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

WALKING FOR HEALTH

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

BENEFITS OF WALKING

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

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

PLAN AHEAD

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

SET REALISTIC GOALS

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

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

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

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

TRACK YOUR PROGRESS

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

MARK YOUR CALENDAR

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

FIND A WALKING PARTNER

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

USE EFFICIENT WALKING TECHNIQUE

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

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

Visit your doctor regularly and listen to your body.     

Sources : Sapiens.org; WebMD; Mayo Clinic 

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

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

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

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

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

Heat stroke, one of the most serious heat-related illnesses, is the result of long term exposure to the sun to the point which a person cannot sweat enough to lower the body temperature. The elderly and infants are most susceptible and it can be fatal if not managed properly and immediately. Believe it or not, the exact cause of heat stroke is unclear. Prevention is the best treatment because it can strike suddenly and without warning. It can also occur in non athletes at outdoor concerts, outdoor carnivals, or backyard activities.

Hot Temps and Exercise

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

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

Treatment of Heat Stroke:

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

Treatment of Heat Stroke:

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

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

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

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

STAY ACTIVE & HAVE FUN IN THE SUN!

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

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

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

Gear:

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

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

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

Check out the video for more information: REI paddleboard basics

Elliptical Peddle Boarding

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

Aqua Zumba

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

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

Website: www.zumba.com

Elliptical Biking

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

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

Visit your doctor regularly and listen to your body.     

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

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

 

Summer heat and humidity are here and the risk of heat related illnesses are particularly high for those over 65, especially dehydration. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round. Furthermore, age related changes in 50-60 year olds can also make one vulnerable to dehydration if they are active and exercise in the heat. Not long ago, a local medical professional and good friend of mine was hospitalized for several days due to dehydration and associated illness. He is an active, fit, healthy 59 year old who continued his daily running for exercise during the June/July heat wave.

It is often forgotten that, next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.

In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.

Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.

Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. The elderly often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly persons may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration. 

Elders may suffer headaches, fainting, disorientation, nausea, a seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated. Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms (but these symptoms apply to both young and old):

• CHANGE IN MENTAL STATUS (CONFUSION)
• WARM,MOIST SKIN WITH POOR SKIN ELASTICITY: gently pull the skin on the forehead and over the breastbone by pinching and releasing a skin fold; if the skin remains elevated for 3 seconds or more, dehydration is suspected
• DRY, STICKY MOUTH WITH CRACKED LIPS AND DRY FURROWED TONGUE
• DRYNESS IN NOSE
• DECREASED BLOOD PRESSURE
• INCREASED HEART RATE (RACING HEART; HEART BEATING TOO QUICKLY)
• CONSTIPATION
• CONCENTRATED URINE WITH SCANTY OUTPUT: as the urine becomes more concentrated and dark, it irritates the bladder and may increase the urge to void resulting in frequent, small voiding (urine output)
• WEIGHT LOSS
• SUNKEN, TEARLESS EYES
• FAINTING WHEN STANDING UP (FEELING LIGHT-HEADED AND DIZZY WHEN STANDING AFTER SITTING OR LYING DOWN)

Plain old tap water is a good way to replenish fluid loss. Some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed form the stomach. Consuming alcoholic and caffeinated beverages actually has an opposite, diuretic effect!

Visit your doctor regularly and listen to your body.     

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

Contibutor: Janet M. Caputo, DPT, OCS

NEXT MONDAY! – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week: Part II - Dehydration Prevention”

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, check out our exercise forum!

“The 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

The purpose of this column is to present an alternative to traditional running that will allow training on more interesting and less stressful surfaces such as those used when hiking, mountain biking and horse riding trails in the beautiful woods of Northeast Pennsylvania…”trail running!”

I remember my trail running days with fondness. One day, when the temperatures soared above 90 and my wife pleaded with me to avoid running in the heat (she was wise), as a typical runner, I needed hit the road. As I set out on State Road 348 just on the periphery of Lackawanna State Park in Dalton, the sun was beating down on me. I happened to see a sign that read, “Orchard Trail, Bull Hill Trail, Tree Line Trail.” I thought it might be a good idea to find some shade and decided to run on this path normally used for hiking, mountain biking and horseback riding. It turned out to be a great decision. While I was forced to run 25% slower due to the uneven terrain (rocks, tree roots, stumps), I was able to practice “light running” techniques by running with short strides on the balls of my feet. I felt much more refreshed as I avoided the direct sunlight under the cover of the trees.

Furthermore, I enjoyed the up close view of nature as I ran by cool streams and wet mossy rocks. I saw beautiful flowers, rhododendron, and mountain laurel. I observed deer, chipmunks and birds. In my quest to avoid the hot sun, I discovered the beautiful underworld of “trail running” – a growing trend in today’s running community. If you, like me, enjoyed pounding the pavement for many years, trail running can help you rediscover why you love to run. 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 or snagged.
• 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 water proof and offer better traction.
• Water – a hand held 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) or download the app AllTrails. Learn the difference between “non technical 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

Visit your doctor regularly and listen to your body.     

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Paul's articles. check out our exercise forum!

Have Fun and Get in Shape!

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

Exercise and Arthritis

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

Benefits

The following are some of the benefits of water exercise:

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

Getting Started

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

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

Visit your doctor regularly and listen to your body.     

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM. For all of Dr. Mackarey's articles, visit our Health and Exercise Forum!

Part II of II: Gardening with Disabilities

Summer (and Memorial Day, the kickoff of the gardening season) will be here soon and gardeners in northeast PA are anxious work in their gardens and enjoy the fruits of their labor. Last week, Health & Exercise Forum presented tips for gardeners for preventing hand and arm injuries such as carpal tunnel syndrome. This week’s column is dedicated to prevention of lower back and lower body injuries when working in the yard and for gardeners with disabilities.

A relaxing and enjoyable activity for many, gardening can turn dangerous without proper precaution as repetitive stress injuries, back pain, muscle pulls, can stem from raking, weeding, digging and pruning, can turn into serious problems if not treated appropriately.  Since prevention is the best approach, the US Dept of Agriculture promotes warm-up exercises and injury prevention tips to help all levels of gardeners avoid serious and long-term injuries while enjoying this popular outdoor activity.

People with various disabilities enjoy gardening at different levels. For example, those suffering from neurological diseases with muscle weakness, paralysis and poor balance as well as those with musculoskeletal problems such as neck and LBP or hip and knee arthritis can safely enjoy gardening at some level. This outdoor labor of love is very therapeutic.

Warm up and stretching is important. Don’t garden first thing in the morning before you have a chance to warm up. Get up, go for a short walk, have breakfast and maybe warm up with a hot shower before working in the garden. Some stretches include:

Corner Stretch: Stand facing a corner wall with arms and shoulders at 90 degrees. Lean into corner and stretch shoulders and back. (PHOTO 1)

Knees to Chest Back Stretch: While lying on your back, bring both knees up towards your chest. (PHOTO 2)

Note:  These exercises should never be painful when completing them.  You should only feel a gentle stretch. Hold the stretch10 seconds and repeat 5 times before you garden and every 2-3 hours while working. Should you experience pain, please consult your family physician or physical therapist.

The following guidelines to prevent injury and foster healthy gardening for those with and without disability:

• Listen To Your Body – Aches and pains are signals from your body that you may be doing something wrong or overdoing it. Just like a baseball player in spring training, you must ease into a new activity slowly and stop before you get pain. Do not try to do it all in one day.
• Take Frequent Breaks – Perform work in short sessions, with a rest and stretch break between gardening sessions to reduce muscle fatigue and pain.
• Change Positions Often – Alternate positions from standing, sitting, bending, and kneeling every 15 to 20 minutes.
• Use Large Muscles- When possible use the large muscles of the body to do the work. For example, use your legs to push a shovel blade into the ground instead of your arms. Also, lift with your legs and not your back.
• Avoid Awkward Motions – Do not squat, twist and bend at the waist for prolonged periods or with repetition. 
• Use Supportive Devices and Braces – Remember to wear wrist and knee supports if you have a problem. A lower back brace or corset is also advisable when working in the garden to protect the spine and add support.
• Use Well Designed Tools.  Use the right tools for the job. Padded, ergonomic handles with extensions to add reach are helpful.   
• Use Sun Block, Sun Glasses and bug spray – to protect your skin and eyes from the sun and ward off ticks and other bugs.
• Plan ahead.  Use a container with wheels to carry supplies to the garden.  When necessary it should be carried/pulled with hands, distributing the workload equally and decreasing stress in the joints of your body.
• Eat Well and Stay Hydrated – When working outdoors eat and drink properly for the climate and temperature.
• Use Adaptive Devices -  Special gardening carts, wheel barrels, motorized carts, and a garden tractor with a cart can make a job easier, especially for those with disabilities.

1. “Easy-Grip” tools are available for those unable to grip strongly. For example, hand shovels and weed cultivators that attach to the wrist/forearm with Velcro straps and tools with telescoping extensions are available. (www.wrightstuff.biz)
2. Mobile Adjustable Stools – with arm rests and 2-3 steps that allow you to go from sitting upright to a position closer to the ground.
3. Elevated and Raised Beds – allows gardening from a standing, sitting or wheelchair height for improved safety and enjoyment.
4. Pipe Planter or Seeder – a PVC pipe 5-6 feet long allows planting and seeding without bending or kneeling. For example, a 6 or 8 inch pipe allows plants to slide down and be tampered into a hole and a 1-2 inch pip allows seeds to slide down to the ground for cover or planting.
5. Kneeling Pads, Mats, Carts – are healthier for your knees and back.

Source: Karen Funkenbusch, MA; Willard Downs, PhD.: U. S. Department of Agriculture - Agricultural Engineering Extension

Model: Ashley Ottaviani, PTA

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. Access all of Dr. Mackarey's articles at our Health and Exercise Forum!

Like many of you, I have always enjoyed the outdoors...walking, running, biking, hiking etc. However, recently, I have been more concerned about my safety, (getting older and more cautious) when doing these activities on the side of the road.

Almost 15 percent of all motor vehicle injuries to people happened to those not in cars but while walking, running or hiking. In fact, over 4,000 walkers or runners were fatally hit by a motor vehicle according to the Centers for Disease Control (CDC). These statistics continue to increase as the number of distractions to drivers increases (phone calls, texts, etc). Consequently, walkers, runners and cyclists must be more aware than ever to prevent injury from motor vehicles.

Five high risk factors for walkers, runners and cyclists:

• After dark
• At rush hour in high traffic
• Walk or run “with” instead of “into” traffic flow
• More than one other person with you
• Headphones

“Runner’s World” offers the following recommendations:

• Leave word. Tell somebody or leave a note at home about where you plan to go and how long you plan to be out. That way your loved ones will know to come look for you if needed.
• Protect yourself: If your route is in a high crime area, avoid dawn and dusk, carry self-defense spray, exercise with a partner, leave jewelry at home and vary your route and routine.
• Identify yourself. Run with proper ID, and carry a cell phone with emergency contacts taped to its back.
• Pretend you're invisible. Don’t assume a driver sees you. In fact, imagine that a driver can’t see you, and behave accordingly.
• Face traffic. Except for cyclists, walking and running “into” oncoming traffic is best. It’s easier to see, and react to, oncoming cars. And cars will see you more clearly too.
• Make room. If traffic gets heavy, or the road narrows, be prepared to move onto the sidewalk or shoulder of the road. When walking or running into traffic, stay as far left as possible. When biking, favor the far right side of the road.
• Be seen. Wear high-visibility, brightly colored clothing. When out near or after sunset, reflective materials are a must. (If you don't own reflective clothing, a lightweight reflective vest is a great option.) And use a headlamp or handheld light so you can see where you're going, and drivers can see you. The light should have a bright LED (drivers see blinking red as a hazard).
• Unplug your ears. Avoid using iPods or wearing headphones—you need to be able to hear approaching vehicles. If you do use headphones, do so with the volume low and just one earbud in.
• Watch the hills. When they crest hills, drivers' vision can suddenly be impaired by factors like sun glare or backdrops.
• Beware of high-risk drivers. Steer clear of potential problem areas like entrances to parking lots, bars, and restaurants, where there may be heavy traffic.
• Watch for early birds and night owls. At odd hours be extra careful. Early in the morning and very late at night, people may be overtired and not as attentive.
• Mind your manners. At a stop sign or light, wait for the driver to wave you through—then acknowledge with your own polite wave. That acknowledgement will make the driver feel more inclined to do it again for the next walker or runner. Use hand signals (as you would on a bicycle) to show which way you plan to turn.

Cyclists

• Stay on the right and obey traffic rules
• Wear a helmet
• Use hand signals when turning
• Wear visible clothing and have reflectors on your bike
• Carry a tire patch and first aid kit
• Maintain your bike
• Watch for pedestrians, parked cars, loose gravel and cracks and potholes.

Source: http://www.runnersworld.com

Visit your doctor regularly and listen to your body.     

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

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician.

For further inquires related to this topic email: drpmackarey@msn.com

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

November is also Native American Heritage Month!

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

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

GET THE HECK OUTSIDE!

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

Even before the pandemic, it was reported that Americans spend 90% of their lives indoors and that number increases with age. Worse yet, for some, venturing outdoors is considered risky behavior with fear of the sun, heat, ticks, wind, cold, mosquitoes and other creatures of God. Well, the truth of the matter is the risk of being one with nature is far less than the ill effects of a life stuck indoors. Please consider the following benefits of spending time outdoors.

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

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

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

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

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

Read “Health & Exercise Forum” – Every Monday.  

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

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

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.