body’s reaction to pain and stress. They also produce a feeling of euphoria, or happiness, that’s comparable to morphine. Just five minutes of aerobic exercise can kick start these anti-anxiety effects, according to some studies.  Next week in “Health & Exercise Forum” specific details about exercise for anxiety will be presented.

Talk to a Mental Health Professional

Chronic anxiety also can point to an underlying mental health issue. When your anxiety causes extreme distress or interrupts your ability to function on a daily basis, or when panic attacks are frequent and debilitating, it’s important to talk to your physician and ask for a referral to a mental health professional. They can provide a treatment plan, which may include specialized anti-anxiety medicine, psychotherapy, or both.

Visit your doctor regularly and listen to your body.     

SOURCES: University of Pittsburgh Medical Center (UPMC); National Institutes of Health (NIH);

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week: Coping with Anxiety Part II 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:

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!

Health Benefits of Dancing

The last two columns in “Health & Exercise Forum” have been dedicated to the health benefits of exercise for Parkinson’s disease. Specifically, the use of dance was featured as a method to promote strength, balance, coordination and agility in this population. However, dance as a form of exercise and for the promotion of balance, coordination and agility, is not limited to those with neurological conditions…it is beneficial for everyone! In fact, my wife, Esther and I, have always enjoyed our dance classes with Vince Brust!

Like most forms of exercise, if done regularly, dance can have multiple health benefits. If dance is your only form of exercise, make it your goal to sustain the activity for about 30 minutes a day, 3-4 days per week for the most value.

If you have any doubt or reservations about the ability of dance to improve your health and wellness, take notice of the muscle tone, flexibility, agility and coordination of a professional dancer...ballet, modern, hip hop, jazz, etc. They are incredible athletes and artists!

10 Benefits of Dancing

1. Improved Agility and Flexibility

It is common to lose agility and flexibility with age especially if you regularly perform the same limited movements throughout your day and lifetime. This will lead to stiffness and lack of flexibility, especially for new or season activities which can make you more vulnerable for injury and pain. Lower back pain and calf or hamstring strains are most common. Research suggests that dance can help.

For example, in one study it was found that cross-country skiers who received months of dance training showed improvements in joint mobility and muscle flexibility of the spine, as well as their speed and agility.

2. Balance and Coordination

It is also expected that balance and coordination are also compromised with age. It’s one of the reasons that older adults are so prone to falls. The research also supports the value of dance to offset this problem.

One particular study found that in people over the age of 80 years, social dancing helped improve balance and walking speed, as well as contributing to a more stable walking pattern.

3. Cardiovascular Health

Moderate-intensity dance, performed continuously for at least 30 minutes on a regular basis has been found to reduce the risk of death from cardiovascular disease in some studies. Moreover, it has been more effective in prevention than average-pace walking ...and is less boring!

4. Muscle Tone and Strength

Most activities of daily living (walking, climbing stairs) occur in a linear and forward directon. However, dance has not set direction and can move in multiple planes (forwards, backwards, and sideways with diagonal and rotational components.

These unlimited movements, not only improves agility, coordination, and balance, but also strengthens muscles that often get forgotten like your core and abdominals.

5. Weight Loss and Maintenance

As with any cardiovascular exercise, dance is a form of aerobic exercise which burns calories. This is especially true if performed a minimum of moderate-intensity for 30 minutes or longer.

According to the American Diabetes Association, aerobic exercise can support weight loss.

6. Osteoporosis Prevention

Weight-bearing exercise is the cornerstone for any osteoporosis prevention program and dance is a prime example.

According to the National Osteoporosis Foundation, high-impact, weight-bearing exercises, such as certain forms of dance, can help maintain bone strength and even build new bone mass. This slows the development and progression of osteoporosis. It is also well established that low-impact weight-bearing exercise (dancing with the impact of jumping etc.) is effective in bone loss prevention. Dance can be whatever intensity you want it to be, depending on your mood, energy level, and physical limitations.

7. Learning, Memory and Cognition

Like most forms of exercise, especially aerobic, dance can improve cognitive health. In addition to releasing special hormones, it can also improve circulation and oxygenation to the brain to enhance brain health.

Some research suggests that dance can help create new connections between brain regions involved in long-term memory and improve mood, cognitive acuity and mental energy.

Physicians and physical therapists often recommend dance as a form of rehabilitation following brain injury, stroke or dementia.

One study found that out of many different types of exercise (including dance, swimming, golf, cycling, tennis, and others) dance was the only one associated with a lower risk of dementia for people in the study. Experts believe the benefit was due to a combo of social interaction and mental focus...that is not to say that the aforementioned types of exercise do not have value.

8. Emotional and Mental Health

Dancing can contribute to your mental health by improving mood and reducing stress. As Morrie advised in Mitch Albom’s best-selling book, Tuesdays with Mori, “dance like nobody’s watching” can be very invigorating!

Dance participants ranked mood enhancement as the number one reason for participation! One study examining people’s motivation for dancing, “mood enhancement” ranked top on the list.  The dancers felt that the activity is expressive and allows you to escape and “let your hair down.”

Some studies also suggest that dance therapy might also reduce depression, especially in those who have serious illnesses, such as breast cancer or Parkinson’s (read last week’s column). Researchers feel that this may be due to increased endorphins and lower cortisol levels.

9. Socialization

The pandemic has taught most of us a valuable lesson ... some of us have a serious need to socialize and some do not. For those like me, who thrive on being among others, dance classes and dance-style workouts often take place in groups, which allows for social bonding in a fun, light and breezy environment.

Depending on your marital status and the specific style of dance you choose (salsa, tango or swing dancing), you may even be paired up with a partner every week!

10. Boosts self-esteem

While exercise on treadmill, bike or elliptical can be great exercise, it also can be boring and repetitive. Research suggests that any form of exercise can boost self-esteem.

When dancing, however, you get all the benefits of exercise, while simultaneously learning a new skill. It can be incredibly rewarding and satisfying to master the skill, especially with others such as learning the tango.

SOURCE: “Greatest”  Debra Sullivan, Ph.D., MSN, R.N., CNE, COI

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.comPaul 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 GCSOM.

For all of Dr. Mackarey's articles visit

Dance Like Nobody’s Watching!

“Dance like nobody’s watching!” This is one of my favorite quotes from Mitch Albom’s book, Tuesdays With Mori, because it represents interesting facts about human behavior. One, of course, is the ability to be comfortable in your own skin. The other, maybe less obvious benefit, is that challenging your balance through dancing, even if it’s not pretty, is very effective in maintaining or improving quality of life for those with challenges in gait and balance, as found in Parkinson’s disease (PD). In fact, “Dance for PDR”, a new and popular treatment for PD, has recently been validated in the scientific literature as a valuable treatment tool for those with PD. 

The Research

Research published in the Journal of Neural Transmission, shows that dancing is shown to help people with PD improve their ability to walk and enhances their quality of life. The program was applicable to those at various stages of PD, including those using walkers. Moreover, the results found that, in addition to physical improvements, participants also had psychological and social benefits through camaraderie, joy of movement and less isolation.

Participants, none of whom had never engaged in a dance class before, performed a structured dance program for 16 sessions over 8 weeks. Each class was 75 minutes long with seated warm-up activities 50% of the time.  Results showed: 10% improvement in overall movement, 26% improvement in walking and 18% improvement in tremor.

What is Parkinson's Disease?

Parkinson’s disease is a chronic, degenerative disease that leads to slowness of movement, balance disorders, tremors, and difficulty walking. PD results from the loss of dopamine-producing nerve cells in the brain. Dopamine is critical to stimulate the nerves of the muscular system in the body. PD affects approximately 1.5 million people in the USA with 60,000 new cases each year according to the National Parkinson Foundation. Most people know someone affected by PD.  PD typically affects those over 65 years of age and only 15% are under 50.

While there is no current cure for PD, exercise is well documented to relieve some of its symptoms. Specifically, exercise can help keep muscles strong, joints mobile, and tissues flexible. Exercise will not stop PD from progressing but it will improve balance, enhance walking ability, reduce muscle weakness, and minimize joint stiffness. In 2007, a study published in the Journal of Neuroscience revealed that exercise may benefit individuals with PD because exercise encourages the remaining dopamine cells to work harder to produce more dopamine. Also, the researchers discovered that exercise decreases the rate at which dopamine is removed from the brain.  

Exercise and DANCE!

Exercise to improve strength, balance, and flexibility can be performed independently at home or supervised at a rehab or exercise facility. Supervised exercise can include physical therapy, recreational therapy, water therapy, yoga, and Tai Chi. Physical therapy can improve walking ability, enhance balance, reduce fatigue, increase strength, promote flexibility and minimize pain. Physical therapy uses movement techniques and strategies as well as various pieces of equipment to enhance an individual’s level of independence and improve his quality of life. PT can also incorporate leisure activities (e.g. golfing and ballroom dancing) to reduce the symptoms and associated limitations of PD. Tai Chi, a total mind and body workout, is a series of individual dance-like movements linked together in a continuous flowing sequence. Particular benefits for people with PD include reduced stress, increased energy, improved concentration and focus, better circulation and muscle tone, and significant improvements in balance.

Just Dance!

According to Dance for PDR, their program offers internationally-acclaimed dance classes for people with Parkinson’s disease in Brooklyn, New York and, through a network of partners and associates, in more than 120 other communities and 16 countries. In Dance for PD classes, participants are empowered to explore movement and music in ways that are refreshing, enjoyable, stimulating and creative. For more information visit:

So, if you like to dance, “keep on dancing!” If you don’t dance and notice some changes in balance and coordination, or if you have PD…it’s a good time to start!  “Dance like nobody’s watching!”

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: Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic 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: