Spring is just around the corner so it is time for running enthusiasts to lace up their sneakers, get outside and run! Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. For example, the caloric expenditure while running is higher than for most other exercises, including biking. Also, it allows for fresh air and beautiful scenery with a minimal investment in clothing or equipment.  It requires little skill and time to learn. Runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphine release (natural chemical in the brain associated with euphoria and pain control) that is greater than found in other sports and activities. These are some of the motives that cause people to run every day, in spite of the constant loading and wear and tear on the joints.

To be a competitive runner and have longevity in the sport, optimal form is necessary. Moreover, a recent study shows that a runner can decrease the stresses on the lower body and reduce the incidence of stress fractures when trained to run with proper form using visual feedback while on a treadmill. The application of this information has significant implications for training programs for runners for the prevention and recovery from injury. One such low impact method is called the “Pose Running Technique,” by Dr. Nicholas Romanov. It is a “soft landing” method which promotes; an S-like body position with slightly bent knees, a slightly forward lean at the ankles to employ gravity and momentum, lifting the feet up under the hips, and landing on the ball of the foot under the body to absorb the center of mass.

It is my opinion, that the best runners, with the least injuries, such as Jordan Hoyt, speedster from Abington Heights, employ these techniques naturally. Additionally, many of the world’s best runners use coaches and trainers to assist them in their quest for success and injury prevention by using perfect form. However, for the rest of us, we must learn to maximize the efficient use of the body as it works with, not against gravity. We must learn to run “soft” to prevent injuries.

PROPER FORM

Head Position

A slight upward tilt of the head to allow a view of the horizon ahead should be most comfortable. Avoid looking down or up to extremes. Do not rock or rotate the head while running.

Shoulder Position

Loose and relaxed shoulders set the tone for a good run. Keep them level without tilting side to side or rotating left to right.  Avoid holding the shoulders in a tight and high position.  

Arms

Loose and relaxed arms also set the tone for a good run. A good arm swing is always in forward motion in a linear direction and stays between the waist and lower chest. Never clench the fist. Do not rotate or twist the arms across the body.

Torso

If the head, shoulders and arms are in correct position, then the torso will be upright. An erect running posture is necessary to promote efficient movement and breathing. The posture that you assume when taking a deep breath is the correct torso position for good breathing while running. 

Hips

The hips will follow the position of the parts above in a linear forward direction. However, if the torso leans forward because the head hangs down then the hips will tilt downward. If the arms swing and torso rotates side to side, then the hips will also rotate.

Legs/Stride

Sprinters need to lift the knees high to thrust the lower legs forward. Long distance runners cannot maintain a high knee lift for a long period of time, however, a slight knee lift with a shorter but quicker stride is more efficient. Proper running requires the foot to softly strike the ground with the knee slightly bent. If the knee is fully extended in front of the body upon impact, the stride is too long and the force too great.

Ankles/Feet

To excel as a runner, when the foot hits the ground it should land lightly, between the heel and the midfoot. The ankle is flexed and rolls quickly forward to the toes to push off the ground with maximum force. The calf muscle propels the runner forward. Efficient running has a quiet and springy landing. A loud foot slap on impact is a sign of poor form and results in excessive force transferred to the lower leg. The foot should spend as little time as possible in contact with the ground…thus a soft runner “floats” when they run.

SOURCES: Runner’s World, Pose Running Technique (www.posetech.com), Journal of Orthopaedic and Sports Physical Therapy.

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.

Pre-pandemic we saw increased popularity of local races such as the Steamtown Marathon and Scranton 1/2 Marathon. With that, local interest in running was exploding and will hopefully return to normal soon. However, during the pandemic, especially when fitness centers were closed, many took seasoned and beginner runners to the streets to improve fitness and alleviate stress. However, as a health care provider, I am seeing a significant number of first time runners visit my office with a wide variety of injuries that are very preventable with a modicum of good judgment.

Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. Caloric expenditure is higher than in most other exercises, including biking. Running also allows for fresh air, beautiful scenery, minimal investment in clothing or equipment, little skill and time to learn. Moreover, the benefits are many; runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphin release (a natural chemical in the brain associated with euphoria and pain control.)

This column will be dedicated to those who are interested in beginning a running program for all the reasons mentioned above and more. The program is designed to promote a safe and gradual introduction or return to running as form of exercise. The initial goal is to help you attain 30 minutes (approximately 2 miles) of running at a slow, relaxed and safe pace. This 30 minute goal is the standard used in most research that shows improvement in weight control, cholesterol, heart disease, blood pressure and adult onset diabetes.  The 8 week program is a simple and safe program that begins with more walking than running and gradually reverses the proportion. The first two miles are the hardest and once mastered; one can begin to build on mileage and intensity if desired. For those interested in advancing to a half or full marathon, I recommend the book “The Marathon” by Jeff Galloway who advocates a run/walk program as you increase distances. Visit his website at: www.jeffgalloway.com.

Before You Begin

• Consult your physician: This is important if you have health issues, have not engaged in exercise for some time or you are 15-20 pounds overweight and over 40 years of age.

• Plan a schedule: Get committed. Use a computer, calendar, or fitness Apps such as Endomondo Sports Tracker or Argus.

• Get mentally prepared: You will have good and bad days. You have to do it, even on the bad days. Once you get to a certain level of fitness, it gets easier and more fun.

• Buy the proper shoes for you: Just because the sneaker fits does not mean you have to wear it! Manufacturers entice prospective buyers with a multitude of colors, fabrics, styles and designs. Instead of focusing on aesthetics, focus on function!

The appearance of an arch in a weight bearing position does not automatically exclude the individual from excessive supination or pronation. Consult a podiatrist or an orthopedic physical therapist to determine the propensity toward supination, pronation or neutrality of the foot and ankle.

Note: New Balance, Brooks, Asics, Mizuno & Saucony all make quality running shoes to accommodate a supinated, pronated or normal foot.

• Other equipment: DryTech is great fabric for running which wicks the sweat away from the skin and prevents chaffing. It can be found in shorts, pants, shirts and socks Also, weather and temperature options are important, such as compression shorts in cooler temperatures to prevent muscle pulls.

WEEK 1

Mon.Wed.Fri.Sat: Run 1 minute. Walk 2 minutes. Repeat 10 Times

Tues.Thurs: Walk 30 minutes

Sun: Rest

WEEK 2

Mon.Wed: Run 2 minutes. Walk 1 minute. Repeat 10 Times

Fri.Sat: Run 3-4 minutes. Walk 1 minute. Repeat 6-7 Times

Tues.Thurs: Walk 30 minutes

Sun: Rest

WEEK 3

Mon.Wed: Run 5 minutes. Walk 1 minute. Repeat 5 Times

Fri.Sat: Run 6 minutes. Walk 1 minute. Repeat 4 Times

Tues.Thurs: Walk 30 minutes

Sun: Rest  

         

WEEK 4

Mon.Wed: Run 8 minutes. Walk 1 minute. Repeat 3 Times THEN: Run 3 minutes

Fri.Sat: Run 10 minutes. Walk 1 minute. Repeat 2 Times THEN: Run 8 minutes

Tues.Thurs: Walk 30 minutes

Sun Rest  

WEEK 5

Mon.Wed: Run 12-13 minutes. Walk 1 minute. Repeat 2 Times THEN: Run 2-4 minutes

Fri.Sat: Run 14-15 minutes. Walk 1 minute. Repeat 2 Times THEN: Run 2 minutes

Tues.Thurs: Walk 30 minutes

Sun: Rest    

WEEK 6       

Mon.Wed: Run 16-17 minutes. Walk 1 minute. THEN: Run 12-13 minutes

Fri.Sat: Run 18-19 minutes. Walk 1 minute. THEN: Run 10-11 minutes

Tues.Thurs: Walk 30 minutes

Sun: Rest

WEEK 7

Mon.Tues.Wed: Run 20-22 minutes. Walk 1 minute. THEN: Run 7-9 minutes

Fri.Sat: Run 24-26 minutes. Walk 1 minute. THEN: Run 3-5 minutes

Thurs: Walk 30 minutes

Sun: Rest

WEEK 8

Mon.Tues.Wed: Run 27-28 minutes. Walk 1 minute. THEN: Run 1-2 minutes

Fri.Sat: Run 29-30 minutes. Walk 1 minute. THEN: Run 0-1 minutes

Thurs: Walk 30 minutes

Sun: Rest

TRAINING TIPS:

• Fuel Up – drink water, eat a piece of fruit or a granola bar 45-60 minutes before
• Warm-up/Cool-down - 3-5 minutes before and after
• Stretch – after the exercise
• Use good form – elbows bent at 90 degrees, swing with momentum forwards, not sideways, limit trunk rotation
• Dress properly – layer to adjust to the temperature, wear a hat and use sunscreen
• Cross-Train- low impact exercise on walking days or one running day to protect your joints and prevent injury and burn-out (elliptical)
• Change shoes –every 250 to 300 miles
• Heat/Cold – use heat before and ice after exercise if you have sore muscles or joints when you first begin.
• Build on foundation – once you have a 30 minute base you can increase the duration and intensity on occasion.

SOURCE: Runner’s World

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   NEXT WEEK…RUN WITH GOOD FORM!

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.

Part II of II

You are never too old to exercise! This is the second of two columns dedicated to appropriate exercise for the elderly. Last week I discussed basic strengthening exercises. This column will address three additional components necessary for independence in the elderly: flexibility, balance and endurance. While it may not be as valuable for those fortunate to be over 75 years of age and capable of running, skiing and playing tennis, you may still find a noteworthy pearl of wisdom.

Why would someone 75 or 80 be interested in a basic exercise program? Well, one must maintain adequate flexibility, strength, balance and endurance to safely function in daily activities around the house. For example, the most common goals of elderly patients are: climbing stairs, getting in and out of a shower, putting on shoes and socks, tucking in a shirt or fastening a bra, cooking, cleaning, and carrying groceries or laundry.

Remember, for most people it is more harmful not to exercise, so contact you physician to discuss whether independent exercise is appropriate for you. You may need to consult with a physical therapist to get started.

FLEXIBILITY EXERCISES

Flexibility Exercises involve moving the arms, legs and trunk through comfortable range of motion to give you more mobility in order to improve your ability to perform daily activities such as tucking in a shirt, tying shoes or fastening a bra. Best if performed after strength exercises because the muscles and joints will be warm and limber. Always perform slowly with slight stretch sensation and no pain. No bouncing or over stretching!

Examples of Flexibility Exercises for the Upper Body in Sitting

These exercises are to be performed while sitting in a chair with a backrest, slowly, 5 repetitions, 3-5 times per week.

• Shoulder Raise – clasp hands together, raise arms up to forehead, then above head, as high as comfortably possible
• Hands Behind Head – raise arms behind head by first touching ears, then back of head
• Hands Behind Back – bring arms behind back by first touching the side pocket, then back pocket and toward small of back as comfortably possible

Examples of Flexibility Exercises for the Lower Body in Lying on Back

• Knees to Chest – bring knee toward chest using hands. Right Leg 5 Times – Left Leg 5 Times -  Both Legs 5 Times
• Leg Spread – Spread legs apart by sliding heels on bed
• Leg Cross – Bring legs together touch by sliding heels on bed
• Gas Pedals – pump ankles up and down like gas pedal

BALANCE EXERCISES

Balance Exercises involve strengthening muscles that keep the body upright and stable in standing in order to improve your ability to perform daily activities without falling. According to the NIH, 300,000 US hospital admissions for broken hips occur each year due to falls. Check with your physician if you have a history of dizziness before performing these exercises on your own. Best if performed with someone at home or some assistance. Always use a countertop or back of chair to hold onto for support.

Examples of Balance Exercises

• Sitting Squat – Squat up and down in a chair. First use both arms to assist, then one arm.
• Standing March – March legs up and down while holding onto countertop
• Standing Scissors – Bring leg out and cross over like a scissors one leg at a time
• Standing Squat – Squat down by bending at hips and knees 20-30 degrees while holding onto countertop
• Dance – Slow dancing with a partner is great fun and a very helpful exercise to improve balance.

ENDURANCE EXERCISES

Endurance Exercises involve any activity such as walking, swimming, biking or raking leaves that elevates your heart rate and breathing for an extended period of time. Check with your physician if you have a history of heart problems or dizziness before performing these exercises on your own. Best if performed with someone at home or some assistance. Start off slowly for only 5 minutes and add 1-2 minutes each week or 2. Wear good and comfortable shoes – no heels!

Examples of Endurance Exercises

While not all of these endurance exercises may be appropriate for you, one or two of these may offer a good starting point.

• Walk Around the House – Start walking around the house for 1-2 minutes nonstop. Every 1-2 hours. Then, add 1-2 minutes every week.
• Static Marching – hold onto the countertop or back of chair and march in place for 30 seconds. Rest 1-2 minutes and repeat. Do 5 cycles. Add 5-10 seconds every week.
• Climb the Steps – If you can do so safely, use the steps for exercise 1-2 times per day. Then, add 1-2 times per day.
• Walk the Mall/Treadmill – If you are able to get out of the house and can tolerate more extensive endurance exercises, get out and walk the malls or use a treadmill.
• Recumbent Bike – If balance is a problem, but you can tolerate more extensive. Endurance exercise, use a recumbent bike (a bike with a backrest)

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 profession of clinical medicine at Geisinger Commonwealth School of Medicine.

For all of Dr. Mackarey's articles visit mackareyphysicaltherapy.com

PART I OF II

You are never too old to exercise! A reader who described herself as “elderly” asked me if she was too old to exercise. Without knowing her age, I replied that she was not. I did qualify my response with the fact that exercise must be adjusted to meet the individual needs of a person based on age, health status and goals. Her question, however, led me to think of the many “elderly” who may be apprehensive to begin an exercise program for a variety of reasons. Fear of injury and lack of information may be two reasons. Another reason, according to this inquiry, is the fact that so many exercise programs featured in the media are geared to the young and healthy or baby boomers and few focuses on the needs of those over 75, home bound and weakened by age and inactivity. Those running, biking, skiing, golfing at 75 and over and do not fall into this category, please do not be offended, you are the exception. God bless you!

Why would someone 75 or 80 be interested in an exercise program? Well, one must maintain adequate flexibility, strength, balance and endurance to safely function in daily activities around the house. For example, the most common goals of elderly patients are: climbing stairs, getting in and out of a shower, putting on shoes and socks, walking safely for functional distances, tucking in a shirt or fastening a bra, cooking, cleaning, and carrying groceries or laundry.

The National Institute of Health (NIH) recommends four areas of concentration for elderly persons to concentrate on in order to maintain safety and independence: strength, flexibility, balance and endurance. It will be the purpose of this column to recommend safe, practical and easy exercises that focus on each of these categories.

Remember, for most people it is more harmful not to exercise, so contact your physician to discuss whether independent exercise is appropriate for you. You may need to consult with a physical therapist to get started.

STRENGTH EXERCISES

Strength Exercises involve using the muscles to move the arms and legs against resistance such as a weighted object, dumbbells, resistance bands, and body weight against gravity. Strength is necessary to perform daily activities such as walking, lifting a ½ gallon of milk, transferring to a shower or chair safely.

Examples of Strength Exercises for the Upper Body

These exercises are performed while sitting in a chair with backrest, slowly, 5 -10 repetitions, and 3-5 times per week. No weight is used in the beginning, only the weight of the arm against gravity. In 1-2 weeks a light 1-2 pound weight and light resistance band may be added.

• Shoulder Shrug – shrug top of shoulders up toward the ears
• Row the Boat – pull both arms back at a 45 degree angle with bent elbows as if “rowing a boat”
• Saw Wood – pull both arms back with arms at side with bent elbows as if “sawing wood”
• Elbow Bend/Extend – bend and straighten elbows
• Wrist Curl – bend wrist up and down Grip – squeeze ball

Examples of Strength Exercises for the Lower Body in Sitting

• Hip Hike – lift hip up 2-4 inches as if “marching”
• Hip Spread – heels on the floor, tie band around thighs - spread knees apart
• Hip Squeeze – heels on floor, put ball or pillow between knees – squeeze knees together
• Leg Kicks – extend knee as if kicking the foot forward and up
• Heel Raise – raise heel up with toe on floor
• Toe Raise – raise toes up with heel on floor

Examples of Strength Exercises for the Lower Body in Standing

• Standing Leg Curl – facing and holding onto the back of a chair or countertop, bend the knee by bringing the foot back

Once you have mastered these exercises against gravity, then advance to using light weights or light resistance bands. Ankle weights are very inexpensive and can be purchased in 1 pound increments. Light resistance bands are available in yellow and red in colors.

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!”  Next Week: Never To Old To Exercise – Part II of 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: 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 profession of clinical medicine at Geisinger Commonwealth School of Medicine.

For all of Dr. Mackarey's articles visit http://mackareyphysicaltherapy.com/forum

82 million adults spend an estimated 28 billion dollars on gym memberships each year! WHY? There are many reasons we exercise. Some people exercise to prevent illness such as cardiovascular disease or osteoporosis. Others exercise for mental health and as a stress release; others do it to improve strength, flexibility, and endurance to prepare for a sport. However, the number one reason people exercise is TO LOOSE WEIGHT!

When it comes to losing weight, patients have asked me a wide variety of questions over the years. However, certain questions are consistent. “What exercise is the best to burn calories?” “Even though I exercise 2-3 times per week, why can’t I lose weight?” “What is BMR?” “If I eat a Snickers bar, how much exercise do I need to do to burn it off?” “Are there any tools that I can use to help me track my calories and exercise output?”

Which Exercise is the best to burn calories?

Have you ever heard people say that they never felt better or burned more calories as they did when they ran? Well, they may be right! The following numbers are based on the average male weighing 150 pounds: running 6 miles per hour will burn 700+ calories (11-12 calories per minute); vigorously skipping with jump rope or fast cycling will do the same; vigorous walking at 4 miles per hour and moderate biking will burn 600+ calories (10 calories per minute). The 400-500 calorie club includes the following activities: slow jogging, swimming, football, basketball, baseball, tennis, skiing, and moderate walking (3.5 miles per hour).  Light gardening burns more calories than golfing using a cart (250 vs. 180).

Why you may not lose weight even though you exercise? What is BMR?

How many times have you heard people say, “It is hard for me to lose weight because I have a slow metabolism?” What does that mean? To explain this in detail you first must understand BMR. BMR is basic metabolic rate. It is the number of calories that your body requires to operate basic body functions that you don actively control, such as continuing to breathe, and keep your cells and organs working each day. The BMR is influenced by age, height, gender, body fat, and fitness level. BMR is inherently different (high or low) in each individual. While you can’t change your gender or height, you can influence some things to influence your BMR and burn more calories at rest. One, exercise for longer durations, with greater intensity and more frequently. Two, lower your body fat by eating less calories, especially fat and carbohydrates in your diet. Simply, eat less calories than you burn! Three, improve you muscle/fat ratio by weight training.

Basic Metabolic Index (BMI):

BMI:           < 18.5  = Underweight

BMI:   18.5 – 24.5  =  Normal Weight

BMI:    25.  -  29.9  =  Overweight

BMI:            >30.    =  Obestiy

For example, I am a 57 year old male, weighing 150 pounds at 5 feet 8 inches tall with a BMI of 22.8

*Calculate you BMI by entering you gender, height and weight and find how many calories per food item at:

www.calorie-counter.net

Are there any tools for tracking calories and exercise?

There are several tools available for free online to help with tracking calories and exercise visit Prevention Magazine at: www.myfooddiary.com or try the App “Lose It”

BMI Calculator – to calculate your BMI

Calorie Burner – to calculate how many calories are burned with various activities

Daily Calorie Calculator – Find how many calories are in specific foods and what you need to do to loose or gain weight.

So remember, the number one reason we exercise is TO LOSE WEIGHT! But depending on exercise alone to lose weight is an exercise in futility. Losing weight is an intelligent and consistent combination of a balanced diet with portion control, proper nutrition, adequate exercise and activity grounded in lifestyle changes.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday

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.

As the country prepares to return to school and work this fall during a new wave of infections from the Delta variant of COVID-19, it is more important than ever to find healthy ways to control stress and anxiety. While exercise is important to trim our waistline or to speed up our metabolism, there may be more benefit to lacing up those sneakers than you’d think.  Recent studies have established a link between exercise, stress and cognition, making physical activity even more important.

Exercise Improvements

Exercise has been shown to improve sleep and mood, decrease stress, and even increase libido.  It also can bolster our self-esteem and ability to problem-solve and to remember details.  In fact, strength training has even been shown to reverse cognitive decline to a degree in aging adults with mild impairment. Though the medical community is still trying to elucidate exactly how exercise boosts our brains physiologically, increased circulation to the brain and modulation of the hypothalamus-pituitary-adrenal axis that regulates the body’s response to stress have been implicated as the bearers of benefit. While exercise can be advantageous for everyone, it perhaps is even more valuable to those struggling with mood disorders.  Exercise can help combat anxiety and depression and quell the symptoms of Attention Deficit Hyperactivity Disorder and Post Traumatic Stress Disorder as it helps the brain to pump out neurotransmitters and pain-fighting endorphins. Exercise makes addiction management easier, as well, and has recently been shown to help alcoholics lessen consumption.

How Much To Exercise

So, how much exercise exactly is enough to illicit tangible cognitive benefit, you ask?  Any amount of weight lifting, running, walking, or yoga helps, but habitual activity helps the most.  Studies cite that a few consecutive weeks of participation in a fitness regimen yielded notable, positive results in subjects.  Try to make exercise part of your daily routine to encourage good fitness habits.  If you find the idea of adopting a strenuous new fitness program intimidating or off-putting, have no fear.  Moderate exercise is enough to do the trick.  The Mayo Clinic cites both brisk walking and mowing the lawn as examples of moderate activity, so an average fitness level is adequate for yielding positive mental results. 

How to Begin

If you’re thinking about beginning an exercise program for the first time, start gradually.  Begin with walking for 10 to 15 minutes twice daily, and add 1 or 2 minutes to your session every time you walk until you can walk continuously for 45 to 60 minutes.  The same principle can be used when beginning other fitness routines involving biking, swimming, running, etc.  Begin a weight training program to strengthen bones and tendons using 3 to 5 pound dumbbells, and increase the weight you use by a pound once you can easily perform 30 consecutive repetitions.  Be careful to pay close attention to posture and form. Contact your physical therapist or a personal trainer for assistance with designing an appropriate exercise program.  Don’t hesitate to contact your physician, either, if you have questions about whether a particular exercise program is safe and suitable for your age group or current fitness level.

Tips to Building Your Workout

• Don’t let the idea of fitting exercise into your busy schedule stress you out (the goal is to reduce stress).  If you can only find time to exercise on the weekends, do that.  Every workout, no matter how frequent, can help to recharge your brain.
• Understand that beneficial exercise doesn’t have to be particularly laborious or formal.  Walks around your block or playtime with the kids count as physical activity, too.
• Consider using a fitness app to track your progress – some even have barcode scanners and calorie counters to help you track food intake in addition to exercise.
• Unless you’re performing brisk aerobic exercise for over 60 minutes, opt for water when you work out rather than sports drinks.
• Exercise outdoors to gain an additional boost in creativity – a recent study showed that hikers performed better on cognitive tasks after spending time outside.
• Use your exercise sessions to let your mind wander.  Instead of using your time on the treadmill to plan your itinerary for the week, use it to focus on yourself, your breathing, and your movement.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. 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: https://mackareyphysicaltherapy.com/forum/

Exercise and be Happy!

Part II of II

Last week in Part I on Depression I discussed the importance of laughter for the prevention of depression. In this column, I will discuss one of the most understated benefits of exercise – mental health! Specifically, aerobic exercise (exercise that increases your heart rate for 30 minutes or more) such as walking, biking, running, swimming, hiking, elliptical & stepper machines to name a few, is the secret to “runner’s high.” This exercise euphoria is not limited to runners alone, but all who engage in aerobic exercise are more likely to experience high energy, positive attitude, and mental wellness.

Physical activity, specifically aerobic exercise, is a scientifically proven useful tool for preventing and easing depression symptoms. Studies in the British Journal of Medicine and the Journal of Exercise and Sports Science found that depression scores were significantly reduced in groups that engaged in aerobic running, jogging or walking programs, 30-45 minutes 3-5 days per week for 10-12 weeks, when compared to a control group and a psychotherapy counseling group.

Depression is the most common mental disorder and is twice as common among women as in men. Symptoms include: fatigue, sleeplessness, decreased appetite, decreased sexual interest, weight change, and constipation. Many of these symptoms are likely to bring an individual to their family physician. Unfortunately, depression is on the increase in the United States. According to the National Ambulatory Medical Care Survey, in the early 2000’s, 7 million visits to a primary care physician were for the treatment of depression. 10 years later the number doubled.

HOW EXERCISE REDUCES DEPRESSION

            According to research reported in The Physical and Sportsmedicine, exercise reduces depression in two ways, psychologically (mentally) and physiological (physically). 

Psychological or Mental Benefits of Exercise on Depression:

• Helps a person gain control over their lives
• Increases self-esteem
• Diverts attention away from worry, concern or guilt
• Improves mood – with visible signs of improvement in physique & body weight
• Increases sense of pleasure and satisfaction
• Anger management – release pent-up frustration, anger and hostility

Physiological or Physical Benefits of Exercise on Depression:

• Increase in brain serotonin (natural mood elevator chemical in brain)
• Increase in beta-endorphins (natural mood, stress & pain control chemical in brain)
• Improvement in natural sleep patterns

HOW TO BEGIN EXERCISE FOR DEPRESSION

• First and most importantly, consult your primary care physician to confirm the diagnosis of depression. Be sure that your symptoms are not related to other health problems. Also, if you are using antidepressant or other medications discuss the impact it may have on your exercise program with your physician.
• Recognize and fight depression symptoms that are contrary to or prohibit physical activity such as: fatigue, lack of energy, slow motor skills.

Work hard to recognize and overcome these symptoms to begin an exercise program. An aerobic exercise routine should eventually lessen these symptoms.

• Be realistic. Expect that aerobic exercise will take time to have a noticeable benefit. Do not get overly ambitious and set yourself up for failure.
• Begin with an aerobic exercise program that is practical and destined to succeed. For example: inactive and deconditioned people should begin walking 5 minutes per day, 3-5 days per week for 1 week. Then, add 3-5 minutes each week until you attain 30-45 minutes per walk 3-5 times per week. Younger and fitter people can begin to walk for 15 minutes and continue until they attain 45-60 minutes per walk, 3-5 times per week. Remember, what seems impossible today will be easier and routine in 3-4 weeks so JUST DO IT !
• Find a pleasurable environment: a beautiful park (Nay Aug), a scenic lake (Lake Scranton), quiet countryside (rural farmlands of Dalton). Use a mall in inclement weather.
• Find a friendly, uplifting group of  people to enjoy a good walk and talk. This may be more appropriate for people feeling isolated or withdrawn. Others may enjoy the peace and quiet of exercising and meditating alone.
• Be specific and compliant! Make a serious commitment. Keep a journal or exercise log. Mark a calendar. 30-45 minutes, 3-5 days per week – NO EXCUSES! Get and exercise buddy you can count on and help keep you compliant!
• Make it fun! Mix it up. Walk 3 days, swim or bike 1-2 days, some days alone, some days with a buddy.
• BE RELIGIOUS! Be religious about exercise BUT don’t get too compulsive!

Read Dr. Mackarey’s Health & Exercise Forum – every Monday

Access all of Dr. Mackarey's articles in the Health and Exercise Forum 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 in downtown Scranton and is an associate professor of clinical medicine at GCSOM.

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. It 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 OA

When performed correctly, exercise for those with OA 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 increase 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 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 sleeping.

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 make adjustments next time. Otherwise, use hot packs, bath or shower before you

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

For all of Dr. Mackarey articles visit 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.

Part II of II

I think we would all agree, technology is a wonderful thing. However, like all good things, it comes at a price. Students and workers alike are suffering from the many physical effects of sitting for too many hours...especially with COVID-19 home confinement! Studies show the impact of prolonged sitting, especially with poor posture, are multifaceted: pain, headaches, vision problems, poor concentration, excess fat storage with weight gain. Studies strongly support the use of using good posture, ergonomic workstations, posture stretches and frequent changes of positions, including the use of standing desks to prevent pain and injury as we discussed last week in part I.

The Problem is Gravity!

The average head weighs 10 to 12 pounds and when tilted down at a 45 degree angle the forces of gravity are multiplied by 5. While reading, studying or working on the computer with poor posture, one must support 50 or more pounds of pressure on the neck, middle and lower back for hours on end. It is no wonder why this activity is associated with headaches, neck and back pain, numbness and tingling in arms and legs, muscle spasms etc.  Some studies report the lifetime prevalence of neck and shoulder pain in office workers as high as 80%.

Spine problems can be prevented with good posture and proper body mechanics. Poor posture and improper body mechanics subject the spine to abnormal stresses that, over time, can lead to degeneration and pain. Good posture and proper body mechanics and frequent changes in positions, can minimize current spine pain and prevent recurrent episodes. Posture is the position in which you hold your body upright against gravity. Good posture involves positions that place the least amount of stress on the spine. Good posture maintains the spine in a “neutral” position. In a neutral spine, the three normal curves are preserved (a small hollow at the base of the neck, a small roundness at the midback and a small hollow in the low back). When viewed from the side, the upper back appears straight with a small hollow in the lower back.

GOOD POSTURE

Standing: Feet should be shoulder width apart. Distribute body weight evenly through both feet. Do not lock knees. Maintain a small hollow in lower back with “tailbone” slightly tucked down. Lift the breastbone by drawing shoulder blades back and down. Make chin level. Earlobes should be in line with the middle of shoulders. Relax jaw and neck muscles by resting tongue on the roof of mouth.

Sitting: Sit in a firm, high-back, straight-back chair. Buttocks should touch the back of chair while maintaining a small space between the back of knees and the seat of the chair. Distribute body weight evenly on both hips. Maintain an arch in the low back. A lumbar roll is recommended. It is a foam roll, 4” to 5” in diameter and 12” long, placed at belt level. Place feet flat on the floor with hips and knees bent at a right angle. Keep knees even with or slightly higher than hips. Use a footstool or footrest if necessary. Do not cross legs! Lift the breastbone by drawing shoulder blades back and down. Earlobes should be in line with the middle of shoulders. Position the armrests properly allowing elbows and forearms to rest with shoulders relaxed. If armrests are too high shoulders will shrug up and if too low will cause slouching.

POSTURE EXERCISES

The following exercises should be performed throughout the day as a break from sitting, studying or working at home, school or the office. They should be performed gently, slowly, held for 3-5 seconds and repeated 5-10 times. The exercises should only cause a slight stretch but NOT PAIN.

For all of Dr. Mackarey's Articles visit our health care forum at https://mackareyphysicaltherapy.com/forum/

Dr. Mackarey’s Health & Exercise Forum – every Monday

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.