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Pisa Syndrome and Parkinson’s Disease

Colleen Bridges/26 April 2024/ All MFN blog/

If you work with people living with Parkinson’s disease then you’ve learned that every PD “fighter” experiences their own unique combinations of symptoms. Someone might have a tremor, hypophonia, and cognitive issues, while another struggles with rigidity, balance, vestibular issues and Pisa Syndrome. Wait. What is Pisa Syndrome?

Pisa Syndrome, also known as Pleurothotonus, affects the spine and is defined as a lateral bending of the trunk with a tendency to lean to one side. Pisa causes changes in the spine such as narrowing of the central spinal canal through which the spinal cord travels leading to stenosis, poor posture and instability.

It is common for Pisa and Scoliosis to be considered the same problem. However, they are not. A person living with Pisa will “list” to one side, while a person living with Scoliosis will have an S or C curvature to their spine and rotation but not necessarily a lateral bend.

This image has an empty alt attribute; its file name is PISA1.png — PISA SYNDROME

What Causes Pisa Syndrome?

It is likely that Pisa is multifactorial, meaning many factors may influence the development of and severity of Pisa Syndrome. We think there is a central (brain and spinal cord) component to Pisa Syndrome involving basal ganglia dysfunction (dystonia and rigidity), abnormal sensory integration, and/or cognitive dysfunctions affecting perception and postural control. Additionally, there is dysfunction with the Peripheral mechanisms consisting of alterations of the musculoskeletal system (myopathy, soft tissue changes).

There is some conjecture that due to medication changes or the increase of the dose of dopaminergic medications, the likelihood of Pisa onset becomes higher. Do not make medication changes without discussing with your care team. Other scientists think that as basal ganglia dysfunction increases, so do the chances of Pisa (Tinazzi et al., 2019; Artusi et al., 2019).

Is Pisa Syndrome Neurological AND Bone-related?

Yes! Because Pisa is associated with basal ganglia and sensorimotor dysfunction, there is a high likelihood of the onset of Pisa with various movement disorders, such as idiopathic Parkinson’s (80% of the Parkinson’s population) and atypical Parkinson’s syndromes (20% of the Parkinson’s population), such as Multiple Systems Atrophy, dementia with Lewy Bodies, Progressive Supranuclear Palsy (Castrioto et al, 2014; Barone et al., 2016).

Although Pisa syndrome is usually classified as a neuromuscular disorder, the spine is greatly affected due to favoring one side, leading to postural abnormalities. This can affect not only muscular health and movement, but also bone health. Bad posture, overcompensation for balance to one side, issues such as falling, and increased risk for osteoporosis may be more likely to occur in those individuals with Pisa, resulting in the likelihood of bone fractures and overall decreased bone health (Barone et al., 2016).

Medication Awareness

Moving on, let’s investigate how medication may affect Pisa Syndrome. Although there are studies correlating the use of dopaminergic drugs, there is no longitudinal or concrete evidence stating that medication causes Pisa syndrome (Castrioto et al., 2014; Barone et al., 2016; Tinazzi et al., 2016). However, it is known that incorrect dosages, either too high OR too low, can affect the onset of this disorder (Castrioto et al., 2014; Tinazzi et al., 2016). Therefore, it is imperative that providers assess the correct dosage, and that medication is taken consistently to lessen chances of this syndrome.

Some medications that may contribute to the onset of Pisa syndrome include dopaminergic medications such as carbidopa-levodopa (Sinemet or generic), dopamine agonists such as ropinirole, or anticholinesterases such as donepezil. This may sound scary, but it is important to note that Pisa can be treated by adjusting PD medications, so make sure to advise fighters to check in with their doctor if they are experiencing Pisa symptoms.

The Effect of Pisa Syndrome On Parkinson’s Disease

Now that we’ve looked at Pisa from a scientific perspective, let’s address how Pisa Syndrome affects activities of daily living and Parkinson’s Disease.

As mentioned earlier, Pisa Syndrome essentially causes changes in the spine which leads to poor posture and instability and causes the following:

The head may droop.
The neck moves forward rather than remaining in alignment with the spine.
The shoulders round causing a forward slump that affects the amount of space for your internal organs.
Breathing becomes shallow and/or more labored.
Movement through the hips and spine decreases which affects gait length and increases risk of falls.

The above postural changes can impact one in the following ways:

Neck/Jaw pain and headaches due to muscle tightness
Loss of sleep
Digestion disruption due to organs being compressed
Depression
Poor circulation
Constricted nerves
Foot pain due to misalignment
High blood pressure

Sensory Components of Pisa

Here we see how the three balance systems are impaired:

Vision: Impaired perception of vertical (vertical can deviate either towards or away from the side the body tilts).
Proprioceptive: Unbalanced proprioceptive feedback (body awareness in relation to space and time).
Vestibular: Unilateral or possible bilateral vestibular hypofunction.

Treatment for Pisa Syndrome

Let’s consider some of the activities a person does during the day-to-day – walking, bathing, dressing, cleaning, laundry, caring for children/spouse/pets, cooking, driving, social events.

We don’t have any concrete data on if/how Pisa affects Parkinson’s severity, but we can see from the above how it may affect Parkinson’s symptoms. So, how can we treat Pisa? Let’s have a look.

1. Medication – Advise fighters/care partners to speak to their physician. Encourage them to review their medications with their physician to see if changes in dosage or type of drug may be initiating or aggravating the syndrome.

2. Reducing Fall Risk – Pisa Syndrome can increase the risk of falls secondary to a lateral trunk lean which results in a change in the center of gravity and inadequate trunk control. As such, one should seek a comprehensive evaluation aimed at eliminating risk factors for falls, improving postural awareness, strength/mobility training, and/or offering effective preventive measures to reduce fall risk. This can be performed by a multidisciplinary team consisting of a physician, personal trainer, and physical therapist.

Additionally, and importantly, a major goal of physical therapy is improving midline awareness and making sure that their curvature does not worsen.

3. Exercise – Addressing your fighters core through exercises that involve vertical and lateral challenges provide the most benefit. While we cannot change the shape of the spine, we can strengthen the muscles that support the core!

Rows
T’s
Front Lateral Pulldown
Shrugs (standing upright)
Modified Cobra (hands on the kitchen counter or ballet barre to protect those
with Osteoporosis and Osteopenia)
Tube rotation exercises
Isometric tube exercises
Stretching to maintain spinal mobility
Trunk alignment and midline orientation exercises
Physical Therapist to assess for somatosensory integration deficits which
- Vision
- Vestibular
- Proprioceptive

*Below, you’ll find a video demonstration to learn how to properly perform these exercises. Bridges For Parkinson’s includes these exercises in the warm-up and strength portion of our routines each week.

Note: Some may need individualized physical therapy to provide postural exercises, reduce lumbar pain, and provide preventative exercises.

In closing, Pisa Syndrome is unique in that it develops over time in conjunction with a movement disorder. The strength of a person’s physical structure depends on having the knowledge to identify possible bone issues such as Pisa Syndrome, properly addressing the issue with corrective exercises and a team that provides support and encouragement.

Bridges For Parkinson’s is focused on helping Parkinson’s fighters, care partners and fitness professionals develop a sense of awareness and provide corrective exercise therapy for those dealing with Pisa Syndrome along with preventative exercises to support a strong, vertical spine!

Parkinson’s Disease is a journey and Bridges For Parkinson’s – Rock Steady Boxing Music City and Franklin wants to support you and your Parkinson’s “fighters” on the journey. As a MedFit author and Parkinson’s Fitness Professional, I am here to help.

Together, we fight back stronger!

Fit Pros: You Can Improve the Lives of Those Living with Parkinson’s

Enroll in Colleen’s 12-hour online course, Parkinson’s Disease Fitness Specialist. The course brings the research, medical and fitness fields together so that fitness professionals gain a comprehensive understanding of Parkinson’s disease, and learn how to work with those who have it.

Written by

Colleen Bridges, M. Ed., NSCA-CPT, Parkinson’s Disease Fitness Specialist, Founder of Bridges For Parkinson’s
Renee Rouleau- PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo
Betsy Lerner, MA English & African American Lit., ISSA-CPT, Parkinson’s Disease Specialist and Rock Steady Boxing Certified
Megan Kelly, PT, DPT, LSVT Big and Parkinson’s Wellness Recovery Certified
Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified

References

Huh, Y. E., Kim, K., Chung, W.-H., Youn, J., Kim, S., & Cho, J. W. (2018). Pisa syndrome in parkinson’s disease: Pathogenic roles of verticality perception deficits. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-20129-2
Huh, Y. E., Seo, D.-W., Kim, K., Chung, W.-H., Kim, S., & Cho, J. W. (2022). Factors contributing to the severity and laterality of Pisa syndrome in parkinson’s disease. Frontiers in Aging Neuroscience, 13. https://doi.org/10.3389/fnagi.2021.716990
Di Lazzaro, G., Schirinzi, T., Giambrone, M. P., Di Mauro, R., Palmieri, M. G., Rocchi, C., Tinazzi, M., Mercuri, N. B., Di Girolamo, S., & Pisani, A. (2018). Pisa syndrome in parkinson’s disease: Evidence for bilateral vestibulospinal dysfunction. Parkinson’s Disease, 2018, 1–6. https://doi.org/10.1155/2018/8673486
Artusi CA, Montanaro E, Tuttobene S, Romagnolo A, Zibetti M and Lopiano L (2019) Pisa Syndrome in Parkinson’s Disease Is Associated With Specific Cognitive Alterations. Front. Neurol. 10:577. doi: 10.3389/fneur.2019.00577
Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson’s disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol. 2016 Sep;15(10):1063-74. doi: 10.1016/S1474-4422(16)30173-9. Epub 2016 Aug 8. PMID: 27571158
Castrioto, A., Piscicelli, C., Pérennou, D., Krack, P. and Debû, B. (2014), The pathogenesis of Pisa syndrome in Parkinson’s disease. Mov Disord., 29: 1100-1107. https://doi.org/10.1002/mds.25925
Huh YE, Seo D-W, Kim K, Chung W-H, Kim S and Cho JW (2022) Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease. Front. Aging Neurosci. 13:716990. doi: 10.3389/fnagi.2021.716990
Tinazzi, M., Geroin, C., Gandolfi, M., Smania, N., Tamburin, S., Morgante, F. and Fasano, A. (2016), Pisa syndrome in Parkinson’s disease: An integrated approach from pathophysiology to management. Mov Disord., 31: 1785-1795. https://doi.org/10.1002/mds.26829
Tinazzi, M., Gandolfi, M., Ceravolo, R., Capecci, M., Andrenelli, E., Ceravolo, M.G., Bonanni, L., Onofrj, M., Vitale, M., Catalan, M., Polverino, P., Bertolotti, C., Mazzucchi, S., Giannoni, S., Smania, N., Tamburin, S., Vacca, L., Stocchi, F., Radicati, F.G., Artusi, C.A., Zibetti, M., Lopiano, L., Fasano, A. and Geroin, C. (2019), Postural Abnormalities in Parkinson’s Disease: An Epidemiological and Clinical Multicenter Study. Mov Disord Clin Pract, 6: 576-585. https://doi.org/10.1002/mdc3.12810

GETTING TO “YES!”: Marketing Strategies to Help People Invest in Their Health

Nicole Gebhardt/17 April 2024/ All MFN blog/

Bill walked into my client’s fitness studio clutching two things: a book and a small piece of paper.

With a sheepish look, he revealed, “My doctor gave me your book and this script to contact you. That was almost a year ago, and I haven’t gotten it done. Until now.”

After discussing his fitness goals and health concerns, Bill pulled out a pen and inked a check for a full year of private training.

It took months to get him in the door … and just 15 minutes to close the sale.

What happened?

The Long Game

Good marketing is about helping people invest in something they’ll be glad they did. If you are selling a $40 product, the sale is relatively easy. But when you’re offering a lifestyle change, complex emotions are involved.

Bill delayed, but when he was ready, he knew exactly where to go and what to do. My client understood marketing for the long game.

Since our ideal prospects often encounter our message before they’re ready to buy, marketing for the long game focuses on two key strategies:

Helping prospects make a decision sooner.
Ensuring they choose you.

Inspire: Lead with Story

One of the most powerful devices in your marketing toolkit should be storytelling.

Specifically, storytelling that creates the emotions you want your prospects to feel and associate with your offer: joy, hope, urgency, victory, etc.

It’s these emotions that drive our powerful unconscious mind to make conscious decisions that make us feel good.

What goes into a good inspiring story?

My two favorite books on this topic are Michael Hauge’s Storytelling Made Easy and Donald Miller’s Building a StoryBrand.

The most critical elements shared in these books come down to four key points:

Show your character is a normal person.
Share the crisis that changed their thinking.
Describe their journey with you as their guide.
Show the reward of their victory.

Even a short 5-sentence testimonial can cover all four of these elements and drive your prospects’ desire to get started.

The more you share stories, the more you can inspire your audience with emotions they will associate with your brand for the long-term.

Encourage: Build Their Confidence

As a publisher, I encounter a lot of business authors who are anxious to write a 200-page book filled with overwhelming details.

Features and facts great for a small portion of the population, but the vast majority of buyers get overwhelmed by analysis paralysis and walk away “to think about it for a little longer”.

Good marketing is educating your prospect to the point they’ve got the confidence to begin your process… but not so much that they gain a false confidence they should be able to do a version of it on their own.

If you truly believe your services offer value they can’t achieve without you, then make sure your marketing doesn’t imply they should try.

Build their confidence in the benefits of your proven process, not the details or the data.

Equip: Help Them Start Simple

Overwhelmed people don’t buy, and confused people don’t start so if you want to make getting started easier, make it simple.

My team and I have been doing this for years within the fitness industry, using 100-page books explicitly designed to convert prospects into clients.

The books are lead magnets, turning the authors into fitness authorities and local celebrities.

They educate without overwhelming; giving readers an idea of who they’ll meet at the studio, what to wear, what to take with them, what to eat (or not eat), and what to expect in their workout sessions (and why). Vital details that can close a sale faster.

Now, think about your company.

Remove the fear-of-the-unknown obstacle by showing potential customers exactly what to expect in their first few visits.

If you’re marketing online, demonstrate – screen by screen – the buying and login process before they click the “buy now” button.

When you clarify exactly what to expect and what to do first, you make the process easier.

And that matters.

Take the Lead

When you understand that marketing is a long game, it transforms your marketing strategy.

Spend time developing assets that stand the test of time; particularly those you can build once and reuse over and over.

An inspirational talk (or webinar), a compelling book, and a thoughtful email onboarding campaign are all reusable assets that give you time to inspire, encourage, and equip people to say yes to life-changing decisions.

Nicole Gebhardt loves marketing, books, and key lime pie. She is the CEO of Niche Pressworks, a consulting and publishing services company for experts, speakers, coaches, consultants, and business leaders. Learn more about her 3-book strategies inside “The Ultimate Book Plan” at NichePressworks.com

Healthy-Lifestyle-Nutrition-Exercise-Medicine

Save the Date: May is Global Employee Health and Fitness Month

Diane H. Hart/2 April 2024/ All MFN blog/

Start thinking about how your company can participate on Global Employee Health & Fitness Month!
Throughout the month of MAY, employers will challenge their employees to participate in health and
fitness activities.

Gait and Alignment

Kama Linden/28 March 2024/ All MFN blog/

Many times when I run in Central Park, I see some elite runners. They look like gazelles. However, sometimes, I will see runners who have knees turned in, toes turned the opposite way, or simply just POUNDING on their feet.

When I teach Yoga, or even strength training, I advocate aligning the hip bone (asis joint) with the knee, and the 2nd toe.

i.e., Squats.

Often trainers will tell students to “bring their feet hip width apart” and perhaps, having read too many magazines with models who are super thin, they bring their feet so wide that they are BEYOND the alignment they could possible sit in or walk in. Imagine the MANSPREAD on the subway. Over time, if clients keep doing “squats” with their feet so beyond the width of their hips, it puts undo strain on the ACL, ankles, and causes many muscle imbalances.

In a squat, the goal is NOT to “go lower”.

A member once wrote a nasty comment via the gym website that “I didn’t go low enough” in my squat. What is “low enough”? If you are compromising form, or bending your back over more to make up for the fact that knees can only bend so much, then this is counterproductive.

When squatting, you should “crease” the hip joint (hip flexors) and imagine a chair being pulled out for you. Reach for the chair with your butt while bending your knees. The chest may tilt slightly forward, but the movement is NOT initiated by bending the upper body into forward flexion. Imagine if you were wearing all white, dry clean only clothing, and were carrying a tray of martinis (or red sauce). You would have a mess if you bent forward with your upper body. Therefore, keep your chest high, hold the platter high, and only angle forward as needed. This way all the work goes into the quads and glutes, and not into the back.

Another drill I like to teach is a step-to 1 leg squat. Take a step to your right, balance on the right leg, and perform 1-3 squats. Then repeat by stepping left. To advance this, take a little hop, and then do 1-3 1 legged squats.

1 leg step ups (pictured above): place 1 foot on a bench laterally. The step should have 2 risers on each side if you are between 5’ and 5’4, and maybe 3 risers if you are above 5’6, and 4 risers if above 6’ tall. Press the weight into the foot that is on the bench and full stand up on this 1 leg. Then sit back down into the squat stance with both knees bent (one will be on the floor).

1 leg dead lifts (pictured above): based on warrior 3: 1 leg is very straight without locking. Like a seesaw, pitch forward by lifting the free leg as high as it can go, but do not round the back, or drop the chest. I also look forward and keep my chest slightly lifted. Recover to upright by raising the gaze. Repeat 4-8 reps per leg.

Sit, stand, raise lower…this is a combination 1 leg squat into 1 leg deadlift (warrior 3). Repeat 4-8 reps.

Practicing 1 legged drills will make it so that when you perform drills such as squats on 2 legs, you will remember that if you were to take 1 leg off the ground, your stance/width should be based on this idea.

This will give you better form for running, and even walking.

The hip, knee, and 2nd toe should always REMAIN FRIENDS in every exercise for better alignment, and pain-free workouts.

Kama Linden has been teaching fitness for over 2 decades. She has taught strength, step, pilates, vinyasa yoga, senior fitness, and has worked with clients and students of all ages and fitness levels. She is certified by AFAA Group Exercise and NASM CPT, as well as 200 hour Yoga. She has a BFA in Dance from University of the ARTS. Her new book, “Healthy Things You Can Do In Front of the TV” is now on sale on amazon.com, BN.com, and Kindle. Visit Kama’s website, bodyfriendlyoga.com, and kamalinden.com.

Seniors with trainer in gym at sport lifting barbell

4 Tips to Help Your Clients Reduce Their Risk of Falls

Christian Thompson, PhD/26 March 2024/ All MFN blog/

No matter how fit and healthy your older clients are, there is one thing that can change their lives forever: a bad fall. Every year, almost 1/3 of older adults fall and many cause injuries that will affect them the rest of their lives.

As a fitness professional, you need to be well-prepared to deliver the most effective fall prevention exercise programming to your clients. You can find excellent guidance on assessment and program design at www.mobilitymatters.fit. But you also should be providing advice to your clients on how to reduce their fall risk in other ways.

Have them do these and keep them on their feet!

1. Many falls happen outside where there are lots of potential hazards. Advise your clients to avoid walking on loose gravel, metallic/painted surfaces and cracked sidewalks and avoid being outdoors in bad weather (e.g., rain, sleet, snow). Appointments can always be rescheduled, but a trip to the ER should never be the reason!

2. Indoors, advise your clients to make sure that their path from the bedroom to the bathroom is free from obstructions (e.g., pet toys, rumpled rugs) prior to going to bed at night – that way a trip to the bathroom will not include a trip and a fall!

3. Advise your older female clients to never wear high heeled shoes outdoors. Put their heels in a canvas tote bag and walk outside in sneakers or flats instead. Nobody looks good falling, no matter how stylish the shoes!

4. In the bathroom, advise your older clients to line the floor of their shower/tub with textured adhesive strips. These are less likely to cause a slip or a trip than a rubber bath mat that might slip or bunch up. They also give a nice pedicure!

Christian Thompson, PhD is an Associate Professor in the Department of Kinesiology at the University of San Francisco and founder of Mobility Matters, an exercise assessment and program design platform designed to help fitness professionals and clinicians work with older adults. Christian has published scientific articles on exercise programming for older adults in peer-reviewed journals such as Medicine and Science in Sports and Exercise, Journal of Aging and Physical Activity, and Journal of Applied Research.

Specialized Education for Fit Pros

Break It Down – KISS Principle (Keep it Simple for Seniors)

Holly Benson, BS/21 March 2024/ All MFN blog/

Teaching proper and biomechanically safe movement patterns takes a keen understanding of each pattern. What muscles and joints are involved? What skills are required for good execution? What deficiencies does the client have based on your preliminary movement assessments? Begin with the simplest version of each fundamental movement pattern and build on the complexity and intensity slowly.

Adjust accordingly, and encourage the client to give honest and precise feedback as they are learning. Find out if there is discomfort physically and/or psychologically. Adjust again. You want your client to feel successful and excited about their accomplishments during the exercise session and overall. They need to feel confidence in their ability to learn and improve, and enjoy the learning experience while they get stronger and more functional. Learning to exercise properly and safely is hard work for our clients. We must progress them gradually and with well thought out, logical, and achievable progressions. Knowing when they need to rest and reset is essential to building trust with the client, and creating a positive learning experience for them.

Fatigue and the Body/Brain Duo

It is critical that researchers consider the brain as well as the body when examining fatigue development and its impact on the body. By looking at brain and muscle function simultaneously, they will see that when participating in highly cognitive tasks, brain resources are divided which may speed up the development of physical fatigue. Processing and executing detailed and complex exercise instructions can accelerate the onset of body fatigue.

A study conducted by Ranjana Mehta, PhD., assistant professor at the Texas A&M Health and Science Center School of Public Health, evaluated the interaction between physical and mental fatigue and brain behavior. The study showed that when we attempt mental tasks and physical tasks at the same time, we activate the prefrontal cortex of our brain. This can cause our bodies to become fatigued much sooner than if we were only participating in a physical task. (Study published online as: Human Factors: The Journal of the Human Factors and Ergonomics Society This study was co-authored by Raja Parasuraman, Ph.D., professor of psychology at George Mason University in Virginia)

When we are working with geriatric clients, and one of our objectives is educating them, we must be cognizant that the lesson material must be “dosed-out” in absorbable amounts. Keeping the instructions simple and concise for maximum understandability is advised. When combining actual physical movement with the processing and following the instructional cues, the client is working extra hard and fatigue can set in sooner than you had planned. You may notice them starting to lose attentiveness or move slower. They may abruptly stop what you have them doing. They may look a bit frustrated or flustered. They have detached from the workout experience. The brain is full. The body feels tired. They need a break.

Taking pause to re-assess and re-set allows time for the client to recover mentally and physically. It is also a good time for the trainer and client to decide how to adjust and move forward in the session. Switching to less physically demanding, easy-to-do exercises feels like a relief to the client. They experience ease and a sense of control as their body and mind restore.

You can resume the previous exercise if the client wants to. If they are done with that hard thing, they are done. Save it for the next session to practice or learn again, and celebrate the effort and attention that the client gave the exercise that day. Educate them on the facts surrounding fatigue levels after learning and practicing complex physical movement. Tell them the cognitive benefits of combining cognition with physical effort!

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult. She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.

Stop Stress Eating with These 3 Simple Steps

Deborah Kesten, MPH/19 March 2024/ All MFN blog/

Do you often eat as a reaction to stress, anxiety, and other unwelcome feelings? Do you turn to high-fat, sugary “comfort foods” to cope with negative emotions? Discover why you stress eat in the first place, why it works, and some simple steps for doing some damage control.

Some say it’s “stress eating.” Others call it “self-medicating.” Psychologists describe it as “emotional eating.” Whatever words are used, if you often (over)eat to self-soothe negative feelings such as boredom, stress, anxiety, or anger—in other words, for reasons other than hunger and having a healthy appetite—it’s likely you’re a stress eater. Not only does stress eating increase your odds of overeating, my own original research on overeating reveals that Emotional Eating is the #1 predictor of overeating and becoming overweight or obese.^1,2

Here’s what stress eating might look like:

For Ann, stress-related overeating episodes often start after work, especially when she’s on deadline with a large project. First, she visits her local supermarket to buy a bag of potato chips, a pint of her favorite ice cream, and a bar of creamy dark chocolate. Then she heads home, changes into comfortable clothes, and turns on the TV. Settling into bed surrounded by her favorite comfort foods—and sometimes, a glass of red wine—Ann begins what she describes as “zoning out”—eating until she feels calmer—often to the point of falling in and out of sleep well before bedtime.

All the while, Ann remains vaguely anxious and distressed about her workload, and dependent on food to manage her darker moods. And she’s concerned her stress eating is keeping her overweight. At the same time, on a not-quite-conscious level, she senses the chips and chocolate allay her anxiety in some way. And she’s right: High-sugar, high-fat, high-carb food (products) do indeed relieve emotional tension. Here’s why.

The Food-Mood Connection

The idea that the food you eat can actually medicate your mood and vice versa—that your mood may motivate you to make certain food choices—was given the scientific stamp of approval in the 1970s when Judith Wurtman, PhD, a scientist at the Massachusetts Institute of Technology, uncovered a fascinating facet of the emotional eating enigma. Call it nutritional neuroscience, psychoneuroimmunology, or the study of food and mood, Wurtman launched a new field of nutrition research that has confirmed what many of us know intuitively: what you eat affects your mind and mood, your tendency to pile on pounds, even the quality of your life.

What Wurtman discovered is this: About twenty minutes after you eat a carbohydrate-rich food (such as bread, potatoes, cookies, or cake), your brain releases a naturally occurring substance called serotonin; in turn, you feel more relaxed and calm. Want to feel more perky? Consume a lean, high-protein food such as fish, and the substance that’s released (norepinephrine) lets you feel more awake and energetic (unlike the kick you get from caffeine, you’re not stimulated, just more alert). And certain fats in food end up as endorphins—substances in the brain that produce pleasurable feelings.³ More recent research, specifically on stress eating, reveals that women under stress experience strong sugar cravings that lead to overeating high-carb, high-sugar foods.⁴

The Food-Mood Syndrome: It Can Be a Vicious Cycle

Here is where the food-mood link really gets interesting. Since Wurtman’s discovery about the food-mood connection, we also know that the sugary, sweet, or crunchy and fried processed food products that emotional eaters most often choose to get a serotonin high actually contribute to deficiencies in certain vitamins and minerals that can cause your emotions to plummet, leading to a serious case of the doldrums.

In this way, the food-mood syndrome can become a vicious emotional cycle. You’re feeling down, so you reach for, say, a prepackaged brownie. Sure, the brownie’s sugar and white-flour carb content will soothe and calm you, but its high sugar content has a hidden side effect: it actually depletes some nutrients that could help combat depression. In other words, the sweet concoction may somehow soothe your soul, but isn’t it ironic that at the same time, it may also contribute to anxiety, depression, and other unpleasant emotions?

3 Smart Steps to Stop Stress Eating

Want to get the mood-calming, feel-good benefits of serotonin without the vitamin and mood-robbing downside inherent in high-sugar, highly processed foods? Here are three smart, simple, proactive steps you can take to curtail stress-related overeating episodes—without the downside.

Be “B” wise. From dreary doldrums to a deeper depression, various B vitamins—including B1, B2, niacin, folate, and B12—can help you bust the blues. But most B-family relatives are processed out of refined foods, such as white flour. To help defeat depression, “B” wise and consider some especially good B-abundant blues busters found in unprocessed, unrefined grains (oats, millet, brown rice, etc.), fruits, vegetables, beans, nuts, and seeds. Consuming vitamin B–rich greens such as spinach are especially good for overcoming overeating.

Shake the sugar habit. Consuming a lot of refined white sugar both damages and destroys B vitamins in the body; in this way, it contributes to deficiencies. Cut down on, or eliminate sugar from your diet, and depression often lifts—although why this is so isn’t well understood. One theory is that the “high” a person derives from sugar is due to elevated glucose (blood sugar) and feel-good endorphins, which produce feelings of relaxation and euphoria. Conversely, when a diet is low in sugar and high in B vitamins, levels of B vitamins, glucose, and endorphins remain stable, reducing odds of depression.

Sip some tea. Consuming too much alcohol to relax and de-stress can cause the loss of certain B vitamins—and deficiencies of vitamins B6 and niacin, especially, can bring you down. Not only does excessive alcohol consumption reduce the absorption of B vitamins, but it also contributes to protein and mineral deficiencies. The operative words here are “too much” and “excessive,” meaning, the tipping point is different for different people. Consider this: In place of wine to de-stress, try sipping some soothing herbal tea.

Stopping Stress Eating

The science that studies nutrients in the foods we consume, and the way they influence our brain chemistry and emotions, provides a peek into how food and the mind and body work together. By being aware of whether you “feel” like eating to assuage stress or to appease a healthy appetite, each food you choose to eat may be looked at as an opportunity to fine-tune your moods and emotions, while nourishing your body.

In other words, the key to being a success at stopping stress eating is making a commitment to eating for feel-good feelings, when you have a healthy, authentic appetite for food, and when you’re anticipating the pleasure and experience of true mind-body nourishment.

Article originally printed on integrativeeating.com. Reprinted with permission from Deborah Kesten.

Deborah Kesten, M.P.H., is an award-winning author, specializing in preventing and reversing obesity and heart disease. Her expertise includes the influence of epigenetics and diet on health, Lifestyle Medicine, and research on the Whole Person Integrative Eating dietary lifestyle to treat overeating, overweight, and obesity. She and her husband, behavioral scientist Larry Scherwitz, Ph.D., collaborate on research and writing projects. Her latest book, “Whole Person Integrative Eating” was named the “Winner” in the Health category by the 2020 Book Excellence Awards.

References:

Larry Scherwitz and Deborah Kesten, “Seven Eating Styles Linked to Overeating, Over- weight, and Obesity,” Explore: The Journal of Science and Healing 1, no. 5 (2005): 342–59.
Deborah Kesten and Larry Scherwitz, “Whole Person Integrative Eating: A Program for Treating Overeating, Overweight, and Obesity,” Integrative Medicine: A Clinician’s Journal 14, no. 5 (October/November 2015): 42–50.
Judith J. Wurtman, Managing Your Mind and Mood through Food (New York: Rawson Associ- ates, 1986).
Danielle Marques, et al, “Sweet craving and ghrelin and leptin levels in women during stress” Appetite, Vol 80, September 1, 2014, 264-270.

Why We Lose Balance and How We Fix It

Cate Reade, MS/16 March 2024/ All MFN blog/

It’s no secret that balance tends to decline with age. Your clients may notice they are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently.

Balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand!)

Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). The most common question I hear from older adult clients is, “Why am I losing balance?” Let’s find out why.

What is Balance?

Balance is a sense that lives in the brain. Balance relies on information constantly flowing into the brain from three main sensory systems including our visual, vestibular and proprioceptive systems. Moving properly depends on the ability of the brain to gather and interpret the sensory information provided by eyes, ears and joints. This is essential because the brain then tells the body how to respond to stay upright and balanced.

The quality of the sensory input gathered directly impacts the quality of movement. The stronger the sensory signals sent to the brain, the more accurate the instructions sent to the body will be. On the flip side, as sensory signals become impaired, movement quality dwindles, as reaction time becomes slower.

Making Sense of Balance: The 3 Systems

Let’s explore the sensory systems that make up balance.

Visual System: Your eyes tell your brain about where your body is relative to the environment, whether you are walking inside your home, in a busy airport, or strolling on the beach. With aging eyes, a great many people don eyeglasses to function day to day, and as our eyesight weakens, so too does the quality of the sensory input.

Vestibular System: The ears relay information to the brain about the motion and position of the head to adjust posture to maintain balance. Semicircular canals in the inner ears contain fluid and tiny hair cells. As the head nods up and down, moves left to right, or tilts to the side, the fluid in the inner ear moves and the tiny hair cells sense the speed and direction the head is moving in.

By age 70, it’s typical to have lost 40% of those sensory-detecting hair cells (Zalewski 2015).

Proprioceptive System: Proprioception, literally meaning “sense of self”, is your sense of body awareness and is a prerequisite for balance. It’s how you understand the parts that make up your body, where they are located, how they feel and even what they can do. It’s the way your body communicates with itself so you can walk without looking at your feet.

Proprioceptors are sensory nerves that live in and around joints, in ligaments, joint capsules, tendons, muscles and connective tissues. They sense and send signals to the brain about joint position and motion, as well as the muscle force involved in movement.

As we age, our sense of body awareness is impaired leading to poor joint function, body alignment, control and coordination. The result: poor balance and higher risk of falling.

Losing and Restoring Balance

As our eyes, ears and joints lose their sensory capabilities, this is why balance is gradually lost.

To regain what was lost, we apply the SAID principle (Specific Adaptations to Imposed Demands) to improve function with targeted training. Up to 70% of the sensory input for balance comes from your joints (Peterka 2002), so improving joint function can be a highly efficient way to improve proprioception at any age so clients can enjoy better balance and more confidence to prevent falls.

Most Efficient Balance Training

I start each balance training session using the MoveMor® Mobility Trainer to warm up clients’ lower body, restore ankle mobility and foot stability while increasing proprioception. Clients are thrilled to experience improved functional abilities so they can save themselves in time to prevent falls.

With 12-points of resistance, MoveMor® makes it simple to restore joint flexibility and strength in less time than any other tool, all from a safely seated position! This wakes up proprioceptive sensory nerves essential for balance while stimulating motor nerves for quicker reflexes.

You can get started with training clients on their journey to feeling steadier, stronger and more confident by visiting MoveMor.com/exercise-programs. There are 7 exercise programs to choose from that vary in length from 5-30 minutes. Our Take 10 to MoveMor exercise program is proven to improve balance, ankle flexibility, strength and more in just 10 minutes! An exercise guide makes it simple to identify weaknesses and tailor exercises.

MoveMor® seamlessly integrates into your balance and fall prevention training to accelerate functional outcomes and satisfaction so your clients can enjoy better balance and an extra spring in their step today!

Special Discount Offer!

As a MedFit professional, we are offering you a special $100 discount off of MoveMor. Please visit www.MoveMor.com and use discount code: MedFitBalance. Discount is valid March 16-March 31, 2024.

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

The Importance of Exercise for the Disabled or Handicapped

Terrance Hutchinson/14 March 2024/ All MFN blog/

Everyone must remain active. This is only achievable with the help of exercise. Contrary to popular belief, handicapped people also wish to stay fit and healthy. On the other hand, some of handicapped individuals do not realize the importance of it.

Let’s discuss the importance of exercise for handicapped people.

Prevention of Heart Disease

Exercise can help reduce the risk of developing diseases relating to the heart. This includes high blood pressure, heart attack and ischemic heart disease. Furthermore, exercise is essential for preventing various other medical conditions.

Prevention of Comorbidities

Inactivity is a disease in itself. Being inactive makes the body less productive. This makes them more prone to the development of illness, ranging from something as small as flu to as big as cancer. Disabled and inactive individuals have a higher chance of developing colon cancer and diabetes.

Prevention of Anxiety and Depression

Being inactive and indoors can lead to depression and anxiety. You may feel down most of the time. Exercising releases endorphins in our body. These help in regulating mood; those who exercise regularly experience improvement in their moods.

Alleviates pain

Inactivity can cause harm to your bones and muscles as well. The majority of people suffer from pain in joints and other complications. Stiff muscles are also an additional drawback of inactivity.

Handicapped people who exercise more often do not suffer from these symptoms. They report relief of pain. Furthermore, such people also have faster healing of wounds and injury from trauma.

Clears the mind

Exercising not only helps with our physical well-being. It also aids in improving our mental health as well. Brain fog is a real thing; people can be doubtful about the decisions they make. Exercising helps people to think clearly. They can divert their mind from useless jargon to more productive thoughts.

DO NOT LET OTHERS STOP YOU FROM EXERCISING

Being handicapped has a certain societal stigma with it. The perception of people can often stop you from exercising. Always remember that exercising will only benefit you alone. Don’t worry about what others think!

Conclusion

Being disabled can be a hard thing. But, exercise is an activity that will help you to gain self-esteem. You do not need to start with rigorous workouts.

This journey begins with a single step, time will help you get better in the long run. So what are you waiting for? Start looking for an exercise regimen that suits you best.

Here’s to your health!

Terrance Hutchinson is the Owner of Your Best Lifestyles Fitness and Nutrition. He is a Certified Personal trainer specializing in Exercise Therapy, Corrective Exercise, Sports Nutrition, and Corporate Wellness. He an author of 3 books, he has his own podcast, he has contributed articles to major newspapers and magazines, Terrance has spoken at health events, webinars, seminars, hospitals, schools, doctors offices and has been featured nationally syndicated television platforms. Terrance has clients in many states and counties and is looking to help others bridge the gap between the medical and fitness industries. To learn more about Terrance, visit yourbestlifestyles.com