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Have Fun and Get in Shape!

Happy Independence Day! 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 of Water Exercise:

Getting Started

  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: www.mackareyphysicaltherapy.com/forum

Research shows, those who prepare in advance for their physician visits, have more satisfaction than those who just show up for their appointment. Moreover, for patients seeing multiple physicians, such as specialists, often communication is poor and your participation in the process can be invaluable. There are things you can do to prepare for your physician visits:

  • 1. Make a Checklist:
    • Fill out a detailed checklist before the visit that includes health issues, concerns and questions. This is especially important if you are seeing more than one physician specialists since your last visit and have had a change in health or prescribed medication.
    • Example: when visiting your primary care physician for the first time in several months you notice that you have seen two specialists in between. First, you saw a cardiologist for high blood pressure and were put on a blood pressure medication and a blood thinner. Second, you went to an orthopedist for knee pain from osteoarthritis and were prescribed an anti-inflammatory drug for pain and inflammation. With proper preparation, such as keeping a hand-written or electronic file medical log or journal, sharing this information with your family physician may be critical. The anti-inflammatory drug may not be safe when taken with the blood thinner and if communication between three physicians did not take place, it is important for you to assist in the process.
    • List any changes in your body (weight loss), medications (daily aspirin prescribed by cardiac specialist) or daily function (unable to walk 1 block without shortness of breath) since your last visit.
  • 2. Insurance Information:
    • Don’t forget to bring your health insurance cards, both primary and secondary.
  • 3. Medication List:
    • List: type of medication, date prescribed, who prescribed it, and dosage. Be sure to include over-the-counter drugs such as aspirin, multivitamins and herbals.
  • 4. Pharmacy Information:
    • The name, address and phone number of your preferred pharmacy will be necessary if medications are prescribed.
  • 5. Symptom List:
    • Make a list of symptoms that you want to tell your physician. For example; weight loss, shortness of breath, weakness or loss of voice, or difficulty sleeping.
  • 6. Be Honest:
    • It is important that your physician has complete and accurate information. For example, if you are having anxiety and you are drinking alcohol regularly, it can have serious implications if an anti-anxiety medication is prescribed.
    • Don’t be embarrassed…chances are you are not the only one. For example, if you are using a drug prescribed by another physician for erectile dysfunction, it is important for to share this with your family physician as it may impact the use of other treatments or drugs and may be related to new symptoms or problems you are experiencing.
  • 7. Keep a Medical Journal:
    • A medical journal can be kept in a written log or electronic file. It should be chronological and include dates of medical visits, including specialists, tests, medications, vaccinations, etc. After each visit with a medical professional, enter the information before your forget the details. Also, include health insurance and supplemental insurance information.
  • 8. Bring a Family Member or Friend:
    •  A friend or family member can serve as your eyes and ears to remember to ask questions and follow orders that you might forget. They can help you take notes and organize papers and instructions.
    • If you do not speak English fluently, bring a family member, friend or interpreter to assist you. If you do not have an interpreter, you can usually prearrange for one in advance with your doctor’s office.
  • 9. Bring Your  Glasses and Hearing Aid:
    • If you require glasses and a hearing aid, be sure to wear them for your visit. It will help insure better communication with your doctor.
  •  10. Silence Your Cell Phone:
    • This simple courtesy will go a long way to improve the quality of the visit for you and others.

Remember, your health is too important to rely on memory for accuracy…so be a proactive participant. With technology, it has never been easier to keep a medical journal to improve accuracy and communication. There are several “Apps” such as “mymedicalapp.com” that allow you to do this on your phone, tablet or lap-top computer and offer privacy code features.

SOURCES: www.webmd.com; National Institutes of Health – National Institute on Aging “A Guide for Older People - Talking With Your Doctor”

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: http://www.mackareyphysicaltherapy.com/forum

Despite a recent surge in Covid cases from the new variant, more than 70 percent of Americans anticipate high levels of enthusiasm for travel this summer. Moreover, travel abroad in 2022 is expected to exceed pre-pandemic levels, as isolation weary Americans take to the air!

Confession; I recently was on a long trip that required sitting on an airplane for more than six hours…and I wore compression stockings … guess I’m getting older (and wiser)!

Have you noticed that being in a car or on an airplane for more than three hours leads to neck and back pain? Soreness, stiffness and swelling in your legs? With a little planning preventing or limiting these problems on long trips, is possible. Also, as people age and/or develop other health problems, they are more vulnerable to develop a more serious problem associated with long trips; deep vein thrombosis (DVT) or blood clots. But problems from long-distance travel can be avoided. The following tips, based research and personal experience, can prevent neck, back and leg pain and stiffness and DVT.

Deep Vein Thrombosis  (DVT)

A DVT is a blood clot that forms in a deep vein. The deep veins pass through the muscles and cannot be seen like the veins just under your skin. While it may occur in your arms, it is much more common in the legs, especially the calf muscle when traveling. When a blood clot forms in a leg vein it usually sticks to the vein wall. Often, pain and swelling lead you to the doctor and treatment is rendered before serious complications develop. However, there are two possible complications. One, a pulmonary embolus, occurs when a part of the clot logged in your deep vein of the calf breaks off and gets lodged in the lung. This is a very serious problem that can be fatal. Two, post-thrombotic syndrome, occurs when you have pain and swelling in the calf after a DVT.

Risk Factors for Travel Related DVT?

The following risk factors for DVT significantly increase the potential for problems when traveling on long trips by air more than 5 hours. Trains, cars and buses also create a risk, but air travel creates a greater risk for the following reasons: reduced cabin pressure, reduced cabin oxygen levels, dehydration and alcoholic drinks, which may increase dehydration and immobility.

health

Risk Factors For Travel Related Neck and Back Pain

Prevention of Travel Related DVT and Leg Pain/Stiffness

Prevention of Travel Related Neck and Back Pain

Airplane seats are “C” shaped and force you to round your neck and back forwards. These exercises are designed to stretch and extend your back in the opposite direction. Please perform slowly, hold for 3-5 seconds and repeat 10 times each hour.

Sitting

When sitting in an airplane seat, take the neck pillow in the overhead compartment and place it in the small of your lower back. While sitting or standing up, perform postural exercises every 30-45 minutes.

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.

Part I or II

May is National Bike Month! In fact, Saturday, May 7, 2022 Lackawanna Heritage Valley’s Heritage Explorer Bike Tour is returning in person for the first time since 2019. For those who have a bike, now might be a good time to dust it off and enjoy the many beautiful and well-maintained trails that are available at the Countryside Conservancy at Lackawanna State Park, other locations in the Abingtons or the Lackawanna Heritage Valley Authority. For those who don’t have a bike, it might be a good time to get one!

WHY BIKE?

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

BENEFITS OF BIKING:

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

INJURY MANAGEMENT:

Prevention is the best management of musculoskeletal problems associated with biking. First, many of the problems associated with biking such as knee pain, buttock soreness, and tendonitis can be prevented through proper fitting. Furthermore, it is important that your equipment be in good working order such as tires, chain, brakes and pedals. Next, be sure to maintain a fairly good 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 a 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

Health Benefits of Dancing

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

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

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

10 Benefits of Dancing

1. Improved Agility and Flexibility

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

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

2. Balance and Coordination

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

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

3. Cardiovascular Health

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

4. Muscle Tone and Strength

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

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

5. Weight Loss and Maintenance

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

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

6. Osteoporosis Prevention

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

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

7. Learning, Memory and Cognition

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

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

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

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

8. Emotional and Mental Health

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

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

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

9. Socialization

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

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

10. Boosts self-esteem

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

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

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

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine GCSOM.

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

Dance Like Nobody’s Watching!

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

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

Participants, none of whom had ever engaged in a dance class before, performed a structured dance program for 16 sessions over 8 weeks. Each class was 75 minutes long with seated warm-up activities 50% of the time.  Results showed: 10%improvement in overall movement, 26% improvement in walking and 18% improvement in tremor.

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

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

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

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

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

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

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

April is National Parkinson’s Awareness Month

Part I of II

Parkinson’s disease (PD) is a chronic, degenerative disease that leads to slowness of movement, balance disorders, tremors, and difficulty walking. PD results from the loss of dopamine-producing nerve cells in the brain. Dopamine is critical to stimulate the nerves of the muscular system in the body. PD affects approximately 1.5 million people in the USA with 60,000 new cases each year according to the National Parkinson Foundation. Most people know someone affected by PD.  PD typically affects those over 65 years of age and only 15% are under 50. However, actor, Michael J. Fox brought national attention to the disease in 1991 when he was only 30 years old. Juvenile Parkinson’s, those diagnosed under the age of 40, is rare and only represents 7% of all those with PD.

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

Depending on the stage of the disease and the level of assistance required, exercise to improve strength, balance, flexibility and ambulation for those with PD, can be performed independently at home or supervised at a rehab or fitness facility. Supervised exercise can include physical therapy, recreational therapy, water therapy, yoga, and Tai Chi… AND DANCE! Physical therapy can improve walking ability, enhance balance, reduce fatigue, increase strength, promote flexibility and minimize pain. Physical therapy uses movement techniques and strategies as well as various pieces of equipment to enhance an individual’s level of independence and improve his quality of life. Recreational therapy incorporates leisure activities (e.g. golfing and ballroom dancing) to reduce the symptoms and associated limitations of PD. Recreational therapy adapts these activities to meet the specific needs of the person with PD. The modified activities are taught by professionals who have significant knowledge and experience in this area. Water therapy is especially helpful to people with PD because the water provides enough buoyancy to lessen the amount of balance required to perform essential exercises. The cushioning effect of the water allows for freedom of movement while providing the appropriate level of resistance necessary to achieve the desired results. Using a combination of physical and mental exercises, yoga promotes flexibility, reduces stress levels, and increases stamina and strength in individuals with PD. Tai Chi, a total mind and body workout, and is a series of individual dance-like movements linked together in a continuous flowing sequence. Particular benefits for people with PD include reduced stress, increased energy, improved concentration and focus, better circulation and muscle tone, and significant improvements in balance.

If you choose the convenience of a home exercise program, consult your physician or physical therapist for recommendations regarding: (1) the types of exercise best suited for you and those which you should avoid, (2) the intensity of the workout, (3) the duration of your workout, and (4) any physical limitations you may have.

The type of exercise that works best for you depends on your symptoms, fitness level, and overall health.  Your exercise program should address not only strength but also flexibility and endurance and should include all body parts: face, mouth, neck, torso, arms, legs, hands, and feet. Some general exercise suggestions include:

Since individuals with PD are at risk for falling and freezing (becoming rigid), work out in a safe environment and, if possible, when someone is present. Avoid slippery floors, poor lighting, throw rugs, and other potential dangers (e.g., watch out for the pooch because he might want to join in the fun).  If you have difficulty balancing, exercise sitting down, lying on the bed or within reach of a grab bar or securely installed rail. Stop and rest if you feel tired during your exercise program since overexertion can make your PD symptoms worse.

Contributions: Janet Caputo, DPT, OCS,

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II of II: Dance for Parkinson ’s Disease.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

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

Exercise is Important in Prevention

In 2000, President Bill Clinton dedicated March as National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness of the facts about colon cancer – a cancer that is preventable, treatable and has a high survival rate. Regular screening tests, expert medical care and a healthy lifestyle, which includes a proper diet and exercise, are essential for prevention. Several studies have demonstrated that exercise can also help prevent colon cancer. 

The American Cancer Society estimates that there will be approximately 150,000 new cases of colorectal cancer in 2021. Of these, 52,980 men and women will succumb to the disease. It is the second-leading cause of U.S. cancer deaths for both men and women combined. The good news is incidence and mortality rates are dropping both nationally as well as in northeast Pennsylvania. The bad news is northeast Pennsylvania still has increased incidence and mortality rates when compared to the national average.

Studies show that prevention of this disease is multifaceted and includes: engaging in daily exercise, eating a low-fat diet with little red meat, avoiding smoking, drinking in moderation and having regular colonoscopy screenings.

Early detection is the key to survival. Death from colorectal cancer can be eliminated if caught at the earliest signs of disease. Colorectal cancer progresses very slowly, usually over years. It often begins as non-cancerous polyps in the lining of the colon. In some cases, these polyps can grow and become cancerous, often without any symptoms. Some symptoms that may develop are: blood in stool, changes in bowel movement, feeling bloated, unexplained weight loss, feeling tired easily, abdominal pain or cramps, and vomiting. Contact your physician if you have any of these symptoms.

The risk of colon cancer increases with age, as 90 percent of those diagnosed are older than age 50. A family history of colon cancer increases risk. Also, those with benign polyps, inflammatory bowel disease, ulcerative colitis or Crohn’s disease are at greater risk and should be screened more frequently.

Prevention of Colon Cancer:

How Exercise Prevents Colon Cancer:

The intestine works like a sewage plant, recycling the food and liquid needed by your body. However, it also stores waste prior to disposal. The longer the wastes remain idle in your colon or rectum, the more time toxins have to be absorbed from you waste into the surrounding tissues. One method in which exercise may help prevent colon cancer is to get your body moving, including your intestines. Exercise stimulates muscular contraction called peristalsis to promote movement of waste through your colon.

Exercise to prevent colon cancer does not have to be extreme. A simple increase in daily activity for 15 minutes, two times per day or 30 minutes, once per day is adequate to improve the movement of waste through your colon. This can be simply accomplished by walking, swimming, biking or playing golf, tennis or basketball. For those interested in a more traditional exercise regimen, perform aerobic exercise for 30-45 minutes four to five days per week, with additional sports and activities for the remainder of the time. For those in poor physical condition, begin slowly. Start walking for five to 10 minutes, two to three times per day. Then, add one to two minutes each week until you attain a 30-45 minute goal. 

Medical Contributor: Christopher A. Peters, M.D

Dr. Christopher Peters is a partner of Radiation Medicine Associates of Scranton (RAMAS) and serves as medical director of Northeast Radiation Oncology Centers (NROC). He is an associate professor of clinical medicine at GCSOM.

Sources: American Cancer Society/Northeast Regional Cancer Institute, and CA Cancer J Clin.

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

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

Part II of II

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

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

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

FLEXIBILITY EXERCISES

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

Examples of Flexibility Exercises for the Upper Body in Sitting

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

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

BALANCE EXERCISES

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

Examples of Balance Exercises

ENDURANCE EXERCISES

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

Examples of Endurance Exercises

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

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

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

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

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

The number one resolution each year is to lose weight. The internet is flooded with endless recommendations for diet and exercise. While not guaranteed, the recommendations below are safe, simple and easily implemented. And, it is a good way to start your day…give it a try!

  1. Weight Yourself – Step on the scale first thing in the morning for a more accurate reading. After a day of eating and drinking different amounts and types of foods with various activity and exercise levels, will alter the numbers. Inconsistencies can be frustrated.
  2. Hydrate – Drinking 1 – 2 glasses of water before breakfast can aid your cause. Water is calorie free and fills you up. It may also stimulate your metabolism to burn more calories.
  3. Work Out Early – A moderate duration and intensity of exercise before you eat breakfast can yield better results. Some studies show that fasting workouts rely less on food to burn for energy and more on body fat stores. Also, you are less likely to miss a workout due to other commitments if you do it first thing in the morning.
  4. High Protein for Breakfast – Protein will make you feel fuller. So enjoy a Greek yogurt smoothie with fruit and peanut butter or eggs and turkey sausage with whole wheat toast. Moreover, your body will use energy (calories) to breakdown the protein and less likely to store it as fat. Unfortunately, a delicious stack of pancakes will do the opposite…stored as fat.
  5. Plan for the Day – by making a meal plan for the day, you can choose to eat less calories and healthy foods. Once the day gets away from you and you’re too hungry to prepare healthy options, it is easy to grab a convenient but unhealthy and high calorie fast food. Pack grapes and apples for snacks at work or school and have dinner prepared the night or weekend before.
  6. Spend Time Outdoors – being outdoors is not only healthy for your mental wellbeing, but also your physical health (vitamin D etc). Some studies suggest that people who spend time in the morning sun tend to have a lower BMI, even compared to those who soak up the afternoon sun!
  7. Measure it! – Using a measure cup or spoon will allow for more accurate portion control. A half filled bowl of cereal in the morning, may actually be 1-2 cups.
  8. Be Mindful – Think before you put food in your mouth. Instead of eating while reading the paper or watching the morning news, eat slowly, chew thoroughly, and taste your food. In between bites, take deep breaths and relax because this ritual can help you eat less and lose weight.
  9. Use Small Plates and Glasses – Smaller dinnerware will give the appearance of having a full plate with small portions. Also, standard drinking glasses are very large and when filled with orange juice it is very high in calories, so use a small juice glass.
  10. Don’t Make Your Coffee a Dessert – Specialty coffees with excessive sugar, cream, and flavored syrups can add more than 500 calories to your diet, which is 1/4 the entire daily caloric recommendation for women (2000 for women and 2500 for men). Use skim milk and sugar-free flavors or try green tea.
  11. Healthy Snacks – prepare and pack healthy snacks for work or travel. Fruit, veggies, low-fat cheese, and fiber rich crackers are some examples. Beware of granola bars high in sugar and calories pretending to be healthy!
  12. Limit Time Spent Sitting – Studies show a strong correlation with time spent sitting (commuting to work) and weight gain. Consider using a travel app to shorten commute times and park further from work to encourage walking.
  13. Make a List – Those who make a shopping list buy less junk food. So, make a list that includes healthy choices for dinner and snacks and stick to it!
  14. Hot Sauce – A recent study suggested that hot and spicy condiments on your foods may help with weight loss. Capsaicinoids, the hot chemical in chili peppers, can reduce body fat, suppress appetite and boost metabolism. So, spice up your breakfast with chili peppers and hot sauce on your omelet.
  15. Sleep it Off – getting adequate sleep and controlling excessive stress can have a positive impact on weight control. Those not getting enough sleep tend to be hungry, eat more and exercise less.

Source: WebMD, Mayo Clinic

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

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

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

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