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

• Caloric Expenditure – as stated above, wearing a WV can increase caloric expenditure up to 12-13%.
• Bone Mineral Density – wearing a WV can increase mechanical axial load, (increasing the impact of gravity) to signal bone remodeling more than casual walking without a WV. However, those with existing osteopenia/osteoporosis should consult with their physician prior to using a WV.
• Cardiovascular Load – wearing a WV while walking or stair climbing has been found to elevate oxygen consumption and heart rate.
• Functional Strength – WV use while performing non-impact exercises (pull-ups, push-ups, squats, lunges) can improve functional strength.

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:

• Chronic neck pain, middle and lower back pain…especially with radiating symptoms into the arms or legs.
• Osteopenia/Osteoporosis – bone density problems
• Balance or Vestibular Problems
• Arthritis – symptomatic arthritis in spine or lower extremities (hips, knees, ankles, feet)

Types of WV’s:

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

• Plate Carrier Vest: Holds flat metal plates often preferred by those performing cross-fit or rucking (walking, marching, hiking while using a weighted backpack).
• Pocket/Plug Vest: Has small pockets to hold individual sand or iron-filled weights. This type of vest tends to be close-fitting and balanced. It allows for easy changes in the amount of weight.
• Fixed-Weight Vest: Offers an inexpensive, easy to use, pre-loaded vest for weighted exercise. However, this vest does not allow for variation in weight.

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.

• Start Light: Begin with a vest that allows variation in weight. Start with a light weight which should be approximately 5-10 pounds or 5% of your body weight. Weight can be added gradually over time but should not exceed 10% of your body weight.
• Maximum Weight: Although an adjustable WV allows a light start with gradual increases, it is recommended that users keep the amount of weight under 10% of their body weight for safety and the ability to maintain proper alignment and posture.
• Adjustable Weight and Straps: WV’s with the ability to adjust the amount of weight and the straps for a proper fit are recommended. A proper fit prevents blisters, chafing and back pain.

How to Begin Using a WV:

• Limit Load -start conservatively at 5% to 10% of your total body weight.
• Movement Safety – start with non-impact movement and activities such as walking, hiking, lunges, step-ups and avoid running or jumping.
• Proper Fit – a snug fit with adjustable weights and straps is best.
• Caution for Those with Pre-existing Risks – medical clearance is advised

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!

Provisional Bag/First Aide Kit

It is one week away from the 29^th 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:

• Dress:
  • Columbus Day Weekend in NEPA could bring 30 to 40 degree temperatures when you catch the bus in Scranton and at the 8:00 am race starting time in Forest City.
• Clothing:
  • Hat and Gloves: Wearing a hat, light gloves can be a good idea. DryTech materials are best to prevent retention of sweat.
  • Long Sleeve Shirt and Light Jacket may be necessary. Wearing old items are best so they can be discarded along the way once you are warmed up.
  • Remember, any extra items can be placed in a labeled bag at the starting line and will be transported to the finish line for your convenience. So, if it’s a cold morning, wear a jacket and warm up pants on the bus to the starting line and “bag it!”
• Accessories:
  • Sunglasses and Sunscreen: If sun and warm temps are forecasted, sunglasses are best placed on top of your hat until needed and sunscreen applied before the race.
  • Skin Lubrication: Lubricate your skin with petroleum jelly in areas of potential friction such as arm pits, nipples, thighs and feet.
  • Dry Tech Clothing: Wear dry tech protects, including shirt, underwear and socks, to prevent excessive moisture and friction.
  • Favorite Water Source and Snack: Water and light snacks will be provided every 2 miles but sometimes it is good to have your own favorites, especially in the high school gym before the race.  

• FANNY PACK – Especially for those running without a support team
  • If you don’t mind the little pack on your butt, a fanny pack can be valuable. In it, you will want supplies such as: small bandages, small roll of medical tape, ibuprofen, antacid tablets, small tube of lubricant, favorite running snack, and extra shoe laces. One might also consider packing a little money, credit card, ID, emergency contact numbers and medical insurance cards. A cell phone is optional.
• SUPPLY BAG – For those with support team
  • Have your support team meet you at prearrange locations along the race route and bring your supply bag. In the bag, you might consider all of the above fanny pack items and: A change of clothes such as: extra running shoes, socks, shorts, shirt, water proof wind breaker, according to the weather, especially if rain is predicted.  Towels, ace bandages, gauze pads and wrap, antibiotic cream, mole skin, sunscreen, petroleum jelly, safety pins, extra water and favorite sport drink, favorite sport snacks, extra ibuprofen, antacid, anti diarrhea medicine, chemical ice pack, mobile phone, money, credit cards, ID, medical insurance cards.
  • For those with allergic reactions, remember to pack: epinephrine, antihistamine, and other important medications.

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!

Patients often tell me that they would like to exercise but hesitate due to their knee or hip pain. They want to know what type of exercise is best for those suffering from osteoarthritis (OA). Osteoarthritis is also known as degenerative arthritis. It is the most common form of arthritis in the knee. Osteoarthritis is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle. It causes gradual onset of pain, swelling and stiffness in the involved joint, especially after increased activity and weakness with loss of function due to disuse.

However, OA is not an excuse to avoid exercise, but it is important to be smart about it. Regular exercise is essential to maintain a normal lifestyle for those with OA. However, if you do the wrong exercise, use poor technique, or are too aggressive, you could flare up your joints and do more harm than good.

Benefits of Exercise for Those with Osteoarthritis:

When performed correctly, exercise for those with Osteoarthritis has many benefits:

• Pain Control
  • Exercise controls OA pain by releasing natural pain control chemicals in the body called endorphins. It also controls pain by assisting in weight loss and improving range of motion.
• Weight Control
  • We all know how well exercise burns calories and that increased body weight creates increased stress on the joints.
• Prevention of Joint Stiffness
  • Exercise will help maintain joint range of motion. A stiff joint is a painful joint.
• Prevention of Muscle Weakness
  • Exercise will help maintain muscle strength. Weak muscles will allow or increase in joint wear and tear.
• Maintain Lifestyle
  • If a joint is stiff and weak, then they become painful which negatively impacts your lifestyle. Exercise can prevent this problem.  

Tips How To Exercise With Osteoarthritis:

• Start Slowly
  • Wean into exercise because if you advance too quickly, you will flare up the joint and have increased pain. For example, walk for 5-10 minutes the first session. If you do not have pain, add 1-2 minutes each session.
• Lose Weight
  • Every pound lost equates to less stress on your joints. For example, a loss of 5 pounds of body weight translates to 20-30 pounds of stress through the knee, according to David Borenstein, MD, President of the American College of Rheumatology. Also, body weight has a direct impact on daily activities. For example, walking upstairs creates stress through the knee equal to 4 times body weight and seven times body weight going downstairs. Therefore, less body weight equals less stress.
• Low Impact Workouts
  • Low impact exercise creates less stress on the joints while strengthening leg muscles and those who maintain leg muscle strength have less stress on their joints. It is even important not to load your arms with heavy objects when walking or using stairs to limit joint stress.
  • Some examples of low-impact exercises are walking, swimming, elliptical trainer, and biking. Strength training is also low-impact and should be performed with low weight and high repetitions. Water therapy is great for those with OA, especially in a heated pool. It is a great low-impact exercise with less gravity and stress on the joints. Walk, swim and do mild resistance exercises in the water. Use a snorkel and mask for swimming to limit excessive neck turning and back extension.
  • Walking is a great form of exercise; however, walking softly is important for those with OA. Wear good running shoes and orthotics if necessary. Discuss this with your physical therapist or podiatrist. When possible, use soft surfaces like cinder, mulch or rubber. Avoid grass and soft stand due to instability and torsion that may irritate your joints.  
• Warm-Up
  • Warming up your body is critical to prevent injury to the muscles and tendons. This can be done by marching in place or using aerobic equipment such as a bike for 5 to 10 minutes before exercise. Always perform the warm-up activity at ½ your normal pace.
• Balance & Relaxation Techniques
  • Tai Chi and ballroom dancing are two good examples of activities which promote balance and relaxation. Studies showed that those with OA who participated in Tia Chi two times a week for eight weeks reported less pain, increased range of motion and improved daily activities and function. They also noted less low back pain and better sleep.
• Proper Clothing
  • Stay warm in winter and consider wearing compression shorts. Be cool in the summer months with Drytech^R type material.
• Pre/Post Exercise First Aid
  • If you are sore for longer than 12 to 24 hours after exercise, then you overdid it and must adjust next time. Otherwise, use hot packs, bath or shower before you exercise to loosen up and apply ice to your joints after exercise, especially if they are sore.
• Post Exercise Stretch
  • Gentle, active range of motion stretches after exercise is important to maintain mobility. Do not bounce or cause pain. For example: Low Back – knees to chest; Arms – row –the – boat, arms behind head, arms behind back; Legs – wall lean calf stretch, bend and extend knees, open and close hips.

SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons; www.lifescript.com

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!

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 mid-July, and we have managed to survive two “heat waves” in NEPA. While it is important to have fun in the sun, please be mindful of how your body reacts to high humidity and heat and take appropriate precautions. Athletes are particularly vulnerable due to daytime practice sessions. In response to this potential problem, the PIAA has established acclimatization guidelines for fall sports beginning in August. 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. Adults 65 and older, and infants/young children (5 and younger) are vulnerable. Those with chronic conditions such as diabetes, cardiovascular diseases, and obesity are also at higher risk.

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 heatstroke is unclear. Prevention is the best treatment because it can strike suddenly 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 increase your core temperature, your body will try 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 have the following recommendations which are appropriate for both the competitive athlete and weekend warrior:

Signs of Heatstroke:

• 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 heatstroke and they can sweat even with an increased core temperature
• Very rapid pulse
• Mental confusion, disorientation or hallucinations
• Physical clumsiness, sluggishness or fatigue
• Seizure
• Dizziness

Treatment of Heatstroke:

• 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

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!

Have Fun and Get in Shape!

Happy 4^th of July! As our country celebrates 250 years and the summer heat is kicking into gear, it is time to think about getting to the pool to cool off. It may also be time 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 a 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.

Pool Exercise 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

• 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          
• Submerge The Body Part
  • That you want to exercise into the water and move it slowly
• Complete The Range of Motion
  • Initially 5 times, then 10-15-20-30 times
• Assess
  • Determine if you have pain 3-4 hours after you exercise or into the next day. If so, you overdid it and adjust next time by decreasing repetitions, speed, amount and intensity of exercise.
• Warm-Up
  • Make sure you warm up slowly before exercise with slow and easy movements
• Advance Slowly
  • By adding webbed gloves, weighted boots, and buoyant barbells to increase the resistance.
• 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.     

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!

Spring has finally arrived in NEPA as we get outdoors to enjoy sunshine and blue skies. It is also time to dust off your hiking shoes and hit the trails to enjoy fresh air and exercise…but don’t forget the trekking poles. I have been recommending walking or trekking poles to my patients for many years. These poles are an essential part of hiking or distance walking gear, for the novice and expert alike.

Specifically, for those over 50 who have degenerative arthritis and pain in their lower back, hips, knees, ankles or feet, these simple devices have been shown to improve the efficiency of the exercise and lessen the impact on the spine and lower extremities. Additionally, using poles reduces the likelihood of ankle sprains and falls during walking. Trekking poles are also a safe option for those with compromised balance. If you want to walk distances for exercise and need a little stability but don’t want the stigma of a cane, trekking poles are for you.

History of the Hiking Stick

Early explorers, Europeans and Native Americans have been using walking sticks for centuries. More recently, in the 1968 classic hiker’s bible, “The Complete Walker,” Colin Fletcher praised his “walking staff” for its multipurpose use: for balance and assistance with walking and climbing, protection from rattlesnakes, and for use as a fishing rod. Today, these sticks are now versatile poles made from light-weight materials.

Trekking Pole Features

Trekking poles are made of light-weight aluminum and vary in cost and quality. But, like most things, “you get what you pay for!” These hollow tubes can telescope to fit any person and collapse to pack in luggage for travel. Better poles offer multiple removable tips for various uses, conditions and terrains. For example, a basket to prevent sinking too deeply in snow, mud or sand; a blunt rubber tip for hard surfaces like asphalt or concrete, or the pointed metal tip to grip ice or hard dirt/gravel. Better quality poles offer an ergonomic hand grip and strap and a spring system to absorb shock through your hands, wrists and arms upon impact.

The poles should be properly adjusted to fit each individual. When your hand is griping the handle the elbow should be at a 90 degree angle. Proper use is simple; just walk with a normal gait pattern of opposite arm and leg swing. For example, left leg and right arm/pole swings forward to plant while the left arm/pole remain behind with the right leg (PHOTO 1).  This pattern is reciprocated with as normal=ait advances (opposite arm and leg). I have been very pleased with my moderately priced poles (Cascade Mountain Tech from Dick’s Sporting Goods ($34.99 per pole). Prices range from $19.99 to 79.95 per pole. dickssportinggoods.com; montem.com; leki.com; rei.com. However, if you travel frequently to hike the State and National Parks, you may want to purchase more expensive poles that collapse and retighten more efficiently. (montem.com; leki.com;) 

Research

There are numerous studies to support the use of trekking poles, especially research that supports their use for health and safety. One study compared hikers in 3 different conditions; no backpack, a pack with 15% body weight and a pack with 30% body weight. Biomechanical analysis was performed blindly on the three groups and a significant reduction in forces on lower extremity joints (hip, knee, and ankle) was noted for all three groups when using poles compared to those not using poles.

Another study confirmed that trekking poles reduced the incidence of ankle fractures through improved balance and stability. Additional studies support the theory that trekking poles reduce exercise induced muscle soreness from hiking or walking steep terrain and another study found that while less energy is expended in the lower body muscles using poles, increase energy is used in the upper body; therefore, the net caloric expenditure is equal as it is simply transferred from the legs to the arms.

Reasons to Use Trekking Poles

• Reduced Stress on Lower Back, Hips, Knees, Ankles and Feet –
  • Biomechanical studies confirm that using trekking poles creates less stress on the lower back and joints of the lower body. Those with a history of degenerative arthritis and pain in these areas are wise to consider this when planning to hike or walk distances for exercise.
• Improved Stability and Balance/Less Injury –
  • Studies have found that those using trekking poles were less likely to suffer sprains, strains and even fractures of the lower body, especially the ankle, due in great part to the improved balance and stability. This benefit is found not only on uneven terrain, but also for those walking distances and may have age-related balance issues.
• Upper Body Workout –
  • One comment I have heard from those questioning the value of trekking poles is that they do not want to make their walking/hiking exercise too easy because they desire a “good workout.” Studies show that the caloric expenditure is equal to exercise without using poles as the energy is simply transferred from the legs to the arms.
• Improve Walking Posture and Stride
  • It is common when walking distances, especially if carrying a backpack, to lean your trunk forward. Using poles has been found to promote a more upright posture while walking.

• Less Perception of Cardiovascular Exertion
  • While cardiovascular demands increased with pole walking, subjects reported less exertion when using poles. 
• Reduced Exercise Induced Muscle Soreness
  • Studies testing the blood for chemicals associated with muscle damage found less exercise induced muscle soreness/tissue damage and delayed onset muscle soreness among pole users. This was reported to be critical in walkers and hikers who participated in their activities several days in a row to complete the task such as hiking in and out of a canyon. In conclusion, it is important to remember that trekking poles for hiking or distance walking are much more than a style statement. They are proven to be an invaluable tool for health, safety and wellness by reducing lower extremity joint stress, improving stability and balance, and enhancing efficiency for muscle recovery.    

Sources: Medicine and Science in Sports and Exercise. The Complete Walker, by Colin Fletcher

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

May is National Bike Month! For those who have a bike, now might be a good time to dust it off and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority. For those who don’t have a bike, it might be a good time to get one!

However, whether you head out for 5 or 50 miles, ensuring a proper bike fit should be on your checklist. Riding a bicycle that is properly fit for your style and body will not only help to prevent injury but allow for a more comfortable riding experience.  There are many things to take into consideration when checking your bike fit. First and foremost, you must choose a bike that fits your style of riding.

BIKE STYLES:

For the sake of simplicity 3 basic styles of bikes include Road bikes, Hybrid bikes and Mountain bikes. Road bikes are designed for long distance riders, hybrid bicycles can be used for longer distance riders, but usually accommodate a recreational cyclist, and mountain bikes are designed for dirt or gravel and technical trails. The next component of ensuring a proper bike fit is making sure that you have a good foundation by choosing the right sized frame. To find the right sized frame you can use the following guidelines as a way to start or simply ask the local bike shop or bike fit consultant of your choice for help.

• Road bikes: When straddling the bike, you should have about 1” of clearance between your body and the top tube if the bike has a straight top tube (which runs parallel to the ground). When lifting the bike, you should have 1” clearance between the tires and the ground. If the bike has a sloping top tube (semi-compact design) you should have a clearance of 2” or more.
• Mountain bikes: When straddling the bike lift the bike off the ground and you should have a minimum of 2” clearance between the ground and the tires. With full suspension bikes you will want 1”-2” standover clearance because when you sit on the bike the frame will become lower from compressing the suspension. More aggressive riders will likely have 3”-5” of clearance.
• Comfort bikes: Standing over a comfort bike to choosing the right sized frame is not necessary. They are commonly designed with a steep sloping top tube and allow the rider to put feet firmly on the ground when the rider comes to a stop.

PROPER FIT:

Now that you have right size for your bike you should adjust the components of the bike to allow for a more comfortable riding experience. Please use the diagram as a point of reference for the following tips. Also be sure to re-examine your bike fit after any bad falls. Keep in mind these measurements are meant to be used as a simple guideline and if you have any preexisting injuries or concerns please be sure to consult your local Physical Therapist or bike fit consultant.

Seat/Saddle:

1. Your Seat or saddle should be level (See “A” on diagram). If it is tilted too far forward there will be too much weight on hands, arms and lower back. If it is too far backward, there may be strain on LB and may lead to saddle related pain.
2. Your knee should be measured at the most extended position to adjust saddle height. (see “Knee to Pedal”)
3. The saddle should be a comfortable distance from handlebars. If it is too close it will place too much weight on your mid-back and arms. If it is too far it will put extra strain on your low back and neck. Also make sure seat is the proper width to ensure a more comfortable ride.

Handlebars (HB):

1. Your handlebar placement will affect your hands, shoulder, neck and back. The higher the handlebars are the more weight is placed on the saddle. Taller riders should have lower handlebars in relation to height of saddle
2. For road cyclists there should be a 90° angle between your arm (near the shoulder) and your trunk with a slight bend at your elbows of about 15° (See “B” on diagram).
3. Your trunk angle should be 25-35° if you are a road bike cyclist and 35-90° comfort/recreation cyclist

Knee to Pedal:

The knee to pedal measurement should be taken with the knee in the most extended position. There should be about a 25-35° angle at the knee (See “C” on diagram)

Foot to Pedal:

The ball of your foot should be over the pedal spindle (See “D” on diagram). This will allow for the best leverage, comfort and efficiency. Using a stiff soled shoe is recommended.

If you are a recreational cyclist, it’s a good idea to take all the proper steps in preventing injury. This article can be used as a reference point to help to prevent common cycling injuries, enhance your comfort and improve your riding efficiency. If you have any further questions about enhancing your bike fit, please contact your local physical therapist or bike fit consultant.

Sources: REI.com, APTA.org

Contributions & Illustrations: Sarah Singer, BFA, PTA

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!

May is National Bike Month!

HAPPY MOTHER’S DAY!

Consider a Giving Mom a Healthy Gift…a Bike!

May is National Bike Month! It is time to dust it off your bike and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, Lackawanna Heritage Valley Authority and other locations in the Greater Scranton Area. For those who don’t have a bike, it might be a good time to get one!

WHY BIKE?

There are many obvious reasons to bike…cardiovascular fitness, burn calories, improve leg strength and others. But the real question is, “what are the advantages of biking over other forms of exercise?” Glad you asked…

BENEFITS OF BIKING:

1. INEXPENSIVE – while not as cheap as running, biking can be much cheaper than other sports. Starter bikes can be less expensive than high end running shoes.
2. EASY – most people can learn to ride a bike. Kids begin with training wheels and adult tricycles are available.
3. FAMILY FUN – something the whole family can enjoy in your neighborhood, at the beach or on one of the trails.
4. PRACTICAL EXERCISE – it is an opportunity to exercise while traveling to work, store, lunch etc…bike it!
5. CARDIOVASCULAR FITNESS – good for the heart and all that goes with it: burns calories, lowers blood pressure, lowers LDL, and elevates HDL and boosts the immune system.
6. LEG STRENGTH – pedaling a bike is a great way to improve leg strength.
7. CORE STRENGTH – core muscles of the neck, middle and lower back and the associated arm strength will improve while biking in order to maintain your torso on a bike on hills and turns.
8. IMPROVES BALANCE/COORDINATION/FALLS PREVENTION – riding a bike requires some balance and coordination and therefore will improve balance as a form of falls prevention.
9. GOOD FOR YOUR JOINTS – bike riding only requires partial weight bearing to the spine and lower body joints, so it is more comfortable and gentler to your joints than walking or running. For this reason, it is often recommended to pregnant women suffering from leg or lower back pain as a safe alternative to running.   
10. MENTAL WELLNESS – biking, like all aerobic exercise, is a great source of stress management as it releases endorphins and serotonin which improves mental health. With the added feature of being outdoors in the sunshine and fresh air, biking keeps you smiling!

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order, such as tires, chain, brakes and pedals. Next, be sure to maintain a reasonable fitness level in order to bike safely. If you are a beginner, start slowly. Warm up and slowly bike for 10 to 15 minutes and build up over time.

Practice the coordination of stopping, starting, shifting and braking. Work on good strength and flexibility of the hamstrings, quadriceps, calves and gluteal muscles. All of these muscles are necessary to generate pedal force. Balance is also important to safety and can be practiced on and off the bike. Be aware that adaptive equipment can modify your bike for added comfort and safety such as soft handlebar tape, seat post and front fork shock absorbers, padded biking shorts, c-out and gel pad saddle seats, and wider tires.

Be careful not to progress too quickly because inactivity to over activity in a short period of time can create problems. Overuse injuries such as tendonitis can be avoided by cross training. Bike every other day and walk, run or swim on off days. Make sure to take time off to recover after a long ride. Use ice and massage to sore muscles and joints after riding.

Remember, cycling should be fun! Pain from improperly fitted and poorly maintained equipment is preventable. Excessive workouts and training rides should be kept to a minimum and consider cross-training in between.  

SAFETY:

EQUIPMENT: Helmets are a must! Also, keep your bike in good condition. Road bikes should have mirrors and reflectors. Use hand signals and obey traffic rules. Dress for weather and visibility. Have first-aid and tire patch kit, tire pump and tools. Seat comfort can be improved with gel cushion or split seat.

BE ALERT: for traffic, parked cars, pedestrians’ loose gravel and cracks in the road. 

SOURCES: American Physical Therapy Association

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!

“The woods are lovely, dark, and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.”  Robert Frost

On March 30, 2026, NEPA lost one of its most dedicated conservationists, Dorrance Reynolds Belin…our version of John Muir, Theodore Roosevelt, and Rachel Carson. While Dorrance served on numerous boards, in my view, he will be most fondly remembered for his environmental stewardship as founder of the Eastern Pennsylvania Chapter of the Nature Conservancy and Countryside Conservancy. I am not sure if Dorrance ever had the pleasure of meeting Robert Frost, Pulitzer Prize winning American Poet, but it is not hard to imagine that he had Dorrance in mind when writing the above poem. Thank you Dorrance, and those who worked with you, for the vision and foresight to preserve these special places for our children, grandchildren and great grandchildren to enjoy!

According to their mission statement, The Countryside Conservancy manages 1,190 acres of lands and waters to protect their conservations value. Most of these acres are open to the public for visitation and many have trails. Collectively, the conservancy contributes to 10 miles of singletrack hiking and biking trials to the 30-mile Lackawanna State Park/Countryside Conservancy Trail System …for more information visit: countrysideconservancy.org.

Please get outdoors and enjoy the trails…walking, running, biking, snowshoeing, cross-country skiing or horse back riding. But if you want to try something new this spring that will allow you to exercise on more interesting and less stressful surfaces in the beautiful woods of Northeast Pennsylvania…try trail running!

Trail running forces one to run 25% slower due to the uneven terrain (rocks, tree roots, stumps), incorporate “light running” techniques by running with short strides on the balls of my feet. You will feel much more refreshed by avoiding the direct sunlight under the cover of the trees. Furthermore, you can enjoy the up-close view of nature as I ran by cool streams and wet mossy rocks, beautiful flowers, rhododendron, and mountain laurel. Observe deer, chipmunks and birds. In my quest to avoid the hot sun, I discovered the beautiful underworld of “trail running” - it is beautiful, peaceful, natural and unique. It is fun to get in touch with your inner child as you run in the woods and get muddy. Trail running makes running fun…and it’s good for your joints!

The trail running community purports that trail running is popular because it satisfies a primal need for man to move through nature, derived from hunter/gatherer days. Others who promote trail running feel the popularity is due to the many advantages it offers. One, trail running prevents impact injuries due to soft surfaces. Two, the training style of running with shorter strides on the ball of the foot, lessens impact. Three, this type of running will develop stronger ankles and trunk core muscles while improving balance, coordination and proprioception from running on uneven surfaces. Lastly, the ability to release copious amounts of endorphins while breathing fresh air instead of roadside fumes is invaluable.

Trail Running Gear:

• Clothing - Trail running clothes can be the same as those worn for road running except be sure you don’t mind if they get dirty and a little torn.
• Shoes – While you can begin trail running in the same shoes you road run in, you will find that a different pair is necessary due to excess dirt and water. Also, if you decide to get into trail running, it is worth purchasing trail shoes which are stronger, more waterproof and offer better traction.
• Water – a handheld water bottle or a water bottle belt is essential. The belt offers little pouches for money, keys, ID, and power bars for longer runs.
• Insect Repellent - a must for mosquitoes and ticks! 
• Headlamp – necessary for evening runs because it gets very dark in the woods. Also, it gets dark earlier in the woods than on the roads and you need to see the terrain clearly.
• Change of Clothes – it is a good idea to have a first-aid kit, towel and change of clothes in your car to change into before you drive home.
• Cell Phone – just in case of an emergency.

Tips to Begin Trail Running:

Find a Trail – Start by asking around. Hikers, mountain bikers, and horseback riders are a good start. The American Trail Running Association has a website with a free directory of trails in the United States. PA State Parks such as Lackawanna State Park in Dalton, offer many options www.visitPAparks.com, countrysideconservancy.org. or download the app AllTrails. Learn the difference between “nontechnical trails” which are wider with a paved, dirt or gravel base and much easier than “technical trails” which are narrow, rocky, hilly and challenging.

• Run Slowly – To be safe, run 25% slower when running a trail in the woods. Use a short stride and land on the ball of your foot. Forget about the pace, feel the dirt under your feet, work on balance and stability. It is a different type of running.
• Walk – Don’t hesitate to walk when necessary, especially up rocky and slippery hills.
• Keep Your Eye on the Trail – Pay careful attention to the terrain by looking 5 to 10 feet ahead.
• Anticipate Slippery Rocks and Stumps - Pick your feet up higher and bend your hips and knees more when necessary to avoid tripping over a log. Walk over obstacles if necessary.
• Keep a Distance – Don’t crowd the trail. You may have to share it with other runners, bikers and hikers. Pass with care.
• Be Safe/Be Prepared– Remember the first-aid kit, cell phone, extra clothes and food in the car and make sure someone knows where you plan to run. Run with a friend.

Sources: American Trail Running Association, Trailspace.com, countrysideconservancy.org.

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!

New study recommends a 15 minute walk after a meal reduces blood sugar!

Spring has sprung in NEPA and summer is just around the corner... great news for outdoor enthusiasts! It is also good news for those who need walk for health reasons. However, 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.” A recent study demonstrated that a 15 minute walk after a meal is very effective in reducing blood sugar levels.

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!” 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!