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Parkinson’s Bone Health: Camptocormia

Welcome back fighters, care-partners and fitness professionals! At Bridges For Parkinson’s, posture/vertical stability is a big concern and one we address in every class. Why? Because a strong, vertical spine means reduced falls, better gait, less back pain, increased lung capacity, ability to enjoy activities and live independently. However, fitness professionals observe some folks living with Parkinson’s disease having a severe forward lean at a 45-90 degree angle.

What is this? What causes it? And, is there a solution?

This forward lean is called “Camptocormia”, derived from two Greek words: Kampto- (To bend) and Kormos (trunk). Camptocormia was first documented in the 17th century by the Spanish painter Francisco de Zurbaran. In the 19th century, Brodie wrote about it. Later the term was coined by Rosanoff and Saloff who described the abnormality in World War 1 soldiers traumatized by shell shocks.

Camptocormia is defined as bent spine syndrome (BSS), an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position.

According to Srivanitchapoom and Hallett, approximately 3%-17% of the Parkinson’s population suffers from Camptocormia. See below examples of Camptocormia syndrome.

What Causes “Camptocormia”?

From a muscular perspective, the paraspinal, hip and glute muscles are in a weakened state making it difficult for the body to “fight back” against the neurological side of Camptocormia which we will discuss later in this article.

The paraspinal muscles are located on the left and right side of your spine and are made up of three groups.

  • Iliocostalis
  • Longissimus
  • Spinalis

Paraspinal muscles

The job of the paraspinal muscles is to extend your spine and to bend it over to the same side on which the contracting paraspinal muscle is located. For example: bending to the side to pick something off the floor.

The four main hip and glute muscles include:

  • The gluteal group (butt muscles) – responsible for stabilizing the upper body and pelvis, aid in locomotion and extend the hip. Example: when your leg travels behind you before kicking a ball.
  • The adductor group – responsible for pulling the thighs together and rotating the upper leg inward and stabilizing the hip. Example: When the leg moves to the center of the body after stepping out for a half-jumping jack..
  • The lateral rotator group – responsible for rotating the hip joint laterally. Additionally this group will aid in extension and adduction of the hip. Example: Piriformis stretch also known as the “figure 4 stretch”
  • The iliopsoas – this is the primary hip flexor and assists with external rotation of the hip joint. It plays an important role in correct posture for standing/sitting lumbar position and walking/running.

These muscle groups play a vital part in your activities of daily living! Bridges For Parkinson’s addresses these muscles groups with exercises such as:

  • Sit to stands
  • Squats
  • Bridges/Bird dog/Seated Back Extension (with tubes)
  • Clamshells
  • ½ Warrior step
  • Deadlifts
  • Lunges (forward, reverse, lateral and diagonally)
  • Rows
  • T’s

And we progress the exercise to a higher level of difficulty by:

  • Standing on one leg
  • Adding repetitions or length of time
  • Standing on the BOSU/Pad

Now, let’s discuss the neurological aspect of Camptocormia. Much like “Pisa Syndrome”, the root cause is multifactorial and largely unknown.

Camptocormia is largely considered a neurological disorder due to its comorbidity with other neurodegenerative and movement disorders such as ALS, dementia with Lewy Bodies, Alzheimer’s, and Parkinson’s (Srivanitchapoom & Hallett, 2016). As mentioned, although the presentation of this disorder is largely based on the forward lean, with a tendency to worsen throughout the day due to muscle fatigue, the causes are up for debate in research. For now, the best guess we can take is that the association with PD and other dystonias translates to a faulty cascade of events in the major movement centers of the brain, and the brain-body connection as consequence (Margraf et al., 2016).

Typically, you will find Camptocormia in the more advanced stages of PD, such as those living with Parkinson’s for 7 or more years, those with previous spinal issues, and those who indicate lower motor function on neurological exams (Srivanitchapoom & Hallett, 2016). However, even if you meet any/all of these criteria you won’t necessarily develop this disorder.

The onset of Camptocormia can be mitigated with proper preventative care such as exercise and physical/occupational therapy. Additionally, for individuals with this syndrome, botox and surgery (DBS) can alleviate the severe forward lean.

Botox may be used as a treatment that “freezes” the muscles affected in this disorder, allowing the muscles to lengthen, in turn helping to improve posture. However, this is neither a permanent nor strong solution, although it is seemingly effective in smaller studies assessing the benefits of this treatment (Bertram et al., 2015; Todo et al., 2018; Anandan et al., 2021) . There are also long term drawbacks, the biggest one being muscle weakness that can cause overall worsening of the disorder. There are other, more permanent ways of managing this as well, but are much more invasive. Spinal surgery and Deep Brain Stimulation are two of the more “common” options, although to be considered for these the symptoms must be severe (Margraf et al., 2016). The best ways to manage this disorder are to continue taking your prescribed medication, and exercise to strengthen the muscles involved with keeping your posture upright.

How Does Camptocormia Affect Activities of Daily Living?

Similar to Pisa syndrome, Camptocormia is a non-fixed flexion of the trunk, which can lead to significant deficits in posture, balance, safety, and ability to perform daily activities. Posture is one of the pivotal components for ALL ADLs. So, from an occupational therapy scope, restoration of posture and maintenance of current occupational performance is key.

ADL training: due to posture changes when standing, patients may experience difficulty maintaining routine activities with dressing, bathing. ADL retraining helps to maintain independence and current level of occupational performance.

Seating and positioning: in order to promote improved posture, position hips in an anterior angle, which can allow for increased participation in ADL’s such as feeding or grooming. This can also help with visual ability and increase social participation. Positioning during sleep is another potential area to examine as we do not want to encourage further postural deformity.

Visual strategies: due to the posture changes while standing, camptocormia can lead to difficulty interacting with our environment as we typically would, especially visually. Implementing visual cues or compensatory strategies can help promote improved posture and allow for safe interaction within their home or social environment.

Examples of Cues

1. Sit/stand with shoulders down and shoulder blades pinched together as if you are royalty. Automatically, people position their head over the shoulders and sit/stand taller.

2. Walk with eyes lifted and looking in the distance. When people look down they tend to bend over and slump their shoulders. Looking in the distance prepares them for what is ahead and trains them to use peripheral vision for what is right in front of them.

Home Modifications: modifying home and using assistive devices such as installing grab bars, removing trip hazards (rugs), training with reacher will ensure safety and promote ADL participation.

Energy conservation: as the day continues and the patient feels more fatigued, posture will be more difficult to maintain. Learning and implementing energy conservation techniques could help to promote improved posture throughout the day.

Supine exercises: Supine exercises (on your back) will help to maintain muscle strength and endurance while maintaining proper posture throughout range of motion. These exercises eliminate gravitational pull and forward flexion due to Camptocormia.

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

Bridges For Parkinson’s focuses on helping our fighters and care-partners develop a sense of awareness, provide corrective exercise therapy for those dealing with Camptocormia or preventative exercises to support a strong, vertical spine!

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.


Originally printed on bridgesforparkinsons.com. Reprinted with permission.

Written by:

  • Colleen Bridges, M.Ed., NSCA-CPT, Parkinson’s Disease Fitness Specialist
  • Renee Rouleau, PhD candidate, Jacobs School of Biomedical Sciences, University at Buffalo
  • Betsy Lerner, ISSA-CPT, MA English and African American Lit, Parkinson’s Disease Specialist and Rock Steady Boxing Certified
  • Cindy Nyquist, LPTA, ATC, Rock Steady Boxing Certified

References

  • Anandan, C., & Jankovic, J. (2021). Botulinum Toxin in Movement Disorders: An Update. Toxins, 13(1), 42. MDPI AG. Retrieved from http://dx.doi.org/10.3390/toxins13010042
  • Djaldetti R, Mosberg-Galili R, Sroka H, et al. Camptocormia (bent spine) in patients with Parkinson’s disease-characterization and possible pathogenesis of an unusual phenomenon. Mov Disord. 1999;14:443–7.
  • Margraf NG, Wrede A, Deuschl G, Schulz-Schaeffer WJ. Pathophysiological Concepts and Treatment of Camptocormia. J Parkinsons Dis. 2016 Jun 16;6(3):485-501. doi: 10.3233/JPD-160836. PMID: 27314757; PMCID: PMC5008234.
  • Schäbitz WR, Glatz K, Schuhan C, et al. Severe forward flexion of the trunk in Parkinson’s disease: focal myopathy of the paraspinal muscles mimickingcamptocormia. Mov Disord. 2003;18:408–14.
  • Srivanitchapoom P, Hallett M. Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):75-85. doi: 10.1136/jnnp-2014-310049. Epub 2015 Apr 20. PMID: 25896683; PMCID: PMC5582594.
  • Todo, H., Yamasaki, H., Ogawa, G. et al. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson’s Disease. Neurol Ther 7, 365–371 (2018). https://doi.org/10.1007/s40120-018-0108-x
  • Wartenberg R. Camptocormia. Arch Neurol Psychiatry. 1946;56:327.
gout feet

Fitness Tips and Strategies to Prevent Gout Flare-Ups

Gout, the disease of kings, is quickly becoming a global epidemic. You’re probably wondering why we called it the “disease of kings.” Well, the reason is pretty simple. Gout is (or was) called the “disease of kings” because it was a result of the overindulgence of food (like red meat) and alcohol in medieval times. Due to the cost of such a diet, the condition was associated with nobility. Hence the nickname “the disease of kings.”

Gout is one of the oldest joint diseases known to man, as far back as 2640 B.C. However, gout remains the most common form of inflammatory arthritis that haunts mankind in the 21st century. Although certain foods worsen this condition, scientists have found that gout occurs due to very high concentrations or build-up of uric acid in the blood.

In this article, we will shed more light on what gout is and explore useful fitness tips and strategies to help you prevent gout flare-ups. From choosing the right exercises to incorporating healthy habits into your daily routine, these tips can help you manage your condition and lead a more comfortable life.

Let’s get started on the path to better health and fewer gout attacks!

What is Gout?

Gout is a painful inflammatory arthritis caused by excessive build-up of uric acid in the body/blood. Uric acid is a natural substance in the body. It is an end-product of human purine metabolism and is excreted by the kidneys in urine. However, if it becomes too much, the uric acid circulating in the blood will form crystals that gather or deposit in the joints, leading to swelling, redness, and pain in the joints, tendons, and surrounding tissues.

Therefore, gout occurs when there’s an overproduction of uric acid in the body or when the kidney removes too little uric acid from the body. Both ultimately lead to an excessive build-up of uric acid in the body.

This condition causes painful swelling in the joints, most commonly affecting the big toe joint. However, you can have gout in the ankle, knees, feet, elbows, hands, and wrists. Gout is a chronic condition with symptoms that come and go (recur) in episodes known as gout attacks or flares. The symptoms tend to worsen during these episodes.

If left untreated, gout can cause permanent joint damage, joint deformity, and chronic pain. This can lead to immobility or a sedentary lifestyle, which will lead to muscle weakness and stiffness of the joints.

Tips and Strategies to Prevent Gout Flare-Ups

Whether you have gout and simply want to prevent future flares or you are at risk of having gout, making certain lifestyle changes will help. Prevention and management of flares is a possible endeavor.

Here are several tips and strategies to help you prevent gout flare-ups. By following these tips, you can manage your condition better and reduce the chances of experiencing painful attacks.

  1. Stay Hydrated Always

Staying hydrated (by drinking more water) is one of the simplest and most effective ways to prevent gout flare-ups and reduce symptoms. The ability for uric acid excretion is proportional to urine flow. Increasing water (or other fluid) consumption helps flush uric acid out of your body. It forces the kidneys to release excess fluid, reducing uric acid concentration and the risk of crystal formation in your joints.

Water is the best and easiest way to stay hydrated. A study found that adequate water consumption in the 24 hours before a gout flare significantly decreased recurrent gout attacks. However, other fluids like herbal tea can suffice. Nevertheless, soda, alcohol, and fluids high in purines must be avoided. Aim to drink at least eight glasses of water daily to stay well-hydrated. If you have kidney disease or congestive heart failure, consult with your doctor before increasing your fluid consumption.

  1. Choose Low-Impact Exercises

Exercising decreases uric acid levels in the blood, reducing the risk of gout or gout flare-ups. When the body doesn’t move often, the joints become stiff and less flexible. A study found that physically active males had a lower risk of gout than sedentary males. However, the pain from gout attacks makes it difficult to move around. Fortunately, exercise modalities can help restore mobility after a gout flare-up.

High-impact or strenuous muscle exercises can put too much pressure on your joints and increase uric acid levels, potentially triggering a gout attack. Whereas moderate or low-impact exercises do not have such an effect. Moderate-intensity physical activity reduces uric acid concentration in obese individuals. Therefore, opt for low-impact exercises like swimming, cycling, or walking. These activities are gentle on your joints while still helping you stay fit and active.

  1. Maintain a Healthy Weight

Carrying extra weight increases the stress on your joints and raises your uric acid levels. In summary, weight gain is a strong risk factor for gout attacks. The good news is that it is possible to lower uric acid levels and the risk of gout by reducing body weight. This can be achieved through dietary modifications and regular exercise. When you shed excess weight, it corrects both the body’s underexcretion and overproduction of uric acid.

Keeping a healthy weight through a balanced diet and exercise can lower your risk of gout flare-ups. Even losing a small amount of weight can make a big difference.

  1. Eat a Balanced Diet: It Does Wonders!

What you eat plays a big role in managing and preventing gout. After all, people with gout (or hyperuricemia) typically have a poor diet. The trick is to have a balanced diet. By balanced diet, we mean a combination of nutrient-dense and minimally processed foods. These foods will help reduce uric acid levels and the risk of gout flares.

Avoid foods high in purines, such as red meat, shellfish, and sugary drinks, as they can increase uric acid levels. However, not all purine-containing foods increase uric acid levels and gout risk. Plant-based foods like beans and nuts are okay to eat, while animal-based foods like red meat and shellfish are not recommended.

Nevertheless, focus on a diet rich in fruits and vegetables. They contain high amounts of antioxidants, which can reduce inflammation. People with gout can also have a diet of low-fat, whole grains, low-carb, and lean proteins. Foods like cherries, which have been shown to reduce uric acid levels, can be especially beneficial.

  1. Avoid Alcohol

Alcohol, especially beer (which is high in purines), can raise uric acid levels and trigger gout attacks. Unfortunately, there’s no way around this. Alcohol intake triggers gout attacks, regardless of the type of alcohol. So, try to limit your alcohol intake of all types of alcohol or avoid it altogether. If you choose to drink, opt for wine (as it contains antioxidants and phytoestrogen) instead of beer and do so in moderation.

Conclusion

Living with gout flares can be a painful and exhausting ordeal. Plus, the inflammation that comes with it is just too much to deal with. Fortunately, you take back control by employing the fitness tips and strategies outlined in this article.

It’s not too late to make these healthy lifestyle choices. By following the tips mentioned in this article, you can prevent gout flare-ups and live a more comfortable life. Remember, small changes in your daily routine can make a big difference in managing and preventing gout flares.

Frequently Asked Questions

How can I fix gout permanently?

Gout cannot be cured, but it can be managed to prevent flare-ups. Some treatments can help slow down the progression of gout and reduce the frequency and severity of flare-ups or attacks. Making lifestyle changes and fitness strategies, such as eating a healthy diet, maintaining a healthy weight, and drinking plenty of water, can keep gout under control.

Are eggs bad for gout?

No, eggs are not bad for gout. In fact, they are low in purines and may lower uric acid levels in the blood. Plus, they are a good source of protein. So, people with gout can include eggs in their diet without worrying about a gout flare-up.

Can you squeeze gout out?

No, you cannot squeeze gout out. The inflammation caused by gout is quite tempting to squeeze. Moreover, gout cannot be excised without affecting the surrounding tissue. There’s simply no way to break up gout crystals physically, and trying to squeeze or massage the affected area will make the pain worse. The only way to manage gout symptoms is to reduce uric acid levels in the blood.


Victor Alex is a seasoned freelance writer with a passion for health and wellness, fortunate enough to turn his interests into a fulfilling career. With a keen eye for the latest developments in overall wellness, he crafts engaging content that resonates with his audience. When he’s not writing, Victor can be found exploring the latest trends in fitness and nutrition.

References

running-bleachers

Exercise & Fitness: Cardio Conditioning & Training

The real power of being fit is in the ability of the cardiovascular system to perform at high levels throughout the day. The process of becoming fit is inherently tied to the heart’s ability to pump blood and oxygen to the organs, tissues, muscles, and extremities during periods of peak demand. The conditioning process is a daily effort requiring activity and movement. The training process is the planned activity that is designed to stress the system intentionally over time and at a prescribed intensity. They are two sides of the same coin and will be highlighted in this article.

The benefits of cardiovascular development and training are: Increased cardiac output (stroke volume), decreased blood pressure, reduced blood sugar levels and increased insulin sensitivity, increased aerobic capacity, increased energy levels, improved sleep patterns, improved emotional balance, decreased risk of developing heart disease, and of course – improved ability to control body weight. These and other benefits are derived from the purposeful movement and increased adaptability of the human body. We were meant to move, even run, and over the millennia have learned NOT to run – or even move – and this has led to the rise of chronic and debilitating diseases such as diabetes and heart disease on a massive scale.

Determining Your Training Heart Rate

The standard formula that has been used to determine your training heart rate has been a simple one: 220-your age = your maximum heart rate. Take the result and multiply by 55-85% and get the range for most people’s training heart rates. It is flawed and subject to a 10-20% margin of error. Example: 220-66 (my age) = 154x.85=131 or my maximum training heart rate. If by chance I am de-conditioned and have not exercised in quite a while I would choose a lower percentage – 70% or 108 beats per minute for my training heart rate. 

The training number (or intensity) is subject to the individual’s level of fitness, medical profile, and their ability to perform the exercise as designed at the prescribed rate. If you feel that your weight is an issue then you start at a lower intensity (65-75% for example) for a shorter period of time, increasing the number of minutes gradually over time. This is the conditioning aspect of cardio conditioning and training. It is the first phase of the cardio conditioning process and can last up to 6 months to a year (or more), depending upon the individual’s ability and how often you schedule sessions during the week. 

Cardiovascular Exercise

I have been a runner since 1964 so for the past 48 years I have been training my cardiovascular system at higher intensity levels in order to maintain its capacity to deliver blood and oxygen to my body’s tissues and organs – for a very long time. This is the point of the training activity over time. Training is determined by the body’s ability to adapt to varying levels of intensity over time. The more flexible and adaptable the program becomes the more flexible and adaptable the cardio system becomes. This long term approach enables and empowers us to reach for higher levels of achievement and accomplishment over time. Cardio conditioning and training are the long term partners in the fitness formula for success. Effort and discipline MUST be demonstrated over time for results to take hold and again, recording the training sessions is KEY to remaining dedicated, motivated, and directed toward your goals.

The final point I want to make about cardio training is that there are an unlimited number of activities that qualify as cardio conditioning and training methods. They are as diverse as the number of people engaging in these activities. Walking, swimming, cycling, hiking, skiing, rollerblading, skating, playing or participating in endurance sports and many others you can define for yourself can open the door to a happy and healthy fitness lifestyle. Running has always been my passion and over the past 48 years I have run approximately 70,000 miles. It is my hope that I will reach 100,000 miles before I leave this planet. Whatever you choose to do over the course of your life for cardio health and fitness make sure you choose something you LOVE to do. This is the secret to a long and healthy life. What is the best exercise? Answer: The one that you WILL DO! It is that simple. So get moving and breathe today!

Exercise to me is life itself. In our world today we are encouraged to sit – and sit some more. It is toxic to life and our lives in particular. Cardio activities are “breathing” activities. They require us to move our WHOLE bodies – not just individual parts. The feelings of joy and happiness that are generated by “intentionally” moving our bodies on a daily basis are lasting. They can carry us through many of life’s ups and downs – and help us emerge whole and healthy on the other side of sadness or defeat. I can remember many years where I was struggling emotionally, financially, and spiritually and running “saved” me so that I could try again tomorrow. My tomorrows came because I spent some of my days in activity that I loved – and that made all the difference. I believe in exercise as the KEY to our future health and well being. Let’s decide today to get moving and have many “happy tomorrows”! 


Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach, a fitness professional with over 25 years of experience whose passion for health and fitness comes from his boyhood in Hawaii where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

meno1

Six Considerations for a Protected Menopause Journey

Hey there, ladies! Today, I’m excited to share some insights about navigating the menopause journey with grace and resilience. As a certified fitness professional who works exclusively with midlife women, I’ve observed several key areas that, when protected, can significantly improve your menopause experience. Let’s dive into these six considerations for a protected menopause journey!

1. Protect Your Peace

Menopause can be a stressful time, with your body’s stress response already heightened due to hormonal changes. It’s crucial to find ways to reduce distress. Whether it’s practicing mindfulness, setting boundaries, or simply taking time for yourself, protecting your peace is paramount. According to Dr. Jen Gunter, chronic stress can exacerbate menopausal symptoms by increasing cortisol levels, which negatively impacts overall health. Dr. Gunter emphasizes managing stress through activities like mindfulness meditation, yoga, and ensuring adequate rest to mitigate these effects.[1][2]

2. Protect Your Sleep

Sleep disturbances are common during menopause, thanks to hot flashes, anxiety, and other factors. Good sleep hygiene, such as a dark, cool room and avoiding screens before bed, can help. Dr. Vonda Wright suggests incorporating practices like cognitive behavioral therapy for insomnia (CBT-I), which has shown effectiveness in improving sleep quality among menopausal women. Additionally, supplements such as melatonin and magnesium can be beneficial for regulating sleep patterns.[3][4] A good night’s sleep can make all the difference in how you handle menopause.

3. Protect Your Identity

It’s easy to feel like you’re losing yourself during menopause. But remember, you’re evolving, not disappearing. Find activities and connections that remind you of who you are beyond the roles of mom, wife, or caregiver. Embrace this transition as a time of growth and self-discovery. The Feisty Menopause Network highlights the importance of staying engaged in hobbies and social activities that bring joy and a sense of purpose, helping maintain a strong sense of identity during this life phase.[5][6] Dr. Jen Gunter also stresses the importance of understanding menopause as a natural transition, much like puberty, and not something that diminishes your worth or identity.[7]

4. Protect Your Heart

Withdrawing estrogen increases the risk of cardiovascular issues. Maintain a heart-healthy lifestyle with a balanced diet, regular exercise, and stress management techniques. Dr. Lisa Mosconi recommends a Mediterranean diet rich in fruits, vegetables, whole grains, and healthy fats to support cardiovascular health. Regular physical activity, particularly aerobic exercises, and resistance training are also crucial for maintaining heart health during menopause.[8][9] Keeping your heart healthy is essential for overall well-being during menopause.

5. Protect Your Muscle

Muscle loss is a serious concern during menopause, but strength training can help maintain and even build muscle. Dr. Stacy Sims advises incorporating heavy resistance training and high-intensity interval training (HIIT) to combat muscle loss and boost metabolism. These types of exercises stimulate muscle growth and improve fat-burning capacity, which is particularly important during the menopause transition. Additionally, ensuring sufficient protein intake is critical for muscle maintenance.[10][11] Your muscle is your independence, your ability to travel, play with grandkids, and enjoy a high quality of life.

6. Protect Your Bones

Bone density decreases with age, and menopause can accelerate this process. Incorporate weight-bearing exercises and a diet rich in calcium and vitamin D to protect your bones. Dr. Carla DiGirolamo suggests including activities like plyometrics, which involve jumping and landing, to stimulate bone growth and improve density. Additionally, resistance training helps maintain bone strength and reduces the risk of osteoporosis.[12][13] Dr. Jen Gunter also emphasizes the importance of maintaining bone health through diet and exercise, and debunks many myths about menopause that can lead to poor bone health decisions.[14][15] Your bones are your foundation—keep them strong to maintain your elegance and posture.

Navigating menopause can be challenging, but with these six protections, you can turn the journey into an empowering experience. Remember, every woman’s experience is unique, and it’s about finding what works best for you. Stay informed, stay strong, and embrace this transition with confidence. Until next time, keep it simple and take care of yourselves!


Ren Jones is your guide through the health maze, specialized in nutrition, fitness and menopause, dedicated to improving the lives of midlife women since 2014. You can catch more insights on his podcast, “This Podcast Has No Name,” (Apple and Spotify) where he delves deep into these vital health topics.

References and Sources
These sources provide a wealth of information and evidence-based suggestions to support your menopause journey. Feel free to explore these references for more detailed insights and guidance.

1. Dr. Jen Gunter, [The Menopause Manifesto] (https://drjengunter.com/the-menopause-manifesto/)

2. Dr. Jen Gunter, [7 Menopause Truths] (https://www.huffingtonpost.co.uk)

3. Dr. Vonda Wright, [Cognitive Behavioral Therapy for Insomnia] (https://www.cbt-i.co.uk/)

4. Dr. Jen Gunter, [The Menopause Manifesto] (https://www.penguinrandomhouse.ca/books/652048/the-menopause-manifesto-by-dr-jen-gunter/9780735280786)

5. The Feisty Menopause Network, [Website] (https://www.feistymenopause.com)

6. Dr. Jen Gunter, [7 Menopause Truths] (https://www.huffingtonpost.co.uk)

7. Dr. Jen Gunter, [The Menopause Manifesto] (https://www.penguinrandomhouse.ca/books/652048/the-menopause-manifesto-by-dr-jen-gunter/9780735280786)

8. Dr. Lisa Mosconi, [The XX Brain] (https://www.lisamosconi.com/the-xx-brain)

9. Dr. Stacy Sims, [Women Need Strength for Life] (https://www.drstacysims.com/women-need-strength-for-life)

10. Dr. Stacy Sims, [Training During Perimenopause] (https://www.drstacysims.com/training-during-perimenopause)

11. Dr. Jen Gunter, [The Menopause Manifesto] (https://www.penguinrandomhouse.ca/books/652048/the-menopause-manifesto-by-dr-jen-gunter/9780735280786)

12. Dr. Carla DiGirolamo, [Feisty Menopause] (https://www.feistymenopause.com)

13. Dr. Stacy Sims, [Women Need Strength for Life] (https://www.drstacysims.com/women-need-strength-for-life)

14. Dr. Jen Gunter, [The Menopause Manifesto](https://drjengunter.com/the-menopause-manifesto/)

15. Dr. Jen Gunter, [7 Menopause Truths] (https://www.huffingtonpost.co.uk)

change clouds

What Motivates Us to Change?

Humans are neurobiologically wired to seek out safety, convenience, and familiarity in our day to day choices.  The repetition of these choices create our behavioral patterns.  

Behaviors serve two purposes; first, to get something. Second, to avoid something.

Our behaviors cannot change until we become consciously aware of what environment and/or triggers are creating them.

skiier

Pre-Season Conditioning for Winter Athletes

As a sports medicine physician, my job requires me to evaluate and treat injuries. What I am passionate about, however, is injury prevention and sport maximization! So, for those of you who don’t want to be “sidelined” for the ski season… read on and start training smarter!

Tens of thousands of skiers and snowboarders enjoy snow sports every year, however few prepare for the physical demands that these sports place on the body. Different sports use different muscles in different ways – if your muscles are prepared they will perform and injuries will be reduced. If you have been exercising all year and are merely switching into your “ski/snowboard” mentality, you should anticipate that you will need about 6 weeks for the body to adapt to the new activity and/or exercise before it’s ready to take on the challenges of the mountain. If, however, you have not been exercising, you will need a directed exercise program focused on the specific muscles required for at least 8 to 12 weeks prior to your first day on the slopes!

Depending on how aggressive a winter sport athlete you are, and how old you are, you should start with an assessment of where you’re starting from. I recommend having a baseline functional movement screening (FMS) done by a licensed physical therapist or certified strength and conditioning coach.  This type of assessment can help to find your weaknesses and asymmetries to allow you to tailor your strength program to them.  By doing this, you can minimize injuries and maximize your performance on the slopes! Starting your strength program early will allow you to enjoy the season to it’s fullest!

Warming up and stretching before hitting the slopes is another consideration. There are many schools of thought about warming up, however it is generally accepted that warming up muscles that will be used for a specific activity is a good way to avoid injuries such as muscle tears. A good warm up routine to use is to perform the activity you’ll be doing at about 1/3 to 1/2 the speed or intensity for 5 to 10 minutes.  For example, start on an easy hill even if you’re an intermediate or advanced skier/snowboarder, remind yourself to keep form, look up, move your legs, engage your CORE, etc. Skipping the warmup can result in painful muscle tears that may take as long as 8 to 12 weeks to heal. 

Stretching (Pre- and Post-Workout): Stretching your muscles after your warmup increases your flexibility and may help to prevent injuries. Additionally, if you incorporate a cool down into your workout you will increase your overall “fitness” and improve your cardiovascular health. Just 5 minutes of a brisk walk after your main workout can improve your cardiac tone and overall fitness. Believe it or not, the research shows that a cool down is MORE important than a warm up for fitness!

So, the secret to enjoying the slopes is easy… assess early, customize your strength training, and once the snow flies, start your warm up and stretching program on the hill.  Happy winter!

Learn More: Specialized Education for Fit Pros

MedFit Classroom’s Sports Medicine Fitness Specialist online course is designed to provide fitness professionals with a thorough understanding of common sports injuries and recovery post-medical/surgical intervention with considerations in training, pre and post rehabilitation, nutrition and in some cases medication to support recovery in this population.

Advance your education and specialize with this 10-hour online course!


Naomi L. Albertson M.D. is Board Certified by the American Academy of Family Physicians and specializes in the non-surgical management of musculoskeletal problems, sports injuries, concussions, and the treatment of osteopenia and osteoporosis. 

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The Neural Hierarchy and the Stroke Survivor

“We have a brain for one reason and one reason only, and that’s to produce adaptable and complex movements.” This quote may come as a surprise. As we are often only concerned with our client’s muscles, joint, lungs, and hearts. The reality is that all training is brain training, we just don’t think of it that way.

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Pelvic Floor: Lower Region Muscles with Big Responsibilities

The area of the body referred to as your pelvic floor are the muscles that are used to urinate, pass bowel movements, and for sexual intercourse. When or if these muscles weaken, there can be uncomfortable and inconvenient interferences for someone’s day to day living. The side effects of having a weak pelvic floor are negative, so taking preventative measures can be important and incorporating exercises to strengthen these muscles is necessary. We need to be in control of squeezing and relaxing these muscles, although most of the time this is done automatically. 

Your pelvic floor muscles are your core. These include your abdominal muscles, back muscles, and your diaphragm. They wrap around the pelvic bone to tailbone and then extend on both sides of the pelvis. If you want to feel where these muscles are you can squeeze the urethra to stop yourself from peeing or squeeze your anus to stop yourself from passing gas. There are two main muscles of the pelvic floor which are the levator ani (which has three parts) that wraps around the entire pelvic and the coccygeus which is located near the back of the pelvis. 

There are a few reasons the pelvic floor can weaken over time. Childbirth, trauma, and surgery are the most common culprits. These muscles are stressed during pregnancy. Hormonal changes in women as they age, particularly during menopause, can weaken the muscles. Persons with diabetes are also at higher risk for weaker pelvic floor muscles. Certain conditions can also weaken them. These would include stress incontinence, urge incontinence, anal incontinence, fecal incontinence, and what is called pelvic organ prolapse. Stress incontinence happens to many women post childbirth and for men post prostate surgery. This is when you might dribble pee when you sneeze, cough, laugh, and/or lift something. Urge incontinence is the constant feeling of needing to pee. Anal incontinence is having a hard time controlling when you pass gas, and fecal incontinence is having a hard time controlling bowel movements. Pelvic organ prolapse is when the muscles including the uterus, bladder, and rectum might bulge into the vagina and cause a protrusion. 

Treatment depends on the severity of the condition. There are natural approaches to do this, but surgery could be required. Kegel exercises would be the first measure. Kegels are an effective exercise which involves squeezing and relaxing the pelvic floor muscles, focusing on controlling the sensation. Squeezing time can start with 3 seconds and increase to 8 to 12 seconds over time. Exercises shouldn’t be done if there has been trauma or injury to the area unless cleared by a medical professional. There are trained physical therapists to guide and assist with pelvic floor exercises as well. Avoiding constipation if possible is also helpful. This could include lifestyle changes revolving around diet, activity, and medications. 

Most people don’t even think about their pelvic floor muscles until a problem arises. Natural aging brings about new areas of the body we become aware of and took for granted at younger ages. As with all areas of our health, being proactive rather than reactive is desired. It’s important to address health issues even if the topic is embarrassing or private. Helping ourselves helps others and there are natural measures we can take without extreme invasive procedures. 


Originally printed on Every BODY’s Fit blog. Reprinted with permission.

Dr. Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health and a Ph.D in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

References:

Pelvic floor muscle exercise and training for coping with urinary incontinence – PMC (nih.gov)

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice – PMC (nih.gov)

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Sleep and CVD: What Can Midlife Women Do?

It was the scorching summer of ’96 when I received a call that rocked my world—my 60 year old mother had suffered a stroke. This powerful woman’s life changed forever. Years later, my brother, a firefighter whose sleep was frequently interrupted by alarms, tragically lost his life to a heart attack. These personal stories illustrate the profound effects of sleep on heart health, particularly for midlife women.

The Hard-Hitting Stats: Focused on Midlife Women

Let’s dive into the statistics that underscore the importance of this issue specifically for midlife women:

  • Stroke Alert: 20% of midlife women will encounter a stroke by the age of 55. This statistic is drawn from the National Stroke Association, highlighting the elevated risk for this demographic.
  • Death by Stroke: Women account for 57% of stroke deaths, a significant gender disparity in stroke mortality rates reported by the American Heart Association.
  • Race and Risk: Black midlife women face disproportionately higher mortality rates from strokes, pointing to an urgent need for targeted health interventions, as noted by the National Institutes of Health.
  • Heart Disease Dominance: Over 60 million women, many in their middle years, live with heart disease, the leading cause of death for women, outpacing all cancers combined. These figures are supported by data from the Centers for Disease Control and Prevention (CDC).

Research Revelations: The SWAN Study by Rebecca Thurston, PhD

Dr. Rebecca Thurston’s research utilized the Study of Women’s Health Across the Nation (SWAN), a multi-decade study initiated in 1996. Focusing on 2,517 women whose sleep patterns were monitored through midlife for 22 years, the study involved 16 different interviews where participants self-reported their sleep habits. Here’s what they found:

  • Long-term Insomnia Risks: Women with persistent insomnia throughout midlife have a 70% increased risk of developing cardiovascular diseases, revealing the critical impact of sleep quality on heart health.
  • Impact of Sleep Quality: Those with persistent insomnia and short sleep exhibited a 75% increased risk of cardiovascular issues, emphasizing the importance of both sleep quantity and quality.

What Can Midlife Women Do?

So, what actionable steps can midlife women take to mitigate these risks? Here are some effective strategies:

  • CBT-I for Better Sleep: Cognitive Behavioral Therapy for Insomnia (CBT-I) helps develop healthy, drug-free sleep patterns and is endorsed by numerous sleep studies and health organizations as an effective treatment for insomnia.
  • CPAP for Sleep Apnea: For those disrupted by sleep apnea, using a CPAP machine can significantly improve sleep quality.
  • Lifestyle Tweaks: Engaging in morning exercises and avoiding blue light exposure from electronic devices in the evenings can greatly enhance sleep quality and overall heart health.

This isn’t just about discussing sleep; it’s about taking actionable steps to improve heart health for midlife women. By transforming personal loss into proactive health strategies, we aim to advance this conversation together and ensure every moment is lived to its fullest.


Ren Jones is your guide through the health maze, specialized in nutrition, fitness and menopause, dedicated to improving the lives of midlife women since 2014. You can catch more insights on his podcast, “This Podcast Has No Name,” (Apple and Spotify) where he delves deep into these vital health topics.