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The Role of Exercise in the Treatment of Diabetes

Diabetes Word Cloud Concept

According to the American College of Sports Medicine’s flagship journal, Medicine and Science in Sports and Exercise (1), there are more than 21 million Americans with Type 2 Diabetes as of 2010 with an estimated 7 million undiagnosed. If these numbers don’t mean much, let’s give it some perspective: in 1958 there were only 1.5 million. (Granted, the US population has increased, but only from about 180 million to 310 million, not 15-fold as in the numbers of T2D.) Furthermore, due to the now-defined pre-diabetes – or sub-clinical diabetes where the precursors to diabetes are lurking if lifestyle does not change dramatically – it is estimated that 80 million Americans are at risk. Thus, some public health officials are predicting that 21-33% of Americans will have diabetes by the year 2050. The healthcare burden this portends will bankrupt the nation. To make matters worse, the preponderance of both pre-diabetes and T2D is increasing in children and adolescents as sedentary behavior, poor diet and obesity abounds.

While prevention is optimal and much is being done in the way of public health messaging, one of the best means by which to regulate blood sugar in either healthy, pre-diabetes or T2D patients is through physical exercise. Recall above where we discussed how muscles use the sugar in the blood for fuel. The more muscles you have and the more regularly they work at some critical level of effort, the easier it is to control blood sugar. In fact, one’s levels of physical activity (PA) may be a better predictor of risk for diabetes than one’s BMI (body mass index, a ratio of height to weight.)

For the sake of discussion, we should break down physical activity into three main types – activities of daily living (ADL), aerobic exercise (AE) and resistance (or strength) exercise (RE). The MSSE article reviewed the data on all these for their impact on blood sugar, insulin control and T2D risk. Not unremarkably, the evidence strongly suggests that the more active you are, the lower your post-meal and long-term blood sugar is, the better your muscles are able to use the sugar in the blood (glucose tolerance or insulin sensitivity), the lower or lesser your insulin response is to food intake, and the lower your risk for diabetes is. What is remarkable, however, is how little physical activity is required in order to affect many of these changes and benefits.

As far as ADLs is concerned, the general prescription is to ambulate (walk, run, bike, etc) for 30-60 minutes a day or close to 10,000 steps/day, or almost 4 miles/day. This does not mean you have to take walks that last that long; it means you should move around more often throughout the day and sit less often. In fact, some studies show that simply standing up for 2 minute bouts of walking every 20 minutes of sitting lowered post-meal blood sugar and insulin response to eating. (2) While walking is effective, new studies (3) demonstrate that high intensity interval training (HIIT), or sprinting, may be an even better regulator of blood sugar. Comparing training programs in two groups of sedentary women, one doing intervals of moderate intensity, the other at high intensity, the authors found that the HIIT group had slightly greater fat oxidation in the muscles, a roundabout indicator of improved glucose control. HIIT might also be more time efficient.

Between the two studies referenced here, and many more that have looked at HIIT programs compared to traditional long, slower/lower intensity programs, the general belief is that the more muscles that are contracting and the harder they contract, the better the short-term and long-term blood sugar control. The only caveat here is that large muscle groups or bigger body movements are necessary to see these effects; single joint/small muscle contractions will not elicit the disease-modifying effects one might be seeking. For these reasons, RT has been getting more looks when it comes to modifying risk factors for T2D. In fact, the preponderance of evidence shows that RT, at sufficiently high enough intensities to build muscle mass, improves blood sugar control both by using sugar to fuel contractions and by improving the insulin sensitivity of those muscles even after the workouts.

Overall, physical activity has been shown to be an effective, efficient and low-risk/low side-effects treatment and preventive for T2D. A single bout of exercise is sufficient to regulate blood sugar for the next 16-24 hours.

As such, it is recommended that exercise be partaken nearly every day for at least 30 minutes; if obesity is a factor in a patient’s disease, then 60-90 minutes of accumulated physical activity is strongly suggested. Furthermore, a combination exercise prescription of cardiovascular and RT exercise – either same or alternating days – is deemed optimal.

To conclude, physical activity of all sorts has been found to enhance blood sugar uptake by muscles during the session and for several hours thereafter. Thus, it is one of the best, least invasive means by which to prevent, regulate and, for early stage T2D, even reverse diabetes and its downstream effects on the heart, kidneys, nerves (especially of the lower extremities), and eyes. Besides its collateral benefits on the cardiovascular system, it may help reduce weight though it is essential in maintaining weight loss. And PA clearly improves quality of life, not just through its physical benefits but its effects on the brain and psyche, reducing the risk of depression which may be a factor in both the sequence of events leading to weight gain, the challenges of both weight loss and disease management, and the reduction in one’s ability to enjoy various aspects of life due to immobility, neuropathy, visual impairment, and dialysis.

For more information about diabetes, exercise, pharmaceutical management and research, please visit the American Diabetes Association site at diabetes.org


Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

References

1. Roberts et al, Modification of Insulin Sensitivity and Glycemic Control by Activity and Exercise. MSSE, Vol. 2013: 45(10):1868-1877
2. Dunstan et al., Breaking up prolonged sitting reduces glucose and insulin responses. Diabetes Care, 2012:35(5): 976-983
3. Astorino et al., Effect of Two Doses of Interval Training on Maximal Fat Oxidation in Sedentary Women. MSSE, Vol. 45(10), pp.1878-1886, 2013

 

 

Fibromyalgia signs

Fibromyalgia and Exercise: How to Get Your Nerve Back

According to the National Institute on Health (NIH), fibromyalgia affects over 5 million U.S. adults and an estimated 3-6% of the world population.  While fibromyalgia is most prevalent in women (75-90% of those with fibromyalgia), it also occurs in men and children of all ethnic groups.  People with fibromyalgia experience aches and pain all over the body, fatigue (extreme tiredness that does not get better with sleep or rest), and problems sleeping.  Fibromyalgia may be caused by a problem in the brain with nerves and pain signals. In other words, in people with fibromyalgia, the brain misunderstands everyday pain and other sensory experiences, making the person more sensitive to pressure, temperature (hot or cold), bright lights, and noise compared to people who do not have fibromyalgia.  Fibromyalgia has been compared to arthritis. Like arthritis, fibromyalgia causes pain and fatigue. But, unlike arthritis, fibromyalgia does not cause redness and swelling, or damage to the joints.

Diagnosis and Causes of Fibromyalgia

Up until recently, fibromyalgia has been very difficult to diagnose coining the condition as the “invisible disease” believing that the syndrome was “all in the head” of those who suffer from fibromyalgia.  However, currently fibromyalgia can be identified through a questionnaire and the Manual Tender Point Survey test.  There has been a breakthrough recently with a blood test that may identify fibromyalgia making it even more possible to treat fibromyalgia.  However, more testing is needed to be more widely accepted.  Here is a short list of what may cause fibromyalgia:

  • Genes:  Mutation or deficiency in the MTHFR or COMT genes specifically
  • Having other diseases such as arthritis
  • Family history
  • Emotional or physical abuse
  • Posttraumatic stress disorder (PTSD)
  • Gender:  Occurs mostly in women
  • Anxiety and depression
  • Not moving enough

Exercise and Fibromyalgia

Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and mobility. While the pain and fatigue associated with fibromyalgia may make exercise and daily activities difficult, it is crucial to be physically active.  Usually, there are no specific exercises to avoid if one has fibromyalgia. Aerobic exercise (running, jogging), weight training, water exercise, and flexibility exercises may all help. Golf, tennis, hiking, and other recreational activities are also healthful. However, exercising hard (overexertion) leads to the problems people experience post-exercise, which are called “post-exertional malaise.”  This occurs because people with fibromyalgia don’t have the energy to condition like others who can handle the increase in exercise and conditioning.  Instead, if the exercise uses more than the limited amount of energy the body can make, their systems crash, and they feel like they were hit by a truck for a few days after.  Because of this, the key is to find an amount of walking or other low-intensity exercises one can do, where he/she feels “good tired” after, and better the next day.  Instead of ramping up in the length or intensity of the workouts, one should stick to the same amount while working to increase energy production.

Benefits of Exercise

Because the main focus of fibromyalgia is neurotransmitters and brain health, one key benefit of exercise is the boosting of endorphins and serotonin in the brain.  Studies show that exercise can help restore the body’s neurochemical balance which in turn triggers a positive emotional state.  Boosting levels of natural endorphins are essentially boosting pain-fighting molecules that help to reduce anxiety, stress, and depression which are symptoms of fibromyalgia.  Elevating serotonin plays a vital role in mediating moods thereby helping relieve symptoms of fibromyalgia.

Other benefits of exercise include:

  • Burning calories and making weight control easier
  • Giving range-of-motion to painful muscles and joints
  • Improving a person’s outlook on life
  • Improving quality of sleep
  • Improving one’s sense of well-being
  • Increasing aerobic capacity
  • Improving cardiovascular health
  • Increasing energy
  • Strengthening bones
  • Strengthening muscles
  • Relieving pain

Quick Exercise Tips

Exercise consistently (aim for daily) for 15 minutes.  Even as little as 5 minutes a day can reduce your pain.  Aim to feel “good tired” after a workout but better the next day.  If exercising increases your pain, go easier and exercise for less time.  Don’t try to ramp up in time or intensity unless you notice an increase in energy.

Learn more on this topic! Join Carol Ann for her upcoming webinar:


CarolAnn (M.S., CPT, CN) is a 25+year fitness industry veteran holding positions such as program director, studio owner, educator, presenter, and author.  She develops health/fitness curriculum for organizations such as FiTOUR, Hydracize, MedFit Network, and PT Global.  Along with producing and starring in several fitness videos, she is an expert contributor for publications such as Livestrong, PFP, and New Tampa Style Magazine. She serves on the Health Advisory Board for MedFit Network.  She is now spreading the gospel of health and fitness targeting churches with Chiseled Faith®.  She has been selected to be a 2019-2021 National Fitness Hall of Fame Fitness Superstar.  You can find her work at CarolAnn.Fitness and ChiseledFaith.com.

healthy middle aged man workout at the beach

Healthy Aging & You: The 7 Keys to Fitness Achievement

What does it mean to be fit or “be in shape”? We set fitness goals for a variety of reasons that are important to us at the time but in the long run is really losing weight a lasting goal? Do we really ever regard the “real” point of becoming fit? Probably not. Getting older means losing “something” in most people’s minds (mobility, independence, freedom to do what we love to do etc.). It however doesn’t have to be that way. If we think in terms of performance based goal setting and being able to do all the things we love to do over time – regardless of age – we will find that getting older doesn’t have to mean “getting old”. I would like to share with you what I consider the seven keys to fitness that if we maintain over time we will be able to be not only functional but vibrant and healthy as well.

Discussion

I have always maintained that if I remained fit for life that I would be training every day toward becoming an “evolving athlete” – capable of “doing what I want, when I want – without getting hurt”. This is as good a definition of what it means to be fit to me given my track record as a fitness professional. Taking time today to evaluate what you REALLY want from your fitness activities is probably a good idea and worth the effort and time up front so that you can access the benefits that you TRULY want from your training program. Here are the seven keys to fitness that will make your efforts worthwhile:

#1.  Strength

Strength is a cornerstone of any fitness program. How we build strength over time is dependent on our effort and focus at being consistent in all we do. I started a weight training program in college with the help of the varsity football team at Syracuse University in 1965 and learned the basic principles of strength training with their help. I am still using those same methods and training principles today 50 years later and the secret to my success is clearly defined methodology and consistency of effort. I record all my results in a written log and am now in a training mode for my 70’s that will enable me to be able to run well into my 80’s thanks to my resistance training program. What do you want to be able to do as you age? Strength training is THE foundation for healthy aging.

#2.  Endurance

Endurance is being able to do an activity – any activity – over time without tiring and running out of fuel. Endurance is training for the heart and the cardiovascular system and enables us to be able to do more in our lives without tiring. Running is a key activity that I have engaged in since 1964 and has remained a cornerstone of my training program since then. I am doing 7 mile runs at a variety of speeds and currently have accumulated a body of work that has stretched over 70,000 miles. Since 2000 I have run 23,500 miles and I know these results because I have recorded each of my workouts in detail in a runner’s calendar and know where I have been, where I am in my training and where I am going. I want to be able to run a 6 minute mile on my 80th birthday in 2026 and current results say I will be able to do it – barring injury or illness. My book on healthy aging is simple but not easy. Pick what you love to do and keep doing it – and continue to learn more about yourself every day. Be a student of your own life and never stop learning!

#3.  Power

Power comes from being able to retain “explosive” ability over time. Old people lose their power and never regain it because they may have known they had it in the first place. Power is both mental and physical. It resides in the mind as well as the body. Many forms of exercise help us retain our power from yoga to dance (yes dance) to tai chi – and of course weight training. I use several exercises in my own programming for this purpose – from pushups, dips, bench press, leg press, weighted ab work, lunges, squats and other exercises that allow me to retain the power in my body. My “mindfulness” work is embodied in my meditation and visualization (imagination) work that I am committed to doing daily. I also use sprint workouts in order to increase my anaerobic threshold which determines my ability to engage as many of my “fast twitch” muscle fibers as I can. So far I am doing 250 pushups, 1000 crunches, and running sub 6 minute miles while still bench pressing 250 lbs. for my “power set”. If I maintain these results over time I WILL retain my power as I enter my 70’s next year.

#4.  Speed

Most of us lose speed after we leave our 20’s. If we have struggles with health issues we most likely never thought of speed as a part of our lives. Injured joints, soft tissue damage and other debilitating issues will prevent us from ever being fast but it is still worth our time to try and improve our speed of movement. I love to run fast and I will always have this aspect of fitness in the front of my mind as I train my body in the future. I love sprint workouts and will most likely keep the track in my sights going forward. Right now running indoors suits me and I am making real strides in developing leg speed and maintaining a “rhythm” that I positively love. What will you do to address speed in your programming? Seek to rise to a higher level of achievement and see what happens to your confidence!

#5.  Agility

Agility is an elusive quality and many of us never really train for it because it is hard to simulate agility in a training program. Athletes must all have some form of agility or quickness to play their sports at the highest level so they routinely add agility drills to their off season programming. It takes effort and desire but can be a real asset to any training regimen. Seek out new ways of addressing this skill set and see how you might incorporate some agility training into your program and see what happens. Personal trainers and group fitness instructors can – and do – use agility training as a part of their instruction. I am thinking about this aspect of fitness as well and have not yet decided on a course for myself yet so I am still an “evolving athlete” too.

#6.  Balance

Balance is a key to becoming fit and implies not only physical balance but mental and emotional balance as well. Being balanced means that we can more easily respond to life’s challenges and roll with the punches as change enters our lives. Being physically capable of balancing our bodies is a worthy goal. Yoga is a great way to learn to balance the mind and body. The poses help you acquire a “sense of self” in space and time. I use yoga as a part of my stretching routine to “release” tension from my joints and muscles following my training. I find breathing exercises to be useful in calming me and balancing my mind with my heart and is also a soothing way to address stress in my life. Use basic principles of achieving balance in your life and you will go far and be healthy along the way.

#7.  Flexibility

I saved flexibility for last because it captures for me the essence of health and fitness. Being flexible in our thinking and in our physical being is a reward for all our hard work. I am more open to change in my life than I ever thought possible. “Change is the only constant in the natural order” is one of the important lessons I learned from a favorite teacher over 30 years ago and only now am I finally beginning to truly understand this concept as change accelerates in my own life. “Feeling in control” of our lives is important but when we realize that what we love today may change in our lives tomorrow we become more adaptable and willing to change so that we can continue to grow and expand in consciousness. Life is bigger than we can imagine and if we become flexible in body we can save ourselves from injury and if we become flexible in our thinking we can become healthier – and happier – grateful for all that we have been given.

Conclusion

The seven keys to becoming – and staying fit are: Strength, endurance, power, speed, agility (quickness), balance and flexibility. Where do you fall short when it comes to your own fitness? Where do you feel you need to improve your training? What do you REALLY want to accomplish with your training? Looking good is fine but what do you want to DO with your training? I want to travel, water ski, play with my grandson and teach him to be active, empower and inspire audiences to make positive changes in their lives, write more books and articles on healthy aging and live a fulfilling and rewarding (and meaningful life). Time is precious so use it well and gain your freedom to be all you were meant to be!

Reprinted with permission from Nicholas Prukop.


Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His 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.

active adults walking

Can movement be therapy for emotional stress?

The more rhythmic and intense the movement, the greater this effect, since it elicits focus.

Emotional stress makes life overwhelming. Sometimes, we experience an extremely stressful or disturbing event, while at other times we accumulate the stress of upsetting interactions over time. In either case we are left feeling emotionally out of control and helpless. Our minds feel like a hamster spinning away on a wheel, leaving us drained, heavy, disconnected and incapable of making rational inferences and decisions. Our bodies feel like logs being lugged around, making daily chores onerous.

Irrespective of how it’s triggered, emotional and/or psychological disharmony has wide-ranging physical reactions and symptoms. While most of us know of the emotional impact (feelings of sadness, anger, fear, guilt, self-doubt and many more) the physical impact is not widely spoken about. This could include muscular tension, aches and pains, difficulty sleeping or insomnia, breathlessness among others.

Everyone’s triggers and responses are unique. Healing from emotional stress, hence, cannot be a one-size-fits-all solution. If symptoms persist for long or are severe, do seek professional help. That said, there are a few practices that can aid in self-healing.

Movement

Movement can be therapeutic for a number of reasons. As we know, stress impacts mental and physical equilibrium, turning the body into a repository of unpleasant side effects. A prolonged state of negative emotions like anger, fear and hyper responsiveness in daily life, adversely impacts the muscular and nervous system. Movement and exercise can help address this at a dual level. At a physical level, it helps by releasing endorphins (aka happy hormones) and calming adrenaline. The more rhythmic and intense the movement, the greater this effect, since it elicits focus. Target at least 30 minutes of exercise/movement on most days. It could be any activity that interests and engages you, be it dancing, yoga, sport, running, swimming, cycling. It might feel better to do it in company, to help break any self-imposed isolation. You could split it up over intervals during the day (though half an hour is not much of an ask to reset yourself and get your mind, body and life on track!).

Mindfulness

Try to pay full attention to the activity and how you perform it. Stay with the process. The mind will eventually tune into the rhythm of the body, making you more ‘mindful’ of the activity and yield a positive sensory outcome, including from deep within. For some, this may be attained with gentler workouts, and for some more intense activities could derive the response, depending on one’s personality as well as physical capacity. Remember, there is no ‘right’ or ‘wrong’ way here. The beauty of movement is that it serves all, and it can be scaled up and down dynamically to make you feel most connected and generate positive inner vibes.

Deep breathing

Focus on the act of breathing and on how the breath goes in and out of the body (‘mindful’ breathing). It acts as another powerful therapeutic tool. This is true even during movement. Movement becomes more mindful when you focus on the breath while executing it, maximizing positive benefits physically (more oxygen, less physical stress) and mentally (greater connection with self, less mental stress). It aids in giving the mind a much-needed break while energizing the body.

Good sleep

Try maintaining sleeping and waking up time and hours even though it may seem silly or impossible. For those with sleeping difficulties or insomnia, the body clock needs resetting, requiring some repetitive reinforcements to break the negative cycle. It’s essential to retrain the body and mind to rejuvenate, rest and recuperate.

Changes won’t happen overnight, but all these practices together can go a long way to impart a greater sense of control, which propels us towards a happier state. It’s about reclaiming peace, being kind to ourselves and catalyzing inner healing.


Vani Pahwa is a Functional Fitness specialist with over fifteen years of experience, and cutting-edge certifications from leading internationally-accredited and globally recognized fitness institutes. She is also a Cancer Exercise Specialist (perhaps one of the first in the country). Sought after for her multi-disciplinary fitness modules and expertise, Vani has conducted fitness workshops for leading corporate houses, conditioning and training camps for various sports communities, training programs for coaches, personal training programs for CEOs of multi-nationals, athletes, junior and senior sports professionals among others. Her combination of specialties, client profile and range, and extensive work experience makes her unique in the country. She is the founder of Body in Motion.

Original article published in a leading national daily:  https://www.thehindu.com/life-and-style/movement-as-a-therapy-for-emotional-stress/article26566357.ece

Elder sporty female doing sport

What Exactly is Exercise?

What is Exercise?

It’s obvious isn’t it?

Seems like a dumb question right?

Professionals such as Personal Trainers, Physical Therapists, and Chiropractors prescribe it to their clients and patients for a wide variety of reasons; to heal from an injury, to increase your endurance, or make your muscles stronger.

But what is it – exactly – that is being prescribed?

Exercise (n.) A physical or mental exertion, or the removal thereof, most often for the purpose of physical training, to improve health and/or performance. A stimulus/stimuli applied, or removed, over some duration, and/or created from within, a neuromotor control system, resulting in a neuromotor solution/response, with the purpose of eliciting an intended and specific physiological change/state
Dunn K., Mack G, McMillin C., Motor Control; pathology, assessment and improvement philosophical basis, research, and methodology, Muscle System Consortia, 2018 pg. 9.

Now there are some ten-dollar words!

The key phrase in this definition is “with the purpose of eliciting an intended and specific physiological change/state”.

Exercise in our world is an intention to make a physiological change. We are trying to change the body in a certain direction. In other words, exercise is something that we do to intentionally change something about our bodies.

This differentiates exercise from activities of daily living.

Is taking your dog for a walk exercise? No

Is gardening exercise? No

How about playing a sport? No

What about an activity like skiing? No

This does not mean that doing these activities does not contribute to your health in some way. They are just not exercise.

Why is it important to make this distinction?

In order to improve your health and fitness in meaningful ways it must be done with intention. If we are not working toward intentional change then we probably won’t get the changes we want.

We fool ourselves into thinking that gardening, walking the dog, carrying the groceries, or shopping in the mall are enough to change or maintain our physical health. This justifies avoiding the regular and committed discipline of intentional activity to stimulate the body at levels high enough to drive the changes we need to enjoy a healthy and robust physical life.

Not too long ago I was on vacation in Florida with my parents and an uncle. We needed to go to the grocery store to get food. Being in a foreign store we did not know our way around. We had a long list. Since we had no idea where the items were, my uncle walked all around the store searching for the numerous things on the list. When he came back my mom jokingly apologized for having him cover practically the whole store to find what we were looking for.

His reply, “It’s ok! I can use the exercise!”

About a month after that I was with the same uncle at the Corning Glass Museum of Art. It had stadium-like seating in an area where they do demos of the glass making. This type of seating is very steep. Climbing up the steep stairs to exit the demonstration room was quite the effort for one woman.

“Well I got my exercise for the day!” was her statement as she made it to the top.

This past winter I snowboarded more than I had the past couple of years. But I didn’t consider it exercising. I went because I enjoy it. It helps winter go by easier. I didn’t do it with a goal in mind. I am not thinking about my heart rate, or what my legs are doing. I strictly go to have fun. My enjoyment of that activity is the byproduct of the work that I put in with intentional exercise to support my physical ability to snowboard.

I do strength training to try and improve – or at least maintain – my strength and muscle mass. I do the elliptical or ride the bike to challenge my cardiovascular system. All these things I do are so that I can maintain my ability to be active. One of those things of being able to be active is snowboarding.

What are some activities or things that are important to you?

Is it being active like running, skiing, or hiking?

Regular exercise, (given the previous definition) in order to stimulate your muscle system to improve and/or maintain itself, will directly contribute to your physical health and capabilities.

Exercise equals healthy muscles, which equals healthy life!


Co-Written by Greg Mack and Charlie Rowe.

Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms, and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease. 

Charlie Rowe, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications. 

blueberries-closeup

Tailoring Nutrition to Help Fight Parkinson’s Disease

Good nutritional practices are the groundwork for a healthy and productive life. People with Parkinson’s and their Care Partners have extra challenges to face as they navigate life with this progressive disease that causes tremors, slowness of movement, muscle stiffness and impaired balance. For people with Parkinson’s, healthy eating is another strategy to fight the effects of Parkinson’s.

Like all of us, people with Parkinson’s should strive to eat a balanced diet of carbohydrates, fats, and protein. Carbohydrates are the body’s preferred energy source. Fats – especially healthy unsaturated fats – are also used for energy. Protein contributes to cell growth, repair and maintenance. It is also important to get necessary vitamins and minerals from fruits and vegetables to truly feel your best. Drinking water throughout the day keeps us from becoming dehydrated and helps the entire body to function optimally.

Because People with Parkinson’s already have a progressive disease to manage – it is important to try to keep other chronic diseases at bay. Vitamin E and C are antioxidants that combat free radicals (compounds that injure healthy cells) in the body. It is important that people with Parkinson’s eat plenty of antioxidant containing foods such as blueberries and spinach.

People with Parkinson’s are at a greater risk for osteoporosis and falls – which is why adequate amounts of Vitamin D and Calcium are essential to keep bones strong. The body can create its own Vitamin D from 15 minutes a day of sunlight exposure – or it can be found in foods such as salmon, pork and eggs. Vitamin D is essential for helping calcium be absorbed in the body – calcium being the primary component of bones. Good sources of calcium include yogurt, cheese, kale and spinach.

Protein serves many vital functions in the body, and it is important for People with Parkinson’s to get adequate amounts. Protein rich foods can diminish the effects of some Parkinson’s medications when they are taken together, so taking medications an hour prior to eating can help them to work most efficiently.

Fiber is the bulky, indigestible part of plants that passes through the digestive tract. Fiber absorbs water in the body and helps with regularity. People with Parkinson’s have higher instances of constipation – so eating high fiber foods such as bran cereals, whole wheat bread, beans and broccoli can help relieve this condition.

Sometimes diseases of the eye can occur in People with Parkinson’s. Beta-Carotene is a type of Vitamin A that helps maintain retina function and is found in carrots and sweet potatoes. Leafy green vegetables and egg yolks contain lutein and antioxidants that may lower the risk of cataracts and macular degeneration.

Finally, People with Parkinson’s should always be sure to drink enough water. Adequate water consumption helps relieve constipation, prevents dehydration, aids in vitamin absorption in the body, and rids the body of waste.

Always consult your physician if you notice any undesired weight loss, and before you make any changes to your regular eating habits.


Carisa Campanella, BA, AS, is an ACE Health Coach and ACSM Personal Trainer. She is the Program Manager at the Neuro Challenge Foundation for Parkinson’s. Neuro Challenge provides ongoing monthly support groups and educational programs, individualized care advising and community resource referrals to help empower people with Parkinson’s and their caregivers.

A man having question

Sports Nutrition Myths: Busted!

Keeping up with the latest science-based sports nutrition recommendations is a challenge. We are constantly bombarded with media messages touting the next miracle sports food or supplement that will enhance athletic performance, promote fat loss, build muscle, and help you be a super-athlete. At this year’s Annual Meeting of the American College of Sports Medicine (www.acsm.org), a sports nutrition myth-busters session sponsored by the global network of Professionals In Nutrition for Exercise and Sport (www.PINESNutrition.org) featured experts who resolved confusion with science-based research.

MYTH: Protein supplements build bigger muscles.

Protein needs for a 150-pound (68 kg) athlete average about 110 to 150 grams of protein per day. (More precisely, 0.7 to 1.0 g pro/lb. body weight/day; 1.6 to 2.2 g pro/kg./day) Hungry athletes can easily consume this amount from standard meals. Yet, many athletes believe they need extra protein. They consume protein shakes and bars in addition to protein-laden meals. They are unlikely to see any additional benefits from this higher-than-needed protein intake. Resistance exercise is a far more potent way to increase muscle size and strength than any protein supplement.

MYTH: Eating just before bedtime makes an athlete fat. 

While it is true the body responds differently to the same meal eaten at 9:00 a.m., 5:00 pm, or 1:00 a.m., an athlete will not “get fat” by eating at night. The main problem with nighttime eating relates to the ease of over-eating while lounging around and watching TV. When your brain is tired from having made endless decisions all day, you can easily decide to eat more food than required.

That said, bedtime carbohydrates to refuel depleted muscles and bedtime protein to build and repair muscles can optimize recovery after a day of hard training or competing. For bodybuilders and others who want to optimize muscle growth, eating about 40 grams of protein before bed provides an extended flow of amino acids needed to build muscle. (This bedtime snack has not been linked with fat gain). Cottage cheese, anyone?

MYTH: A gluten-free diet cures athletes’ gut problems.

If you have celiac disease (as verified by blood tests), your gut will indeed feel better if you avoid wheat and other gluten-containing foods. However, very few gut issues for non-celiac athletes are related to gluten. FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) are often the culprit. These are types of hard-for-some-people-to-digest carbohydrates found in commonly eaten foods such as wheat, apples, onion, garlic, and milk. For example, the di-saccharide lactose (a kind of sugar found in milk) creates gut turmoil in people who are lactose intolerant. The poorly digested and absorbed lactose creates gas, bloat and diarrhea.

For certain athletes, a low FODMAP diet two or three days before a competition or long training session can help curb intestinal distress. If you live in fear of undesired pit stops, a consultation with your sports dietitian to learn more about a short-term FODMAP reduction diet is worth considering.

MYTH: Athletes should avoid caffeine because of its diuretic effect

With caffeinated beverages, the diuretic effect might be 1.2 ml. excess fluid lost per mg. of caffeine. That means, if you were to drink a small mug  (7 oz./200 ml.) of coffee that contains 125 milligrams of caffeine, you might lose about 150 ml. water through excess urine loss. But you’d still have 50 ml. fluid to hydrate your body—and likely more if you drink coffee regularly. Athletes who regularly consume caffeine habituate and experience less of a diuretic effect. In general, most caffeinated beverages contribute to a positive fluid balance; avoiding them on the basis of their caffeine content is not justified.

MYTH: Athletes should be wary of creatine because it is bad for kidneys.

Creatine is sometimes used by athletes who want to bulk up. It allows muscles to recover faster from, let’s say, lifting weights, so the athlete can do more reps and gain strength. A review of 21 studies that assessed kidney function with creatine doses ranging from 2 to 30 grams a day for up to five and a half years indicates creatine is safe for young healthy athletes as well as for elderly people. Even the most recent studies using sophisticated methods to assess renal function support creatine supplements as being well tolerated and not related to kidney dysfunction.

Reading a nutrition label on food packaging with magnifying glass

MYTH: The vegan diet fails to support optimal performance in athletes.

Without a doubt, vegan athletes can —and do—excel in sport. Just Google vegan athletes; you’ll find an impressive list that includes Olympians and professional athletes from many sports (including football, basketball, tennis, rowing, snowboarding, running, soccer, plus more.)

The key to consuming an effective vegan sports diet is to include adequate leucine, the essential amino acid that triggers muscles to grow. The richest sources of leucine are found in animal foods, such as eggs, dairy, fish, and meats. If you swap animal proteins for plant proteins, you reduce your leucine intake by about 50%. For athletes, consuming 2.5 grams of leucine every 3 to 4 hours during the day optimizes muscular development. This means vegan athletes need to eat adequate nuts, soy foods, lentils, beans and other plant proteins regularly at every meal and snack.

Most athletes can consume adequate leucine, but some don’t because they skip meals and fail to plan a balanced vegan menu. Vegan athletes who are restricting food intake to lose undesired body fat need to be particularly vigilant to consume an effective sports diet. Plan ahead!


Nancy Clark, MS, RD counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). The newest 6th edition of her best selling Sports Nutrition Guidebook is being released in July 2019. For information about readymade handouts and PowerPoint presentations, visit www.NancyClarkRD.com. For her popular online workshop, see www.NutritionSportsExerciseCEUs.com.

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The Still Life

I am not referring to the still life of the 17th century, a tradition that originated with Dutch painters and spread throughout Europe, where often there was a religious dimension.[1] I am also not referring to still in the sense that Don Henley encapsulates in his 1994 song, “Learn to Be Still.”  Nor am I insinuating an exploration of the archaic use of still that suggests sedentariness. Quite the opposite, although closely connected to the latter.

It’s 5 a.m. I am seated in a plush black leather chair situated in the corner of a soft-red lighted area of our home designed as a small bistro. The Baja-blue ceramic tea pot is on the stove and I am reading the New York Times. A headline captures my immediate attention: “Lifeguards for Life (Or as Long as Possible).”[2] In a 1,122 word story covering lifeguards who are greater than 60 years of age, the word “still” was used 5 times. That is, every 224th word of the story is “still.” My feelings of calm and delight suddenly mix with this internal emblazoned visceral change that underwent chemical synthesis and became a substance fueling the writing this article. I am perplexed at the use of the word still when describing people who are greater than 60 and the daily activities in which they may be involved.

Although well intentioned, selection of the word still is a curious linguistic choice.  This particular article did a beautiful representation of using two-polar opposite definitions of this word: one suggesting change and the other stagnation. On the one hand “still” suggests the possibility of change. A growing or morphing into a larger state than at present. For example, there was reference in the article to the late 1950s when “surfing was still in its infancy on the East Coast.” Now, in 2017, from Kennsington Cove off the coast of Nova Scotia to South Beach, Florida, one can surf up and down the East coast and find plenty of other surfers amidst the waves. Thus, in this case, still implies growth.

Then there’s another use of still when referring to an unchanging situation. The vernacular appeal of using still as a compliment is readily apparent. As in describing Mr. Labert, “One of the oldest active lifeguards – the kind who still dash into the surf to rescue swimmers.” However, his livelihood or successes, as he ages, are redefined in terms of stagnation. Continuing to do the same activities. Use of still in this sense implies accomplishment sans change. Other elderly lifeguards are “still ocean-certified” and “still kept watch.” Still can be likened to a lexiconic hologram: it appears one way from one direction, change your position (or age) and your perspective changes, or the image changes. Faced with a continuum of age from congratulations to offense to oppressive to objectification, our language lends itself to prescribing a limiting condition: “the tyranny of still.”[3]

Some of us will reach, or have reached, an age where marks of success shift from change to stagnation. We could call this the still life. I still live alone. I still drive. I still eat by myself. I still bathroom by myself. While these are not necessarily accomplishments or accolades to be proclaimed at achieving in one’s thirties or forties or fifties, there is that pivotal age when some of the smallest tasks become trophy winning moments. These triumphs are often treated as moments to be captured on camera and lived and relived, with bystanders singing praises such as, “Yay. You are still using a fork.” A comment actually made to a hundred-year-old woman, to which she responded, “Dignity doesn’t age.”

Embedded in these still comments, intended to be compliments, are platitudes served on silver platters. Sure, they appear nice and clean and friendly, yet under the shiny shellacked surface is a sharp jab. What are we saying when we say someone is still capable of completing activities of daily living? Perhaps a round of applause that they are seemingly independent. Why then is inter dependence not congratulated?  As a species is there truly anyone who is fully independent? We all rely on someone to some extent. Taking a look across the life span, we can see a continual push to be independent. If we say, “She’s 47 and she still lives alone,” then this begs questions of “What’s wrong with her?” or simply, “Why?” However, the script and responses are very different if we say, “She’s 97 and she still lives alone.” Often, the question then becomes, “Oh, what is she doing right?” With an implied, “If I take similar measures then I too will live to be that age and be active.”

Perhaps there are more connections between the still life of the 17th century and use of the word still as we age, than is apparent on the surface. Just as with some Dutch painters in the 1600s conveying religious messages, some research suggests we become more religious as we age. Perhaps the use of still is a way of separating the worlds, between the doers and not-doings. If we are still doing something, then we are not dead. If we are still doing, then we are relevant. A good many people desire to be relevant and alive. And one can be both, without adding still into the game. Still relevant and still alive. No. Relevant and alive.


Adrienne Ione is a cognitive behavioral therapist and personal trainer who integrates these fields in support of people thriving across the lifespan. As a pro-aging advocate, she specializes in the self-compassion of dementia.

Website: yes2aging.com
Guided Meditations: insighttimer.com/adrienneIone
Facebook: silverliningsintegrativehealth

References

[1] Vincent Pomarède and Erich Lessing (Nov. 2011) The Louvre: All the Paintings.

[2] Corey Kilgannon. (July 16, 2017). “Lifeguards for Life (Or as Long as Possible).” New York Times.

[3] Bill Thomas (2015). Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life.