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Weight Training and Aerobic Exercise for GLP-1 Users

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

GLP-1

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

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

Increased Strength
Prevent Loss of Muscle Mass & Bone Density
Improved Performance in daily tasks and activities
Improved Endurance
Improved Injury Prevention
Improved Mental Health
Improved Overall Health & Wellness

Risks From Poorly Designed or Unsupervised Program

Risk level increases if the program is not developed or supervised by a qualified professional for technique, safety, intensity and frequency
Lower Back Pain – from poor technique and overload
Muscle/Tendon Strain – from overuse and overload
Tendonitis – from overuse and overload

How to Begin A Weight Training Program for GLP Users

Primary Care/Family Physician – get medical clearance to make sure that you are not at risk, especially if you have medical issues such as heart disease, hypertension, diabetes.
Orthopedic Physical Therapist – your doctor may think you would benefit from a few visits with an orthopedic PT to make sure your program is well-designed for your specific goals and your specific needs or activities (gardening, walking, golf, tennis)
Avoid Getting Competitive – it sets you up for injury! No Clean-Jerk, Overhead Press, Full Squats. Don’t compete to lift to your maximum. Make Exercise FUN!
Technique
- Slowly lift and lower weight 4 seconds up, 4 seconds down
- Breath – inhale lifting weight up and exhale down
- Never hold breath!
- Exercise Major Muscle Groups
- Upper body: shrugs, rows, lats, biceps, triceps, chest press, wrist curls – all with light dumbbells and bands to start
- Lower Body: hip hike, leg extension, ham curl, step ups, 45 degree squat, calf raise – all light with sandbags and dumbbells to start
Lift 3 times per week on alternating days – 30 to 45 minute sessions
- Warm up
- Cool down
- Work upper body/lower body
- Can alternate days for upper body and lower body
- INCLUDE AEROBIC EXERCISE:
- Can alternate days for weight lifting with aerobic exercise (elliptical, swim, walk, run, bike)
Concentrate on low weights (5-10#)/high repetitions(10-15 times)
- Once you master the technique add 1-2 # and 3-5 reps
- Never advance weight or reps if you overstrain and compromise technique

**STOP:

If you have pain
If you get lightheaded or dizzy
If you experience lower back pain or joint pain
If you have muscle or joint pain that lasts more than 2 days

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

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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!

Part 1 of 2

GLP-1

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

Diet and Nutrition Considerations for GLP-1 Users

FOOD TO AVOID

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

Alternative Food Choices for GLP-1 Users

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

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

Tips for Maintaining a Balanced Diet for GLP-1 Users

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

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

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

PART III OF III

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

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

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

Sleep – somehow, despite a busy academic and social schedule, you MUST get enough rest. Lack of sleep may be the single unhealthiest habit of a college student. It can lead to many negative consequences such as lack of concentration, poor emotional stability, and vulnerability to germs and disease. While one may get by on 3-4 hours sleep for short periods of time, eventually, your body will take control and shut down. Do your best to develop a regular sleep pattern and factor in short naps to catch up on needed rest if necessary.
Diet – the “freshman fifteen” is no joke, it is the real thing. Skipping breakfast, “pigging out” on junk food, late night eating, and drinking high calorie soda and beer all factor into weight gain and poor dietary habits. Make time to eat breakfast, snack on yogurt, fruit and nuts. Fill up on a healthy salad. Avoid a constant diet of fried foods and sweets.
Water – even adults forget to drink plenty of water throughout the day. Carry a water bottle and skip the soda.

Get regular check-ups – see your doctor when home on semester break for an annual check-up or more often if needed. Many college health centers offer this service. Many serious problems can be avoided with early detection.
Get a flu shot, vaccines and mask up – remember, college campuses breed germs and most schools offer inexpensive flu shots and Covid vaccines.
Exercise – make time to exercise regularly (30-45 minutes 3-5 days per week). Walk, run, bike, lift weights, play tennis, racquetball or swim. Colleges have the best facilities for sports and exercise. Just DO SOMETHING! It will help you sleep, relax and feel better.
Relax – make time to relax. Read a book, go for a run, meditate, do yoga, or walk and have good conversations with friends. Mental health is important on a stressful college campus.
Emotional Health – is a vital component of a healthy person. College life can be very stressful. Depression, anxiety, addiction, eating disorders, and homesickness are some examples of emotional problems common among college students. If you feel emotionally unhealthy, get professional help. All colleges have trained counselors equipped to assist you.

Drink Sensibly – binge drinking might be one of the most dangerous behaviors on a college campus. Studies show 44% of U.S. College students engage in binge drinking uniformly among freshman through seniors. Of these, 50% binged 3-4 times in a two-week period. Binge drinking is defined as 5 drinks in a row for men and 4 for women. Binge drinkers are more likely to be victims of poor academic performance, addiction, trauma, auto accidents, assault, unprotected sex, sexual assault, and death. Some of the most common reasons reported for binging are: to get drunk, status, campus culture, peer pressure, academic stress. TALK TO YOUR CHILDREN!
Safe Sex – promiscuous sex is physically and emotionally unhealthy. Unprotected sex can be LIFE ALTERING! Studies by the Center for Disease Control found that almost 80% of college students 18 to 24 years old had sexual intercourse at least one time during college. 73% reported having unprotected sex and 68% of this group did not believe that they were at risk of contracting a sexually transmitted disease. TALK TO YOUR CHILDREN! GET THE HPV VACCINE!

SOURCES: American Academy of Pediatrics

Visit your doctor regularly and listen to your body.

Keep moving, eat healthy foods, and exercise regularly.

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Human beings were designed to move…walk, run, climb, lift, hunt, and gather. Contemporary man has suffered greatly from a technologically driven inactive and sedentary lifestyle. Inactivity is associated with many health problems; obesity, adult-onset diabetes, high blood pressure to name a few. Other problems associated with lack of movement are;

Constipation
- The more you move your body, the more your colon moves! A regular and consistent exercise and activity regime results in a more consistent bowel schedule, especially with age. Healthy muscle tone in your abdominal muscles and diaphragm is also the key to moving waste through your digestive tract.
Stiff Joints
- Osteoarthritis, rheumatoid arthritis and many inflammatory or auto-immune diseases can cause achy and stiff joints. However, even healthy joints can also stiffen when you don’t use them enough. Put them to work so they get tight and cause pain.
Shortness of Breath
- All muscles get weak from lack of use, including the muscles that help your lungs expand and contract as you breathe if you don’t work them out regularly. The less exercise or activity you do, the more you experience shortness of breath, even during easy daily tasks.

Depression or Moody
- Physical problems are not the only complication of inactivity. A lack of movement can also increase feelings of anxiety and depression. Aerobic exercises like walking, biking, swimming, or running, have been proven to stimulate endorphins to boost and steady your mood, and even improve your self-esteem.
Lack of Energy
- Many studies have found that regular movement improves energy. Exercise helps deliver oxygen and nutrients to your tissues. When you sit or are inactive, tissues are not getting the same amount of fuel they need to keep you going.
Slow Metabolism
- Movement stimulates your metabolism. Hyperactive people burn more calories…just by fidgeting! Even if you are not hyperactive, the more active you are, the more calories you burn each time you move.

Difficulty Sleeping
- One of the first recommendations sleep doctors make to their patients suffering from insomnia is exercise. When you keep a regular exercise routine, you fall asleep faster, and you sleep deeper once you drift off.
Brain Fog
- Regular exercise tells your body to make more chemicals called growth factors. They boost blood vessel production in your brain. The more blood that gets to your brain, the better you can think, remember, and make decisions.
High Blood Pressure
- Spending most of your time sitting raises your risk of heart disease, in great part because you’re more likely to have high blood pressure. This is a big risk factor for heart issues like coronary artery disease and heart attack.

High Blood Glucose
- When physical activity is a regular part of your life, your body has an easier time keeping your blood glucose under control. Exercise can stabilize blood sugar levels and keep you out of the type 2 diabetes danger zone.
Lower Back Pain
- When your core muscles are weak from lack of use, they can’t support your back the way they should. This makes it much easier to tweak your back muscles during everyday movements like standing or reaching. Pilates, yoga, and other exercises that use stretching are good for building a stronger back. Schedule an appointment with a good orthopedic and sports PT.
Hunger Pains … “Hangry”
- Logically, one might think that you’d be hungry more often if you exercised more, but the opposite is usually true. Aerobic exercise like biking, swimming, walking, and running can decrease your appetite because it changes the levels of certain “hunger hormones” in your body.

Sick Often
- Studies show the more moderate activity you get, the lower your chance of catching a cold or other germs. When you make exercise a habit, your immune system gets stronger.
Dull and Pasty Skin
- If your skin looks duller than usual, a lack of movement may be to blame. Some studies show that moderate exercise boosts your circulation and your immune system, which helps your skin keep that youthful glow.

SOURCE: WebMD

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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.

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It’s peak summer time … so make time to get to the water! Research shows that spending time outdoors has many positive effects on your health. Moreover, new research has found that being near a body of water makes us calmer and healthier. You know that special feeling you get when you drive to the lake or the beach and jump out of the car and smell the fresh air and hear the sound of splashing in the lake or the waves of the ocean? Well, it is not just because you’re on vacation…the water makes your muscles relax and breath deeper. Your brainwaves slow down to simulate the gentle roll of the water…lake or ocean! These “blue environments,” not to be confused with “blue zones” are the subject of extensive research at the University of Exeter Medical School in the UK.

Time spent near water promotes physical activity, general fitness and well-being. It is also associated with reducing the incidence of diabetes and other diseases associated with obesity. Additionally, time near the water slows down our heart rate, reduces stress hormones and improves mental health. In fact, the study also found that subconsciously, people consistently preferred pictures of natural environments (rivers, lakes, oceans) even when compared to attractive urban landscapes. In fact, urban landscapes with water (rivers, fountains etc) were far more popular than those without. And, health disparities between coastal and inland communities are more noticeable for low-income individuals who do not have the means to venture to the coast. This may be one of the reasons that four out of the five “Blue Zones” discovered by Dan Buettner are islands.

WHY BEING IN, ON, OR AROUND THE WATER IS HEALTHY:

WATER STIMULATES ALL 5 SENSES
- Water provides a totally immersive experience. We feel the coolness trickling on our skin, we taste the salt, smell the seaweed, hear the waves and splash of the water, and see the sun glistening on the water.
WATER STIMULATES OUR NERVOUS SYSTEM
- Water impacts our physiology in that it triggers our parasympathetic nervous system to lower heart rate and blood pressure which promotes relaxation. Even the act of drinking a glass of water can promote relaxation and wellness.
WATER IS BLUE…BLUE IS THERAPEUTIC
- If the rolling blue waves in the lake and ocean aren’t enough, the blue light waves will work to promote further relaxation. Additionally, the beautiful backdrop of a blue sky is the icing on the cake to make you chill out!
- Similar to “white noise” used by millions of parents to promote sleep for infants and toddlers, “pink noise” (the noise associated with natural sounds) is more smooth, soothing, ongoing and natural as it reduces brain wave activity…have you ever experienced a “beach nap?”
WATER STIMULATES OUR INNATE BIOPHILIA
- The biologist and naturalist Edward Wilson coined the term “biophilia” to describe the theory that humans have an instinctive bond with nature. As a species, our origins have begun on open savannahs and endless shorelines. These natural environments instinctively return us to a simpler time and place.

WATER IMMERSION BALANCES OUR HORMONES
- Did you ever notice the inner harmony of swimming underwater or total floating? When you are doing these activities, your body sends signals to balance stress hormones similar to the bodies response to meditation or relaxing.
WATER ACTIVITIES STIMULATE ENDORPHINS
- Whether you are swimming, surfing, kayaking, paddle boarding, fishing, clamming, walking the shoreline, digging a water hole or making a sand castle, these activities will stimulate endorphins. These natural chemicals have been associated withhappiness, pain management and overall well-being.

In addition to the benefits of being by a body of water, just being outdoors promotes better health and wellness:

Nature’s Vitamin D – Current research suggests that Vitamin D (The Sunshine Vitamin), may offer significant disease prevention and healing powers for osteoporosis, some forms of cancer and heart disease. Of all the methods of getting an adequate amount of Vitamin D, none is more fun than spending time outdoors in the sunlight.
Increase Activity Level – While exercising indoors in a gym is valuable, research shows that time spent indoors is associated with being sedentary and being sedentary is associated with obesity, especially in children
Improved Mental Health – It is well documented that light affects mood. So, unless you live in a glass house or a light box, getting outdoors is important to your mental health.
Improved Concentration – Richard Louv, author of the book, “Last Child in the Woods,” coined the term, nature-deficit disorder.” This term is supported by research that found children with ADHD focus better when outdoors.
Improved Health and Healing – Researchers at the University of Pittsburgh found that patients recovering from surgery recovered faster with less pain and shorter hospital stays when they were exposed to natural light.
Improved Breathing – In general, breathing fresh air is good for you. Some exceptions might be those with severe allergy problems when the pollen count is high. Despite this, it may be better to take allergy medicine and enjoy the benefits of being outdoors than to be stuck inside.

Sources: NIH, Global News, Plume, L, University of Exeter Medical School in the UK.

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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.

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Guest Author: Andrea Molitoris Kozlowski, PT, DPT - Andrea is a doctor of physical therapy and an associate at Mackarey Physical Therapy in Scranton and Clarks Summit.

May is national pet month! As we take a moment to celebrate our pets it is important to acknowledge the many contributions having a pet brings to our lives, not the least of which is improving our health and wellness. Pets have a long history of helping humans navigate daily life. In fact, the oldest record of having a pet date back 15,800 years ago in Turkey where archaeologists found dog remains buried with humans.

Pets come in many different shapes, sizes, and species. Whether you are a cat/dog person, a reptilian lover, or marine life enthusiast, having a pet that is right for you can enrich you life in many ways. If you have never had a pet before or might be thinking about adopting a new addition to the house, it is important to research first and know the right ways to care for your new friend in the best way possible. Being a responsible pet owner will help to flourish your relationship with your pet and make the time and bond you share a stronger and more positive experience.

7 Reasons Having a Pet is Good for Your Health & Wellness:

Pets are good for your health.
- Studies show that having a pet in your life helps to lower the amount of stress your body feels by reducing the amount of cortisol your body produces. Cortisol is a natural steroid hormone your body produces at times of stress to help regulate and balance how your body deals with that stress. By having a pet, your body’s natural level of cortisol lowers helping to better regulate and control your blood sugar levels, inflammation, and overall metabolism leading to a healthier you.
Pets help you sleep better.
- Research also shows that those who sleep with their pets are more calm, comforted, and relaxed to produce a better quality of sleep compared to those who do not sleep with their pets. The warmth and comfort of having them near you allows the body to enter and remain in a REM or deep sleep more easily. In addition, the lower cortisol levels, encouraged by your pet, help to better regulate your sleep-wake cycle and provide you with an improved quality of sleep.

Pets can increase activity and movement.
- One of the best motivators to being more active and engaged throughout life stems from having someone to be active with daily. Although pets cannot go to the gym with you, their general presence in life requires you to have more movement and encouragement to move whether it is going for walks around the neighborhood, a visit to the local park, or going to the store for pet supplies. Also, they help with step goals and soaking in some extra Vitamin D by being outside more! If you have pets like mine, they require me to get up and down from my seat at least 30 times a day to let them in and out of the house… and that’s being generous!

Pets enable more consistency and structure in daily life.
- Owning a pet helps to create a schedule and routine for everyday life. Studies suggest that pets provide structure for daily life and responsibilities helping to shape a regular routine of movement, care, and task completion that encourages you to be more punctual and attentive to what needs to be done.
Pets help with feelings of depression and anxiety.
- Research shows that pets, regardless of what kind, provide a sense of companionship and unconditional love for their owner. This relationship helps to boost mood and sense of happiness throughout life. Those with pets also note that there is a greater sense of safety and protection found at home when they have a pet companion. Some even find watching their fish swim in their bowl relaxing and an enjoyable pass time. Don’t forget, pets are great listeners and help to reduce the loneliness that one can feel at times by keeping you company with a listening ear. In addition, their quirky and unique personalities always leave you laughing, smiling, and engaged through the day encouraging more joy and happiness from the relationship.

Pets increase social support.
- Not only are pets a form of social support independently, but they encourage more community engagement and interactions compared to not having a pet. Visits to the parks and pet-friendly events help to create other friendships and sense of community by participating in activities and events geared towards pet-owners. Additionally, pets help with general social engagement via conversation, picture sharing, and even training classes making a person feel more accepted and valued.
Pets assist with child development.
- Having a pet while raising a child has been shown to help children learn responsibility, exhibit fewer behavioral issues, and encourage sharing and thoughtfulness to others. The responsibility that comes with caring for a pet also has shown to help a child develop better attention and focus on tasks at hand in an environment that is calmer and encouraging.

Making an informed and thoughtful decision about getting a pet is important. Don’t be afraid to ask questions, do some research, or simply take some time to figure out the logistics of how adding a pet can influence your life. From personal experience, I could not imagine my life without my four-legged friends by my side to share, enjoy, and enrich my every day. Having a pet can be one of the best parts of life. Remember, although having a pet can be a small part of your life; to them, you are their whole life, so make sure it can be the best life possible. Together, you will form of a bond that in enhances you life in many ways, including your health and wellness!

Sources: https://newsinhealth.nih.gov/2018/02/power-pets

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

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:

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.
EASY – most people can learn to ride a bike. Kids begin with training wheels and adult tricycles are available.
FAMILY FUN – something the whole family can enjoy in your neighborhood, at the beach or on one of the trails.
PRACTICAL EXERCISE – it is an opportunity to exercise while traveling to work, store, lunch etc…bike it!
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.
LEG STRENGTH – pedaling a bike is a great way to improve leg strength.
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.
IMPROVES BALANCE/COORDINATION/FALLS PREVENTION – riding a bike requires some balance and coordination and therefore will improve balance as a form of falls prevention.
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.
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

“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