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Movement Toward Healing: Breast cancer rehabilitation using a Pilates-based approach

Ann Marie Turo, occupational therapist, yoga and Pilates instructor and Reiki master, owns a thriving Pilates-based studio. When Turo was diagnosed with a breast cancer reoccurrence in 2002, she was devastated. Despite having limited range of motion, strength and endurance, as well as decreased ADL function, it was not recommended that she have any rehabilitation. This situation is not unusual.

After undergoing a self-described “meltdown,” she decided to take matters into her own hands. Turo designed her own rehabilitation program, which included visualization, Pilates, yoga and Reiki, along with traditional occupational therapy modalities.

Turo believes that an “integrated” approach is the best way to heal physically and psychologically from breast cancer. That is why she created Integrated Mind and Body in Boston.

Pilates is enjoying wide popularity throughout the United States as a form of exercise. It focuses on the whole person, uniting mind and body through a series of flowing movements that require both flexibility and strength. Recently, therapists have began incorporating Pilates as part of their general rehabilitation program for athletes, back injuries, hip/knee replacements and even autism.

Breast cancer survivors are starting to benefit from Pilates as well. A recent pilot study (Keays, 2007) found a modest effect in improving shoulder abduction and external rotation. However, further research is necessary to determine both the safety and efficacy of Pilates, as well as optimal exercise guidelines.

Gym woman pilates stretching sport in reformer bedThere are eight principles of Pilates: relaxation, concentration, control, centering, fluidity, precision, stamina and breathing. Joseph Pilates, who developed this movement method, believed that one must pay attention to each exercise and perform it with the utmost control to avoid injury. He believed that it is not the quantity that counts, but the quality of each repetition.

Pilates exercises initiate from the “powerhouse,” or core musculature. Therefore, every exercise is an abdominal exercise that initiates at the center and flows outward. This is in tune with developmental principles and ensures a proper base from which to perform more distal work.

Proper breathing is another cornerstone of this technique. Deep breathing is essential to activate the transverse abdominal muscles, which is why the exercises are coordinated with both inhalation and exhalation. Inhalation facilitates spinal extension and trunk stability while exhalation facilitates spinal flexion and scapular depression.

During upper extremity work there should be a sense of gliding the scapulae down the back to promote shoulder stability. Pilates can incorporate more than 500 exercises, which can be performed either on a mat or on special equipment, such as the Cadillac, Reformer and barrels. These exercises can be modified to meet the needs of patients through the use of springs to assist and mobilize the muscles, and provide resistance when patients are stronger.

Women who are diagnosed with breast cancer will have surgery, which can be followed by systemic treatment such as chemotherapy and/or hormone therapy and then, possibly, radiation. After undergoing breast cancer surgery and treatment, the body seems lost and out of control. Breast cancer survivors are faced with many issues including fatigue, loss of range of motion and strength in the affected arm, lymphedema risk, weight gain and poor posture.

Furthermore, there are psychological implications to being diagnosed with a life-threatening disease and breast removal. Pilates is one tool that can help one regain a sense of mastery and control over a body that seems foreign and lost.

How Does the Rehab Work?
Loss of range of motion and tightness in the axillary and pectoralis regions is common after breast cancer surgery, especially after axillary lymph node dissection and mastectomies. The more extensive the surgery, the greater the limitations secondary to greater tissue loss, pain and scar formation. Because many of the Pilates exercises are performed in the supine position, the neck and back can be comfortably supported. Active assisted exercises with a towel or band are used to improve mobility of the shoulder girdle while the spine is in a neutral position.

Aerobic Pilates personal trainer instructor womenPilates focuses on the scapula stabilizers including the rhomboids, latissmus dorsi, middle/lower trapezius and serratus anterior while performing active range of motion, which is different than a traditional rehabilitative approach. The use of imagery is often used to coordinate the mind and body, so one may be told to “place those wing bones in your back pocket.” Even some of the exercises can be done in side lying, which eliminates gravity, making the shoulder exercises easier to perform.

Pilates emphasizes proper alignment and posture which improves movement efficiency, opens up all the lymphatic channels and facilitates good breathing.

The risk of lymphedema, the buildup of protein-rich fluid in the chest, trunk and arms, is another concern for anyone who has received lymph node dissection and/or radiation. This is due to scarring of the lymphatic vessels that disrupts lymphatic flow, along with the loss of mobility. This can interfere with normal lymphatic or venous drainage from the arm.

Since diaphragmatic breathing is used in Pilates both to stabilize and mobilize the spine, this enhances trunk organization. Lymphatic fluid can be propelled through the body with this type of breathing, along with proximal to distal exercise. As one inhales and exhales, the pressure changes, stimulating lymphatic return. In addition, diaphragmatic breathing lowers heart rate and blood pressure, creating a relaxation response conducive to emotional healing.

Use of the deep stabilizer muscles, including the transverse rectus abdominas and multifidus, encourages pumping to the thoracic duct, the main area for lymphatic return. This in effect clears the trunk for fluid from the axillary region and pectoralis area where lymph flow may be impaired.

Once the trunk is cleared, one can exercise the arm at risk. Compression garments or bandages should be worn while exercising if at risk. Exercises should be progressed slowly and gradually to allow the lymphatic system to adjust to an increased lymphatic load.

There are usually few repetitions for each Pilates exercise, which is a natural fit for women at lymphedema risk.

Aerobics pilates women feet  with yoga ballsDealing with Fatigue
Fatigue both during and after cancer treatment is the most common side effect of the treatment. Many women feel unable to function and perform daily activities while undergoing chemotherapy or radiation treatments, and this fatigue can become overwhelming as treatments accumulate. However, many research studies have confirmed the advantages of both strength and aerobic conditioning even during treatment. Pilates offers a gentle introduction or re-introduction to regular exercise that can slowly help restore strength and endurance. One can gradually build up by performing the exercises at least twice a week. This should be combined with an aerobic conditioning program, such as walking, when able.

It is time to think about alternative approaches to meeting the needs of this population, along with individuals suffering from other chronic conditions. As one can readily see, Pilates offers many benefits to women recovering from cancer, especially since occupational therapists are well trained in the modification of such activities and exercises.

At Integrated Mind and Body, Turo works with breast cancer survivors as well as individuals who have had depression, total knee replacements and total hip replacements. She requires a signed physician’s release form, and does a full intake on clients that includes medical history, pain, postural analysis and ADL evaluation, as well as the standard occupational therapy assessments.

Clients pay out of pocket to receive Pilates and Reiki in conjunction with traditional therapy services. Turo demonstrates that therapists can balance an occupational therapy frame of reference along with other healing modalities to be successful.

Reprinted with permission from Naomi Aaronson, MA, OTR/L, CHT; Also published on Advance Healthcare Network.

Naomi Aaronson, MA, OTR/L, CHT can be reached at www.recovercisesforwellness.com.

Baby Boomers and Joint Replacement Surgery

Close to 800,000 people in the United States will have a joint replaced this year. Osteoarthritis is the main—but not the only—reason. Joint replacements have become so common that most massage therapists can expect to see clients who are in various stages of recovery from this procedure. But just because it’s common doesn’t mean it’s risk-free, and a person who has had a joint repaired has a significant chance of complications that impact bodywork choices in both the near and long-term.

Wellness Coaching & Heart Disease

Maybe The Last Heart Attack

Each year over one million Americans experience a heart attack, about one every thirty seconds. CNN produced a program recently about this that has everyone talking: Dr. Sanjay Gupta Reports: The Last Heart Attack. (watch the entire program while it’s archived here)

Following the odyssey of former President Bill Clinton and two more every-day Americans, Dr. Gupta introduces us to the work of Dr. Arthur Agatston whose method of screening for coronary calcium is considered one of the best predictors of heart disease. We’re also exposed to the work of Dr. Dean Ornish and Dr. Caldwell B. Esselstyn whose diet and lifestyle-based programs have shown recognized medical effectiveness at preventing and even reversing heart disease.

“Heart disease could be as rare as Malaria in our country if we put into practice what we already know,” says Ornish. Gupta asks “Could we see the last heart attack in America?” The program brings us excellent information about what we need to do, but hangs on the gigantic “if” in the middle of Ornish’s statement.

Doctor giving medicine to senior woman for arthritis painWhat we know is that medical check ups using the best testing methods available must be combined with successful lifestyle improvement. We know the formula. “Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.”  —The American Heart Association.

What they are recommending, is all about behavioral change.

The work of Dean Ornish has been widely accepted as medically legitimate for years, yet always qualified by mentioning that the probability of Americans adopting the lifestyle recommended is remote. Becoming a complete vegetarian, exercising regularly, practicing stress management skills and increasing social and emotional support is a tall order to say the least. Yet it works!Gupta’s report is telling us that change is possible, now we have to discover how.

Here are some suggestions for the behavioral side of preventing that potential heart attack.

1. Know about your current state of health, in detail. Don’t put off that check-up or blood-work, make a commitment to yourself to get it done.

2. Envision what you want your health to be like.

3. Ask yourself, “What has to change in my life for me to live that vision?” This creates a solid foundation for you to create the plan that you will follow to make your vision a reality.

4. Develop a wellness plan that has a series of small steps. Small steps overtime lead to large lifestyle changes.

5. Gather support for your plan. Share your vision and plan with the people you know who will be positive and encouraging.

6. Track your behavior. Avoid self-deception by writing down or entering on a phone app your progress.

7. Acknowledge and celebrate every success along the way to a better life.

For the person who has already had that first heart attack all of this information and the contents of “The Last Heart Attack” are especially important. Like David Servan-Schrieber says about cancer, there is a lot we can do about heart disease, and when we don’t let people know about the legitimate resources and information out there, we are giving them “false hopelessness.”

Diagram of healthWellness and health coaches need to know about this information as they help their clients explore their way forward towards a wellness way of living. Coaches need to insist that any client they are working with on health issues be under active medical care. Lifestyle improvement is no substitute for medical treatment. Taking on the more behaviorally demanding protocols of lifestyle improvement that Ornish and Esselstyn require may be incredibly easier and more effective with an active alliance with a wellness coach.

We know that people can be successful at improving their health if they can be successful at lifestyle change. Wellness coaching may be the bridge to span the huge gap created by the word “if”.

Reprinted with permission from the Real Balance Wellness Blog.

Michael Arloski, Ph.D., PCC is a licensed psychologist, Professional Certified Coach (ICF) and a Certified Wellness Practitioner. His work as a professional coach with Real Balance Global Wellness Services includes coaching people to achieve more of their potential in three areas: wellness coaching; leadership coaching; and mentor coaching of aspiring coaches.



The Power of Blueberries

Evidence shows this fruit is jam-packed with antioxidants and phytochemicals that may help prevent and slow the progression of chronic diseases.

It’s rare to encounter a client or patient who doesn’t enjoy the taste of blueberries (Vaccinium spp). But beyond their tangy sweetness and the fact you can pop them into your mouth one by one or incorporate them into many recipes, blueberries offer a wealth of health benefits.

Blueberries are rich in antioxidants and phytochemicals that research has shown are associated with cardiovascular and cognitive health and cancer and diabetes prevention. Their popularity is on the rise in North America. And the production of fresh and processed blueberries has grown steadily by an average of 20% every two years since 2008.1 Between 2005 and 2012, North America’s blueberry fields increased 74% from 71,075 to 123,635 acres. British Colombia has the most acres in cultivation, while Michigan has been a world leader in production volumes of both fresh and processed blueberries for many decades.

Nutritional Properties and Antioxidant Composition
Dietitians have stressed the importance of incorporating low-fat, fiber-rich, and nutrient-dense foods into their clients’ and patients’ diets for decades. “Everyone should be aiming to reach their recommended amount of fruits and vegetables for optimal health, and blueberries are an easy and delicious way to help you reach your goal. Just 1/2 cup is considered one serving of fruit, and they require no slicing or peeling—plus there’s no waste,” says Joanne Tehrani, RD, communications manager for the US Highbush Blueberry Council. Blueberries are an excellent source of fiber, vitamins A and C, potassium, and folate.2 One cupful contains 14% Daily Value of fiber. Moreover, blueberries are one of the richest sources of antioxidant phytonutrients.3 Blueberries’ diverse range of phenolic compounds, such as anthocyanins, quercetin, kaempferol, myricetin, and chlorogenic acid, contributes to their overall antioxidant capacity.4,5 (Antioxidant capacity, measured by a chemical laboratory analysis technique called oxygen radical absorbance capacity is one of several methods that doesn’t account for bioavailability, distribution, and metabolism of a product’s ingredients.) “Blueberries also have a rich diversity of different anthocyanin species—like 26 different anthocyanins—whereas some other berries may feature only two or three different anthocyanin species,” says Mary Ann Lila, PhD, MS, director of the Plants for Human Health Institute and a David H. Murdock distinguished professor at North Carolina State University, who has spent 18 years studying various Vaccinium species.

Read the full article at Today’s Dietitian…

From October 2014 issue, Vol. 16 No. 10 P. 42; written by Jasenka Piljac Zegarac, PhD. Reprinted with permission.


Breast Cancer and Exercise

October is National Breast Cancer Awareness Month, when pink ribbons remind women to schedule their mammograms and honor those who have died from or survived breast cancer. According to the National Cancer Institute, one in eight American women (12.3%) will develop invasive breast cancer during her lifetime.

Healing Mind, Body & Spirit

Alone in a Las Vegas hotel room, it happened – a turning point in one’s life that suddenly changes everything forever.

Ray, a 73-year-old retiree, was having a stroke. From his pre-med studies he knew what was happening and what needed to be done. Crawling to the phone, Ray spoke with the front desk staff and requested emergency personnel. When the paramedics arrived, he instructed them on procedure. Later Ray would learn that his stroke was hemorrhagic and had missed the speech portion of his brain by mere centimeters.

After completing physical therapy at St. Jude’s Hospital in Fullerton, CA, Ray wanted to continue exercise therapy. He knew what physical movement had done for him – he felt strong, healthy, and functionally fit. However, at the completion of his program, Ray was turned away. He kept returning, requesting additional exercise therapy, but was told his time there for over because his insurance reached its maximum. Discouraged, Ray found himself in a parking lot where he spotted a business card. The card had the logo for a local community center. Ray called the number and was pleasantly surprised to learn that the center had a personal training staff that worked with clients who survived medical catastrophes, such as strokes and heart attacks.

Ray and I first met in July 2011. He drove a specially designed car and walked with a cane as well as a brace on his leg. One half of his body was rendered completely paralyzed from the stroke. Ray’s gait was extremely slow and he could only walk for a few moments at a time before stopping to rest.

At that initial meeting, I tested Ray’s strength by giving him a light free weight to lift. As he attempted a shoulder press, his left hand shook uncontrollably. For the first several months, Ray and I worked together privately. As the room we were working in was a children’s classroom that contained many toys, we used whatever props were available to improve Ray’s fitness level. Sometimes, I would utilize other objects, such as a small stress ball. We started with basic hand exercises, such as ball squeezes. To improve fine motor skills, Ray picked up small objects with his fingers. As Ray’s motor skills increased, the objects became smaller and smaller, until they were plastic-wrapped caramel candies. Ray reached the point where he was able to unwrap the candies with no assistance.

Ray & JuliaOur exercises also involved hand-eye coordination, such as tossing and catching an under-inflated ball to each other, as I kept running to different parts of the room so that Ray was challenged to located me and then throw the ball in my direction. We also used the under-inflated ball with Ray in a seated position, as he placed the ball between his ankles and lifted it with his legs. Ray was also able to perform basic strength training exercises with free weights, such as bicep curls, hammer curls and chest flys. He was getting stronger and was now able to remove his leg brace and walk for short periods of time. I was amazed at what I was seeing.

After several months, Ray astounded the members when he graduated to the main gym floor and started working out on the machines with the general population. He was now performing leg presses, chest presses, hamstring curls, abdominal curls, lat pull-downs, back extensions, tricep and inner/outer thigh exercises. Ray’s gait had improved tremendously and he now walked all the way into the gym with substantially reduced rest periods.

We were ecstatic on the day Ray had feeling on his paralyzed side for the first time in years. This was a historic milestone and demonstrated the power of healing. Everyone who had seen Ray in his early days were inspired and uplifted as they witnessed a truly remarkable transformation.

IDEA Fitness Journal featured Ray’s story in its November/December 2012 issue.

Ray discovered us by Divine intervention, since physical therapists and allied health personnel do not currently refer patients to Certified Personal Trainers.
Certified Personal Trainers, like many professions, encompass a wide array of specialties. Most people think of us working with the general population, devising exercise programs with goals of weight loss, toning and body building. They know us through aquatics classes, Zumba, yoga, boot camp and Pilates.

What most people do not know is that a significant portion of our client base are actually medical patients who have survived strokes, cancer, heart attacks, polio, joint replacement, Muscular Dystrophy, electrocution, fatty liver disease, diabetes, and lesser known genetic diseases such as Charcot-Marie-Tooth Disease.

Since 2007, the vast majority of my clients have been in this category. With the Baby Boomer generation entering retirement, these trends will continue well into the future. And as the fitness industry moves toward regulation, requiring mandatory certification or professional license, we look forward to the day when we take our rightful place in the healthcare continuum, providing patients with ongoing exercise therapy long after physical therapy is completed. In this way,
clients like Ray, whether mobile or homebound, will receive desperately needed services.

We do not know yet if our titles will be Licensed Fitness Trainer (LFT), Licensed Personal Trainer (LPT), or Licensed Fitness Professional (LFP). No matter what, we will continue to provide necessary and ongoing services to patients who need us the most. Through the Medical Fitness Network, we hope to reach this greatly under-served population. I believe that Ray’s transformation is a miracle. Body, mind and spirit are healed and every day hope springs eternal.

About Julia

julia-lombardoWith a degree in Mass Communications/Broadcast Journalism, Julia has written for national magazines, interviewing actors Tony Danza (Who’s the Boss?), Joe Mantegna (“Criminal Minds”) and Paul Sorvino (“Law & Order”). Julia has written restaurant reviews, cookbook reviews, professional biographies, award show brochures, press releases and promotional pieces. She edited the book “Helping Hilda,” and has written educational columns for a dentist and chiropractor. In the voice industry, Julia narrated books on tape, on-hold voice messaging systems, radio sound bites, and cable television. Her degree in Broadcast Journalism allows her to write scripts as well as narrate them.

Julia started running in 1997 and completed her first marathon in 2000. While spending many hours in several gyms, fellow members approached her with exercise training questions, which convinced Julia to become certified. After much research, Julia chose the American Council on Exercise as her certifying organization, and obtained her ACE Certified Personal Trainer designation in 2006.

Immediately, the Facilities Supervisor for the City of San Dimas called and asked if Julia would develop the city’s first Strength Training Class for seniors. She did, and in 2007 “Strength Training Fundamentals for Seniors,” began, launching her into group fitness right out of the gate. The class, comprised of active, inspired and motivated seniors, was an eye-opener into the generation that survived the Great Depression and would try virtually any exercise until mastering it. The class was so popular that residents were requesting that it be opened to the 30-54 age groups as well.

In 2008, Julia officially earned her ACE- Group Fitness Instructor designation and continued on to provide exercise training services for all ages, in community centers, privately in clients’ homes, and in women’s gyms. Julia has worked with “Medical Fitness” clients more than any other group. They have survived the following medical conditions: Stroke, heart attack, cancer, polio, obesity, Muscular Dystrophy, electrocution, Charcot-Marie-Tooth Disease, Hypertension, Diabetes, Fatty Liver Disease, joint replacement, post-physical therapy patients and more.

“What is incredibly satisfying about working in this field is starting with a client who is severely limited and watching the transformative power of exercise,” she says. Her client, Ray, found amazing success. “Ray had suffered a hemorrhagic stroke and could barely walk. The left half of his body was completely paralyzed. In the beginning, he and I worked in a private room with basic exercises. Ray’s stride improved; his strength and endurance increased. Over time, Ray advanced to the main gym with the general population, who were blown away by his astounding transformation. Ray had feeling on his paralyzed side for the first time in years!”

Todays Dietitian1

Sugar Coating Helps Determine Cancer Cell Survival

Every living cell’s surface has a protein-embedded membrane that’s covered in polysaccharide chains—a literal sugar coating. A new study found this coating is especially thick and pronounced on cancer cells and is a crucial determinant of the cell’s survival. Consisting of long, sugar-decorated molecules called glycoproteins, the coating causes physicalchanges in the cell membrane that make the cell better able to thrive, leading to a more lethal cancer.