All MFN blog Archives - Page 46 of 140

Safely Returning to Exercise Post-COVID-19 Illness

Megan Johnson McCullough/28 April 2021/ All MFN blog/

The world of exercise and fitness was struck hard by the COVID-19 pandemic, taking access to gyms and fitness centers away for a period of time. With these facilities returning to their open availability, many individuals who personally experienced having COVID-19 have been posed with the question of when is it safe and okay for them to return to exercising again. Factors to consider include, of course, not wanting to spread the virus. But from a medical perspective, when is the body ready to safely return to exercising?

Internally, the immune system has just been through warfare depending on the strain and severity of the contracted virus, so the first consideration is feeling confident that symptoms have been eradicated during normal daily living activities, before venturing on to performing more strenuous or even mild/moderate forms of physical activity. COVID-19 affects the lungs (respiratory system), causing severe inflammation. Normal functioning of taking in oxygen and releasing carbon dioxide becomes impaired when the virus impedes by increasing fluid in the lungs and inflammation. Therefore, breathing becomes the common exercise inhibitor when first getting back into movement patterns. In fact, the CDC estimates that 3-17% of COVID-19 patients develop a complication known as Acute Respiratory Distress Syndrome (ARDS). A simple test for readiness is trying to walk quickly for 500 meters without feeling breathless or fatigue. From this self-assessment, endurance and intensity can progressively improve.

Returning to strength training can be challenging when considering cardiac output and fatigue depending upon resistance training goals and modalities. Therefore, it is best to work in the endurance phase for 2-4 weeks prior to strength or power training. This will help prepare the body for more intense training as well as let the body adjust to feelings of fatigue and breathlessness that might occur. A negative COVID test does not equate to the body returning to its normal workload capacity right away. Patience is key and although this can be a frustrating feat for athletes and avid gym-goers alike — movement is medicine but overtraining in sub-optimal conditions only prolongs the perceived setback.

There is no exact timeline upon returning to exercise post-COVID, but one way fitness professionals and individuals can gradually and safely do so is to utilize the “Rate of Perceived Exertion” to modify and accommodate for any potential risks. An example of this is the Borg Rating of Perceived Exertion (RPE), using a scale of 6-20 with 6 being no exertion and 20 being maximal exertion. Realistically working between 6 and 11 to start and pacing oneself to 12-15 and above is a good road map. Wearing a heart rate monitor can also be helpful with the understanding that if you are working at a higher level than what your lungs currently want to or can even do, taking resting breaks before returning the exercise is recommended. Exercising over time will help repair the body’s systems to again function as efficiently as before.

Megan Johnson McCullough is the owner of Every BODY’s Fit in Oceanside CA. She is a NASM Master trainer, holds an MA in Physical Education & Health Science, and is a current candidate for her Doctorate in Health and Human Performance. Megan also holds specializations in Corrective Exercise, Senior Fitness, Fitness Nutrition, Drug and Alcohol Recovery, and is an AFAA Group Exercise Instructor. She’s also a fitness model, professional natural bodybuilder, and published author.

References

Salman, D., Vishnubala, D., Le Feuvre, P., Beaney, T., Korgaonkar, J., Majeed. A. et al. (2021). Returning to physical activity after covid-19. BMJ, 372:m4721. doi:10.1136/bmj.m4721
Yale School of Medicine (2021). Challenge 5: How does covid-19 affect the respiratory system? https://medicine.yale.edu/coved/modules/virus/respiratory/

Breathing to Enhance Exercise Intensity and Recovery

Mike Rickett/27 April 2021/ All MFN blog/

For years the standard measure of resistance training was measured in volumes and loads, usually determined by sets and repetitions. Although an apparent effective way to determine success in a workout program, is it the most effective? Is there another way to determine intensity? Or better yet, a way to enhance recovery during a set? These questions are now being investigated. Some of the research is over fifty years old and more prevalent today than when it was originally hypothesized.

The recent rise of books like Breath by James Nestor, the impressive exploits of the self-proclaimed “Iceman” Wim Hof, or even the Biomimicry thinking of Dr. Robert Friedman has started questioning the traditional thinking of exercise performance, health and the immune system.

Conscious breathing, or diaphragmatic breathing, is not only for yoga and meditation but is a controlling factor in the regulatory governor for resistance training. Instead of counting reps, count breaths. Not any kind of breath, but specific breathing patterns designed for the type of exercise performance desired. For example, if you’re going to perform 12 repetitions of a specific exercise, instead you would do three +patterned breaths that would look something like this: On the first repetition, inhale through your nose (deep into your belly or diaphragmatically), hold your breath on the second repetition, and slowly exhale on the third and fourth repetitions. This allows for more controlled energy in and out!

This breathing style also has its roots in the Golden Ratio and the Fibonacci Sequence. The book Nature’s Secret Nutrient by Dr. Robert Friedman puts it in specific terms where the goal is to exhale 1.618 times longer than you inhale. This breathing protocol can be used, and has been used with success, for resistance, cardiovascular, power, and even flexibility training.

According to Patrick McKeown, the author of 7 publications, including The Oxygen Advantage, conscious breathing is the optimal way to create energy and recovery into your body. Here’s why. First when you inhale through your nose, turbinate’s filter and increase the NO3, you humidify the air, and move oxygen more slowly to allow more absorption. NO3 is vaso-dilater which increases the capacity of arteries. When you hold and exhale slowly and controlled, you create an increase of CO2 tolerance, another vaso-dilator, and increase O2 hunger so more oxygen is absorbed. This dilation of arteries leads to more energy to the muscles and faster recovery.

Another key point to conscious breathing is slower minute ventilation. This means less “dead” air space — the space in your nose and trachea that are not used in the transition of O2-CO2. For example, if you breathe 12 times a minute and inhale 6 liters of air, you would only get about 4.1 liters of air in the lungs. But, if you breathe at a rate of 6 breaths a minute you would only have 6 dead spaces with the 6 liters of air taken in, and therefore take in about 5 liters of air. Considerably more efficient!

Diaphragmatic breathing also allows for more oxygen uptake. Eighty percent of the oxygen absorption occurs in the lower half of the lungs. Therefore, if you are breathing shallowly you are doing your body a great disservice!

With diaphragmatic breathing, you engage all abdominal muscles and create a network that not only moves oxygen and CO2 but creates a stronger, more focused core for activity. Whether running, jumping, lifting, or doing back handsprings, conscious breathing creates the foundation of movement.

Even posture benefits from conscious breathing. Diaphragmatic breathing is greatly hampered if your posture is poor. Allowing an awareness of the most efficient way to breathe increases the likelihood of taking postural corrections and moving in a more anatomically correct manner. Whether exercising, sitting or even sleeping, posture plays a big role in the ability to breathe. Breathe well and you will perform and recover at a whole new level.

These benefits of diaphragmatic breathing not only add to the effectiveness of your workout and make each repetition not only more dynamic but the transition an integral part as well.

Whether it is technology, health concerns, financial issues, relationships, or even weather, we are constantly bombarded by stressors. Individually they are manageable, but together they can become a recipe for disaster. Exercise is an invaluable way to boost your immune system, energy, and most important overall mental health. Use every technique at your disposal.

The respiratory concerns created with the COVID outbreak have raised awareness of the importance of conscious breathing! Any way we can manage stress, improve the immune system and kickstart the recovery process at the same time is golden. Diaphragmatic breathing is that gold.

Mike Rickett MS, CSCS*D, CSPS*D, RCPT*E is a nationally recognized health and fitness trainer of the trainers, fitness motivator, author, certifier, educator, and the 2017 NSCA Personal Trainer of the Year. He has been a fitness trainer for more than 35 years. He co-directs with Cheri Lamperes BetterHealthBreathing.com, a conscious breathing educational program focusing on the diaphragmatic technique to enhance overall wellness. In addition, he also directs the personal training site ApplicationInMotion.com.

Percussion Therapy

Dimitrios Triantafillopoulos/22 April 2021/ All MFN blog/

Percussion therapy involves a revolutionary handheld device that jolts target areas of the body with gentle pulses of pressure. This action softens muscle tissue in areas where there is intense stiffness and build-up. It can be used to accelerate the growth and repair of tissue, increase blood flow, offer pain relief and improve range of motion & function.

Specialize and Thrive: Working with Individuals with Osteoarthritis and Joint Replacements

Dr. Evan Osar/19 April 2021/ All MFN blog/

Arthritis is the most common cause of disability in the world.³Osteoarthritis, the most common form of arthritis, has led to a dramatic increase in the incidence of hip and knee replacements in recent years. The rate of total hip replacements has almost doubled between the years 2000-2010¹and approximately 7.2 million Americans are now living with hip and/or knee replacements.⁶ While these rates have nearly doubled in recent years, the number of younger individuals (ages 45-54) having these replacement surgeries is increasing.⁵

The rapid and dramatic increase in individuals living with osteoarthritis and/or joint replacements has created a massive void between the number of people living with these issues and the number of qualified individuals to help them safely and effectively accomplish their functional goals. This void, however, has created an incredible opportunity for fitness professionals to align themselves with allied health professionals to become part of the solution. This article will discuss some recent changes in the thought process about how osteoarthritis develops, how fitness professionals are an important part of the solution, and why this is the most opportune time for fitness professionals to specialize and align themselves with health professionals.

Why do so many individuals experience osteoarthritis and what can be done about it?

While injury, overuse, age, obesity, genetics, and race have been given as possible causes, there has been a lack of solid evidence to explain why the incidence rate of osteoarthritis continues to skyrocket.^2,3,5 However, recently there have been suggestions that osteoarthritis is not as previously suggested, due only to old age or genetics. Dr. Ian Wallace, a postdoctoral researcher who has studied more than 2,000 skeletons, believes the recent dramatic increase in osteoarthritis isn’t an inevitable consequence of living longer. He believes it is more attributable to the modern decline of physical activity and is quoted as follows: “Dr. Wallace thinks the most obvious candidate to explain the increase in knee osteoarthritis is the modern decline in physical activity.”⁸

Nevertheless, it is not just about people needing more quantity of activity; it’s also about the quality of the exercise.^10,11If exercise is performed without optimal joint alignment and control, the individual is at risk for developing degenerative joint changes.^10,11Therefore, it’s imperative that fitness professionals specializing in working with individuals that have osteoarthritis or joint replacements are able to properly assess for non-optimal and inefficient posture and movement habits and from these results, develop an appropriate exercise program. Additionally, fitness professions specializing in this niche must also be able to instruct proper exercise form and understand what exercises or activities are contraindicated with these populations.^10,11

A well-designed exercise program that includes flexibility, strength, and cardiovascular exercise is required to appropriately address the postural and movement habits that contributed to the development of osteoarthritis. Likewise, many individuals will have developed compensatory patterns as a result of joint pain or loss of mobility and subsequently developed non-optimal posture and movement habits that need to be addressed.

Several organizations including the Arthritis Foundation, Center for Disease Control, and American College of Sports Medicine have created guidelines for working with individuals that present with arthritis. General recommendations include improving joint mobility/flexibility, aerobic conditioning, resistance training, maintaining a healthy weight, and consulting with a medical doctor.^2,3,13

Helping individuals develop a more optimal and efficient posture and movement strategy is one of the most effective strategies for safely working with individuals with osteoarthritis and joint replacements.^9,10,11An approach that includes using the most appropriate soft tissue release, mobilization, stretching, neuromuscular activation strategies, and appropriately progressing the individual through the fundamental movement patterns has been shown to improve joint mobility and strength in individuals with osteoarthritis as well as joint replacements.^9,10,11Additional strategies that have been shown to be helpful in improving strength and mobility and managing the symptoms of osteoarthritis include three-dimensional breathing^7,9,10,11, proper nutrition featuring a whole-foods, plant-based diet⁴, and meditation.¹⁴

The future

The great news is that there is a growing need for qualified fitness professionals to work with the increasing numbers of individuals that have osteoarthritis and/or joint replacements. However, this requires that the fitness professional have both the right education and the appropriate skillset as many of these individuals will require a thorough approach to address their specific needs and to provide them with the best functional outcomes. Organizations such as the MedFit Education Foundation are helping to create the education necessary for health and fitness professionals to develop specializations in working with special populations including the older adult populations experiencing osteoarthritis and joint replacements. Additionally, through their educational platforms and live course work, they provide fitness professionals with strategies for aligning and working with allied health professionals.

For many individuals experiencing pain or loss of function secondary to osteoarthritic changes, seamless integration between medical procedures, rehabilitation, and functional fitness is becoming a viable and necessary alternative to narcotics and surgery. Hence, the birth of the medical fitness space where fitness professionals work either in collaboration with or in the actual physical location of medical doctors, physical therapists, chiropractic physicians, and massage therapists. Clinics such as Rejuv Medical have provided a model for how to improve patient outcomes by combining the benefits of regenerative medicine procedures (Plasma Rich Protein and Stem Cell Therapy), physical therapy, and personal/group training.

Specialization in working with individuals that have osteoarthritis and/or joint replacements and working in the medical fitness space is the future. The fitness professional that acquires the appropriate education and develops a working relationship with allied health professionals will be able to attract more individuals that need, want, and will pay for their expertise. By providing a more integrated and effective approach to helping individuals accomplish their health and fitness goals, these fitness professionals will continue to thrive in the coming years.

This article was featured in MedFit Professional Magazine.

Dr. Evan Osar is an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the on-line educational resource www.IIHFE.com.

References:

American Association of Hip and Knee Surgeons. NCHS Releases Hip Replacement Data. Retrieved from http://www.aahks.org/nchs-releases-hip-replacement-data/
Arthritis Foundation. Osteoarthritis Treatment. Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/
Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
Clinton, C., O’Brien, S., Law, J., Reiner, C., Wendt, M.R. (2015). Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis. Arthritis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359818/
Dotinga, R. (2015). Number of Hip Replacements Has Skyrocketed, U.S. Report Shows. Retrieved from https://consumer.healthday.com/senior-citizen-information-31/demographic-arthritis-news-37/number-of-hip-replacements-has-skyrocketed-u-s-report-shows-696419.html
Mayo Clinic. First nationwide prevalence study of hip and knee arthroplasty shows 7.2 million Americans living with implants. Retrieved from http://www.mayoclinic.org/medical-professionals/clinical-updates/orthopedic-surgery/study-hip-knee-arthroplasty-shows-7-2-million-americans-living-with-implants
Mattek, J. and Fisher, S. (2017). What Lies Beneath: The under-realized effects of breast, abdominal, and pelvic surgeries. St. Bernardino, CA: Niche Pressworks.
McDonald, B. (2017). Skeletons say arthritis isn’t about aging – it’s about activity. Retrieved from http://www.cbc.ca/radio/quirks/august-19-2017-1.4252722/skeletons-say-arthritis-isn-t-about-aging-it-s-about-activity-1.4252755
Osar, E. (2012). Corrective Exercise Solutions for Common Hip and Shoulder Dysfunction. Chinchester, UK: Lotus Publishing.
Osar, E. (2017). Integrative Corrective Exercise Instructor Certification Program: Training the Older Client. Chicago, IL: Institute for Integrative Health and Fitness Education course handouts.
Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning
Pagnano, M., Wolfort, M., Berovitz, A. 2015. U.S. National Center for Health Statistics. Data brief; National Center for Health Statistics.
Riebe, D., Ehrman, J., Liguori, G., Magal, M. ACSM’s Guidelines for Exercise Testing and Prescription. 10^th Philadelphia, PA: Wolters Kluwer.
Selfe, TK., Innes, KE. 2013. Effects of Meditation on Symptoms of Knee Osteoarthritis. Alternative Complementary Therapies; 19(3): 139-146.

The Mental Workout: Work In Before You Work Out

Michael Mantell/16 April 2021/ All MFN blog/

Whether you want to electrify your peak performance under pressure at work or in the mud, boost your confidence and mental toughness in your gym, amplify your leadership or ignite team cohesion in your company or on the ball field, it takes motivation, goal setting, relaxation, concentration, imagery, and self-talk. It takes an exceptional mental workout to arouse and insure a picture-perfect physical workout in the fitness center, on the track or on game day, at your favorite boot camp or in your home gym.

Fitness is 100% mental. Your shoulders, arms, legs, back and core won’t do what your mind doesn’t tell them to do.

Let’s break it down. Sport psychologists and behavior science or mental skills coaches for elite amateur and professional athletes, for everyday Janes and Joes interested in promoting their optimal health and peak fitness, for children and active aging adults alike, teach these mental skills. It’s time for you to learn these mental workout skills as well as you face your own goals and hurdles.

Marcus Aurelius, the last of the “Five Good Emperors,” was the Roman Emperor from 161 to 180. He may have been the first sports psychologist, or perhaps should have been. He observed, “You have power over your mind—not outside events. Realize this and you will find strength.” He taught, “When you arise in the morning think of what a privilege it is to be alive, to think, to enjoy, to love…”

What’s this have to do with a mental workout, you ask? Everything. You see, the current model of teaching mental skills to athletes and fitness enthusiasts trains clients on how what and how they think impacts their practice and competition. It’s what I tell the clients I coach, “The link is what you think.”

Cutting-edge mental skills workout training coaches you in how to control your thoughts and images so that you’ll relax, concentrate under pressure, focus on your routine, and not worry about outside things and events—what Aurelius teaches are beyond your control.

To begin your mental workout, understand the mental workout diagram above. Events (1) don’t create your feelings (3). What you think (2) about outside events do create feelings (3). Again, “The link is what your think.”

Your feelings (3) in turn lead to your reactions and performances (4) —whether doing cross-fit, running a half marathon, in a tennis match, or in a strategic planning meeting with your business work team. Stop, or avoid, thinking (2) and you’ll have no feelings (3). Blame everything on events (1) for what you feel (3), and you are simply a victim of the conditions in your life on and off the field. It’s as if you decapitated yourself by not taking responsibility for the way you think (2) about events (1).

Here’s an example. You miss hitting a goal in your weight lifting, either the number of reps or the amount of weight. That’s the event (1). You think at #2, “No problem, I still did better than I did yesterday!” Then at #3, you feel good about yourself and you are able to stay positive in your problem-solving approach to hitting our rep or goal weight tomorrow.

Imagine this scenario. At #1, the event is, let’s say you completely missed your first lap run time. At #2 you think in black and white terms, “Why bother continuing, I’m having a completely bad day so I’m totally giving up.” At #3 you feel down, like a loser, a quitter and anxious about your next time out.

You won’t stay in the flow of your event, play in your winning zone, if you keep telling yourself that you’re going to fail, strikeout, lose, be unable to lift or get to the finish line. “The link is what you think” on and off the field. Always. Always.

See how this mental control workout works? So let’s move on. Here are the key components of a mental workout pre-game, pre-run, pre-event, pre-business meeting.

My M.I.N.D. workout includes Motivational goal setting, Imagery, Natural relaxation, Directed concentration. Of course, this all rests on accurate, positive self-talk, or “The link is what you think.”

Motivational goal setting

Yogi Berra once said, “If you don’t know where you’re going, you might not get there.” So it is with goal setting, the first set in the mental workout. Rule #1 is to be sure you set process, performance, objective, “how you perform along the way” goals, not outcome or “did I win or lose?” goals. Set goals that are SMARTER than the next guy and you’ll likely come with the gold. These goals are specific, measurable, attainable, realistic, time-focused, enthusiastically set and revisable. These are goals you control. You can’t control outcome goals, only the process and your performance along the way.

Imagery

Imagery is more than visualization in the way I coach my athlete clients. It involves all of the senses, not just “seeing” a specific performance. Take a few minutes before going to the gym, hitting the trails, diving into the mud or talking to your boss, and sit quietly with your eyes closed, doing “imbalanced breathing” into a count of, let’s say 5 and out to a count of 10. If you breath in to the count of 4, breath out to the count of 8. That’s imbalanced. Begin imagining your performances very specifically as you’d like to it to be, only see it not as a future event but rather as an event that has already happened. See yourself already in the position you’d like to be in, controlling your emotions, running along a path, lifting a certain amount of weight, slogging through mud with your team—but in the past tense, not in the future. “I’ve already accomplished a 3 second decrease in my freestyle event.” Imagine having been distracted in an event and that you handled it easily by refocusing. When it happens in reality, you’ve already been there and handled it.

Natural relaxation

Anxiety management is the key to performing well under pressure. Self-control of emotion, not labeling (thinking) outside events in a way that adds invented pressures that only exist in the way in which you think (“I MUST win this tournament or it’ll be awful!!!”), are critical to dealing with pressure, successful performance and doing your best. The best way many coaches suggest is to make practices as close to the event as possible. But there’s more. Techniques such as meditation, breathing techniques described above (“imbalanced breathing”), and relaxation training are all excellent additions to the mental workout. The latter involves a simple method of tensing a group of muscles and then relaxing them, breathing in calming thoughts and letting go of worrisome, anxious thoughts, while tensing and relaxing.

Directed concentration

Those of us who do mental performance coaching in the locker room and in the boardroom, teach concentration that is based on width and direction. Both broad and narrow concentration, and external and internal concentration play a role in your performance. Of course, which you use depends on the sport and the event you are preparing for. Football quarterbacks use broad views to focus on the location of opposing team players. Weight-lifters are quite narrow in what they concentrate on in terms of a muscle group. External concentration may help a runner at various times in a marathon race, for example turning away from internal exhaustion or fatigue late in a race. Mapping out which concentration form to use before an event will enable you to draw on it when necessary as planned.

SIDEBAR: Accurate positive self-talk

The way an athlete talks to him/herself has a direct impact on performance, both positive and negative. Taking longer than you anticipated in that freestyle event? Do you label yourself an “idiot” and predict, “I’ll never win”? If so, you won’t have to wonder much why you feel angry, hopeless and tense. Or do you tell yourself (“think”) “I’m shooting for a one-second decrease in my time and if do it like I did in practice and how I imagined it, I’ll get there.”

Are you an “all or nothing” thinker? You view a challenge in only two categories, win or lose, instead of on a continuum.

Are you a “fortune teller”? You predict the outcome of a challenging event negatively and don’t consider other outcomes.

Are you an “emotional reasoned”? You think something must be true because you “feel” it so strongly, ignoring or discounting evidence to the contrary. You reason from how you feel: “I feel like I can’t get through this, so I must not be able to.”

Are you a “mental filter” thinker? You pay too much attention to one negative detail of your performance instead of seeing the whole picture of your complete effort.

Are you a “labeler”? You call yourself global names with no real evidence. You aren’t a loser because you made a mistake, unless you call yourself that name.

Michael R. Mantell earned his Ph.D. at the University of Pennsylvania and his M.S. at Hahnemann Medical College, where he wrote his thesis on the psychological aspects of obesity. He served as the Senior Fitness Consultant for Behavioral Sciences for the American Council on Exercise, the Chief Behavior Science consultant to the Premier Fitness Camp at Omni La Costa and is a member of the Scientific Advisory Board of the International Council on Active Aging, a best-selling author, an international behavior science fitness keynote presenter, an Advisor to numerous fitness-health organizations, and is featured in many media broadcasts and fitness publications. Dr. Mantell is a nationally sought-after behavioral science coach for business leaders, elite amateur and professional athletes, individuals and families. He is listed is listed in the 2013 “The 100 Most Influential People in Health and Fitness”

The Power of Collaboration in the Quest for Cure

Phil Kaplan/15 April 2021/ All MFN blog/

Let’s start with four statements I’m willing to call facts:
1. Chronic disease afflicts the majority of American adults over the age of 45.
2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action.
3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.).

Exercise and Dementia — Does Physical Activity Provide Cognitive Benefits?

Today's Geriatric Medicine/14 April 2021/ All MFN blog/

The World Health Organization recommends regular physical exercise—both aerobic and strength training—for older individuals as a means of reducing cognitive decline.1 However, studies on the effects of exercise on cognitive function in individuals with dementia have produced mixed results. While some research indicates a positive effect, other studies have failed to find clear benefits. Thus, the question remains: Is exercise actually effective at slowing down cognitive decline in individuals with dementia?

Evidence in Favor: Cognitive Benefits in Dementia

Repeated randomized controlled trials have found that various types of exercise programs produce cognitive benefits in dementia over a three- to four-month period. For example, one trial of 40 community-dwelling adults with mild to moderate dementia examined the impact of a four-month home-based exercise intervention consisting of strength and balance training exercises plus daily walking. Those in the exercise group showed improved scores on the Mini-Mental State Examination (MMSE) over baseline as compared with controls. (2) Similarly, a Belgian trial of 25 patients with moderate to severe dementia found that a program of daily physical exercises supported by music produced significant improvements in cognition on both the MMSE and the fluency subtest of the Amsterdam Dementia Screening Test 6 compared with controls. (3) Multiple other trials have produced similar results. (4-7)

A weakness of most randomized controlled trials showing a cognitive benefit of exercise in dementia is that the study populations have been small. One 2016 trial, however, tested a moderate- to high-intensity exercise intervention in a larger sample: 200 community-dwelling patients with mild Alzheimer’s disease (AD). Participants were randomized to either a supervised exercise group (one-hour sessions three times per week for four months) or to a control group. The study found no effect on cognition in the exercise group as a whole; however, in an exploratory analysis, the researchers found a possible beneficial impact on cognition among those who were most consistent in attending exercise sessions and who exercised at the greatest intensity, suggesting a dose-response relationship between exercise and cognition. (8)

Evidence Against: No Cognitive Benefits in Dementia

Although a range of studies suggest that exercise has a benefit for dementia treatment, other studies have found no such benefit. Such was the case, for example, with a 2017 Swedish trial of nearly 200 individuals with dementia in a nursing home setting. Participants were randomized either to a four-month high-intensity exercise intervention or to a seated attention control activity. The exercise intervention had no benefit for either global cognition or executive function over control, relative to baseline measures. This was true regardless of the sex of the participants, their forms of dementia, and their cognitive levels at baseline. (9)

In the case of the Swedish trial, the researchers hypothesized that the lack of benefit could be due to the fact that the exercise intervention focused on strength training rather than aerobic exercise. But a 2018 randomized control trial from British researchers produced no better results with aerobic exercise. In this large, carefully designed trial of almost 500 participants with mild to moderate dementia, participants were assigned to either an exercise group (which included both aerobic exercise and strength training) or to a usual-care group. Not only did exercise fail to produce cognitive benefits, but those in the exercise group actually demonstrated slightly worse cognition at the end of 12 months than did those in the usual care group. (10)

Mixed Results From Meta-Analyses and Systematic Reviews

The mixed results in individual randomized trials mirror the contradictory findings of several recent meta-analyses and systematic reviews.

Specifically, a 2015 systematic review of 17 randomized controlled trials found only very limited benefits of exercise in dementia—namely, researchers concluded that exercise programs may improve ability to do activities of daily living in dementia, but that exercise provides no benefits for cognition, neuropsychiatric symptoms, or depression. (11)

By contrast, however, two other recent meta-analyses reached the opposite conclusion and have affirmed the benefits of exercise—especially aerobic exercise—for cognition in dementia. The first of these meta-analyses, published in 2016, found that exercise has a positive benefit on cognition in both AD and other dementias and that both high-frequency and low-frequency exercise programs are beneficial. (12)

The second meta-analysis with a positive result, published in 2018, included 19 randomized controlled trials involving patients with AD as well as those at high risk of AD. This meta-analysis found that exercise interventions appear to slow cognitive decline in both groups—in those who have AD as well as in those at risk of the disease. (13)

Resolving the Inconsistencies

To make sense of the inconsistencies, a first point of note is that the research on exercise and its impact on cognition in dementia is still in its infancy. “There are a relatively small amount of studies that examine this relationship and there are still many unknowns due to limitations of the current literature,” says Gregory Panza, MS, an exercise physiologist at Connecticut’s Hartford Hospital and lead author of the 2018 meta-analysis referenced previously that found a positive benefit of aerobic exercise on cognition in dementia.

Not only are there a limited number of studies, but many of those that are available have been small and of relatively poor methodological quality. In fact, the authors of the 2015 systematic review that found no cognitive benefits of exercise in dementia explicitly noted that there was considerable unexplained heterogeneity in the analysis, and that the quality of the evidence was “very low.” (11)

With respect to meta-analyses in particular, Panza, a doctoral candidate in the department of kinesiology and the Human Performance Laboratory at the University of Connecticut, notes a major weakness of several analyses that have found a lack of impact of exercise on cognition: Namely, they have included mixed samples of people with multiple types of dementia (AD, vascular dementia, and other types of dementia) and analyzed them all together as one sample, rather than examining each group separately. “This is an issue because there are several physiological differences among the different types, and as a result, exercise may be affecting each type of dementia differently,” Panza says. Additionally, previous meta-analyses usually have failed to examine moderators such as age and gender. It’s important to examine moderators, he says, “because it gives you valuable information on which variables may be influencing the impact that the exercise is having on cognitive function.”

To address these limitations of previous research, Panza and his coauthors adhered to high-quality methodological reporting standards in their own 2018 meta-analysis, suggesting that their group’s finding of a positive cognitive benefit of exercise in dementia may carry more weight than the negative findings of some previous analyses. In their study, Panza and his colleagues also conducted within-group analyses (in which they compared cognitive changes both before and after the intervention for both the exercise and control groups), rather than merely conducting a between-group analysis as had previous meta-analyses. The within-group analysis allowed the group to take into account the cognitive decline that occurs naturally with untreated disease in the control group, and this analysis revealed the novel finding that exercise could improve cognition among controls. Overall, then, the Panza’s meta-analysis offers important support to the hypothesis that exercise can indeed slow cognitive decline in dementia.

Exercise in Midlife Protects Against Dementia

In addition to the evidence about the effect of exercise on cognition in individuals who already have dementia, there’s also a body of research on the effects of mid- to late-life exercise on future risk of cognitive impairment. (14) For instance, in a longitudinal study of women spanning 44 years, high levels of physical fitness were associated with a significantly reduced risk of dementia several decades later as compared with medium levels of physical fitness; in fact, high levels of physical fitness delayed onset of dementia by 9.5 years compared with medium fitness. (15)

Some research suggests that exercise may have especially significant benefits for individuals at highest genetic risk for dementia. A 2014 study, for instance, examined a group of 97 cognitively normal adults and compared how high vs low levels of physical activity correlated with each group’s hippocampal volume over the following 18 months. Researchers found that exercise had no apparent impact on hippocampal volume in those without genetic risk. But in those at genetic risk (that is, carriers of the APOE-E4 allele), low levels of physical activity were associated with a decline in hippocampal volume. This same group of less-active, higher-risk individuals was also more likely to show both cognitive and functional decline over the study period. (16)

According to Stephen Rao, PhD, Ralph and Luci Schey Endowed Chair at the Cleveland Clinic Lou Ruvo Center for Brain Health, a main mechanism by which exercise is thought to affect dementia risk is by affecting inflammation. “What exercise seems to be doing is reducing the amount of inflammation that ultimately is a very important factor in the progression of the disease. The disease is going on for 10 to 15 years prior to its diagnosis. So anything you can do to alter processes like inflammation can make a big dent in the rate of progression of the disease.”

To be clear, not all research shows a protective benefit of exercise against dementia: One 2018 systematic review and meta-analysis found that randomized controlled trials on exercise for dementia prevention are limited, but that the existing evidence does not show any significant effect of exercise in terms of reducing dementia risk. (17)

However, several other meta-analyses have come to the opposite conclusion. A 2011 meta-analysis of 15 prospective studies that included a total of more than 33,000 subjects without dementia concluded that all levels of physical exercise, from low to high, offer a significant and consistent protective effect (-35% or greater) against cognitive decline. (18) Similarly, a 2016 meta-analysis of 10 high-quality prospective observational cohort studies found that those who were more active had a 35% to 40% lower chance of developing AD than did those who were less active. (19)

Implications for Providers

According to Panza, there are still significant gaps in the research on exercise and dementia, and there’s a need for considerably more research using neuroimaging and molecular markers to examine the neuropsychological, electrophysiological, and pathophysiological effects that exercise has on dementia. Still, he recommends exercise—especially aerobic exercise—as a valuable treatment option for those who have dementia or are at risk. “Not only is there evidence that exercise can delay the onset of Alzheimer’s disease but the physical benefits of exercise may also help their patients keep their independence longer.”

Rao likewise acknowledges the unknowns, but he too affirms that exercise appears to be an important means of reducing dementia risk. “Exercise is key. It’s never too late. Providers should really encourage their patients to exercise, within reason, within their level of fitness.”

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This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

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This article was featured in the May/June 2019 issue of Today’s Geriatric Medicine (Vol. 12 No. 3 P. 6). Written by Jamie Santa Cruz, a health and medical writer in the greater Denver area. Reprinted with permission from Today’s Geriatric Medicine.

References

1. Physical activity and older adults. World Health Organization website. http://www.who.int/dietphysicalactivity/factsheet_olderadults/en. Accessed October 30, 2018.

2. Vreugdenhil A, Cannell J, Davies A, Razay G. A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial. Scand J Caring Sci. 2012;26(1):12-19.

3. Van de Winckel A, Feys H, De Weerdt W, Dom R. Cognitive and behavioural effects of music-based exercises in patients with dementia. Clin Rehabil. 2004;18(3):253-260.

4. Kemoun G, Thibaud M, Roumagne N, et al. Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dement Geriatr Cogn Disord. 2010;29(2):109-114.

5. Arcoverde C, Deslandes A, Moraes H, et al. Treadmill training as an augmentation treatment for Alzheimer’s disease: a pilot randomized controlled study. Arq Neuropsiquiatr. 2014;72(3):190-196.

6. Öhman H, Savikko N, Strandberg TE, et al. Effects of exercise on cognition: The Finnish Alzheimer Disease Exercise Trial: a randomized, controlled trial. J Am Geriatr Soc. 2016;64(4):731-738.

7. Cancela JM, Ayán C, Varela S, Seijo M. Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. J Sci Med Sport. 2016;19(4):293-298.

8. Hoffmann K, Sobol NA, Frederiksen KS, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer’s disease: a randomized controlled trial. J Alzheimers Dis. 2016;50(2):443-453.

9. Toots A, Littbrand H, Boström G, et al. Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial. J Alzheimers Dis. 2017;60(1):323-332.

10. Lamb SE, Sheehan B, Atherton N, et al. Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ. 2018;361:k1675.

11. Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2015;(4):CD006489.

12. Groot C, Hooghiemstra AM, Raijmakers PG, et al. The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13-23.

13. Panza GA, Taylor BA, MacDonald HV, et al. Can exercise improve cognitive symptoms of Alzheimer’s disease? J Am Geriatr Soc. 2018;66(3):487-495.

14. Defina LF, Willis BL, Radford NB, et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study. Ann Intern Med. 2013;158(3):162-168.

15. Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: a 44-year longitudinal population study in women. Neurology. 2018;90(15):e1298-e1305.

16. Smith JC, Nielson KA, Woodard JL, et al. Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease. Front Aging Neurosci. 2014;6:61.

17. de Souto Barreto P, Demougeot L, Vellas B, Rolland Y. Exercise training for preventing dementia, mild cognitive impairment, and clinically meaningful cognitive decline: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2018;73(11):1504-1511.

18. Sofi F, Valecchi D, Bacci D, et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med. 2011;269(1):107-117.

19. Santos-Lozano A, Pareja-Galeano H, Sanchis-Gomar F, et al. Physical activity and Alzheimer disease: a protective association. Mayo Clin Proc. 2016;91(8):999-1020.

Rolling to Fight Arthritis!

Christine Conti/13 April 2021/ All MFN blog/

“By the year 2040, an estimated 78.4 million (25.9% of the projected total adult population) adults aged 18 years and older will have doctor-diagnosed arthritis” (Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA)

The time is now! Let’s talk about how to prevent the onset and symptoms of various forms of arthritis through myofascial release!

What is myofascial release?

It is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body that are affected by arthritis.

What is fascia tissue?

This holds the muscle together and keeps them in the correct place. The fascia separates the muscles so they can work independently of each other. The fascia provides a lubricated surface so that the muscles can move smoothly against each other. When fascia is constricted, it prevents blood flow and decreases circulation.

What parts of the body can I roll?

Head, Face & Neck
Shoulders, Chest Arms, Wrists & Hands
Upper & Lower Back, Hips, Glutes, Thighs, Knees, Ankles, Feet

What is the Benefit of Rollga Rolling My Face & Neck?

Rolling for Youth Preservation: First, let’s discuss regaining a rejuvenated look for our skin. When looking at what causes skin aging, it is a slowing down of circulation of blood. As noted by the NIH, this consists of a slowing in the circulation of nutrient-rich blood and detoxifying lymph and increasingly sluggish skin-cell turnover; the skin becomes more “stagnant.”

Rolling the Face. When “rolling” the face, be sure to apply gentle to medium pressure. The two main points of tension are in the superficial fascia and the other is lymph. Lymph is a highly underrated circulatory system within the body that is responsible for detoxifying waste from the skin on a cellular level, in addition to its many, many other functions. When holding tension in the muscles and fascia, lymph cannot move freely and do its job of clearing out waste from the tissue. The result of poor lymph flow can present as dull skin, an accumulation of blackheads and milia, and/or stubborn hyperpigmentation, and more. Superficial fascia is the layer of connective tissue right under the skin on the face. It acts as the support and infrastructure for your skin and is responsible for giving it “lift and tone.” It can also carry a lot of tension and adhesions that restrict circulation of blood and lymph. If you’ve ever used a foam roller on tight legs, think of how much softer one leg feels after rolling when compared to the unrolled leg. Foam rolling is a form of self-administered myofascial release, and that is EXACTLY what we want to do for the face.

Rolling for Neck Tension. The neck is the superhighway of ALL circulation to and from the face. A tight neck acts like a traffic jam between the body to face and back again. This prevents detoxifying lymph from draining as well as it should, and working the neck alone can be major in bringing flow and vitality back to the complexion as well as reducing puffiness in the face. Many people experience a very high level of neck and jaw tension due to everyday stress. Remember that working hard also means you must self-care harder!

Rolling to Fight Arthritis: To reduce the onset of symptoms from various diseases such as arthritis that affect facial and neck muscles, various myofascial release techniques such as Rollga rolling stimulates muscles, improves blood flow and enhances circulation. Because the jaw is a joint that is commonly affected by arthritis, myofascial release eases tension, improves joint mobility and decreases pain while speaking or chewing.

Learn more about Rollga rolling for the face and neck by contacting info@ContiFit.com

Request a manual, attend a workshop, or take an online course to learn about myofascial release with Let’s FACE it Together™ Facial Exercise & Rehabilitation!

Check out the Arthritis Fitness Specialist Online Course from MedFit Classroom.

Reprinted with permission from Christine Conti. Originally printed on rollga.com.

Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is currently writing the MedFit Network Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co.

Musculoskeletal System & Healthy Functioning: Parts that Make Up the Whole

Megan Johnson McCullough/12 April 2021/ All MFN blog/

Orthopedics 101: What makes up our musculoskeletal system? In order for our body to move, the joints, ligaments, and tendons must work together. If a person has a disease, injury, or condition, affecting any one of these parts, nerve signals are interrupted and movement is hindered.

When you think of joints, think of two parts of the skeleton being fit together. The bones are connected by joints. Joints are also called articulations. Here’s the lineup….

Bones are lined with cartilage so they don’t grind against each other; it is the covering at the end of the bone.
Bones are joined to bones by ligaments, so where two bones meet that is a joint; ligaments are important for stability.
Muscles are connected to bones by tendons.

Technically, muscles are not part of the joint, but stronger muscles help protect the joints.

You know that cracking sound we sometimes hear with movement?? When you flex or contract a muscle which takes place at the joint, the ligament stretches with that joint. When you straighten out that joint, the ligament helps to pull the joint back to its normal starting position. This means that ligaments are a major part of movement, but over time, they start to lose their elasticity. This loss of stretch makes the joint make that cracking noise from bone on bone.

Tendons are important for our range of motion with movement. They’re found in smaller joints like fingers and wrists. We use tendons a lot, especially at the wrist. A tendon’s job is to make sure you can bend your wrist, but not too far.

After years of constant use, our joints can develop arthritis. This occurs especially in the knee, hip, and shoulder areas. The knee joint has three parts, the hip has two, and the shoulder has the one that seems to be commonly injured.

Tendons and ligaments do wear out. They do not grow or repair themselves. A baseball pitcher who has repetitively used their arm and shoulder to throw the ball as hard as they can over and over again will, after a number of years, most likely experience damage to the rotator cuff. Then it’s surgery.

Long story short, our body sure does do a lot for us to produce movement. As I type and while you read, movement is occurring even in the eyes. We have to appreciate what we have and if we don’t use it, we lose it before that expiration date comes our way.

Your fitness journey is a lifelong commitment to your health, so exercise wisely, fuel your body right, and MOVE!!!!

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 is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

References