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Exercise Combats Frailty

/23 April 2019/ All MFN blog/

Exercise is key to maintaining muscle mass that enables performance of the activities of daily living.

US Census projections suggest that the majority of baby boomers will turn 65 between 2010 and 2030, reflecting the impending need for increasing medical care within this demographic.(1-3)

“Baby boomers are now senior boomers, and just as this group has influenced everything in the past, they will impact tomorrow’s health care services as well,” says Patrick Kearns, MD, a geriatrician at El Camino Hospital in Mountain View, California.

The health and function within this group will range from those who are extremely fit and healthy to those who are physically dependent. How an individual ages is, to some extent, determined by the cards (genes) they were dealt and, to a larger extent, how they’ve played those cards. Research confirms the relationship between living a healthful, active lifestyle and both quantity and quality of life. Proactive steps taken throughout a person’s lifetime may prevent or delay the advent of frailty.(3-5)

The medical profession continues to make significant strides in treating conditions that would have caused death years ago. And while the average life expectancy has increased dramatically since the 1900s, this increase in longevity comes with the possibility of living more years with physical limitations and reduced functional ability.(3,5)

Some studies have discovered that a sizable number of adults over the age of 65 cannot lift a 10-lb bag of groceries, walk a mile, or easily get up from a chair. One study suggests a significantly increased risk of falling for individuals who cannot lift themselves out of a chair at least eight times in 30 seconds.1 But how can frailty be prevented or even reversed?

Identifying the Problem

Anyone, young or old, can experience frailty, which is the loss of some physical function and can result from various causes. Among the most common are a chronic medical condition; loss of a sensory system; changes in medical, mental/emotional, or functional fitness status; age-related muscle loss (sarcopenia); falls; or a sedentary lifestyle.(1,3,5)

Many times a combination of these factors results in a person’s inability to function independently, leading to the classification of frailty. The term “frail elder” often refers to the role age plays in the above conditions. Most of us can visually identify a physically frail person, but currently no definitive criteria exist for defining frailty. However, some professionals are attempting to develop a universal objective definition of elder frailty traits.(3,6)

Often family members, in concert with health care professionals, are the first to recognize an elder’s decline in strength and level of independence. Assessment of diminished balance and muscle strength suggest the need to initiate a comprehensive general conditioning program.(1)

Never Too Late

A recent study published in the Journal of Aging and Health showed that a group of octogenarians involved in a 16-week program of walking or resistance training could improve significantly in strength, flexibility, agility, and balance.(1,7) Of course, prevention is cheaper than treatment, so the intervention of a well-rounded fitness program should begin long before frailty concerns emerge. Some older adults admit that if they had known they’d live so long, they would have taken better care of themselves when they were younger.

Sarcopenia plays a major role in what many believe advances functional loss and contributes to becoming frail. Studies have shown that without the intervention of progressive resistance training, lean muscle tissue loss can begin as early as the age of 30.(1,3,5) These small changes go unnoticed or are even accepted as part of normal aging until a person finds difficulty in completing simple tasks. While the outward circumference of a limb may remain the same, the interior integrity of the muscle mass is decreasing. We can visualize the muscle loss as analogous to a lean steak’s transformation to one with marbled fat. So it is with humans: A muscle biopsy shows intermuscular fat within the muscle.

Why is less muscle detrimental? One reason is that muscle tissue is the furnace that revs the metabolism, thus assisting an individual to better control body weight, which in many cases decreases the risk of type 2 diabetes, hypertension, and other metabolic diseases. An increase of only 7.7% in resting metabolic rate derived from strength training would result in an increase of 50,000 extra calories expended in one year, which could result in a loss of 14 lbs of fat (in a 180-lb person).(1,5,7)

Strong leg muscles lead to improved balance.1 Strong functional muscles enable a more active and independent lifestyle. Being involved in a sensible strength conditioning program can foster improved bone density. Wolf’s Law says the strength of the bones is in direct proportion to the forces applied to them. If a person sits during most of the day, then he or she will have bones made for that kind of lifestyle. “Use it or lose it” applies to muscle strength as well as bone strength.

The hallmark study done by Maria Fiatarone, MD, a researcher at Harvard Medical School, placed 100 frail nursing home residents aged 72 to 98 into several experimental groups.(1,3,5-7) Her research found that those participating in progressive resistance exercises improved their strength significantly vs. those who were given nutritional supplements. The strength-training group increased their overall strength by 113%; gait velocity improved significantly as well stair-climbing ability over the nonexercising groups.

The take-home message was that resistance training is superior to nutritional supplementation and is far more cost-effective.

Exercise Benefits

A review of the literature appears to prove that proper physical activity has broad and positive influences over many of the characteristics associated with normal aging. It could be said that everything that physically declines with age can be positively influenced with proper exercise.(4,8,9)

We’re all familiar with normal aging, but healthful aging often is determined by the activity or lack of activity that precedes old age. An inexpensive strategy to improve the prospects of living long and well includes a regular dose of sensible physical activity. Some commonly acknowledged benefits of a well-rounded exercise program include improved self-efficacy, metabolism, sleep patterns, cardiovascular capacity, balance, muscular strength, endurance, and movement along with reduced fatigue, depression, anxiety, and arthritic and low back pain.(1,8,9)

Designing a Fitness Program

While it’s never too late to feel great, it’s best to start early. While this article attempts to show ways to intervene with a patient experiencing some level of frailty, the best solution is to encourage patients to engage in activities that help prevent it. It’s better to do a little bit of anything than a lot of nothing. Remind patients to start slow and progress cautiously. All of the exercises suggested below can be done simply with a chair. It’s even possible to perform some of the exercises in bed.(4,8,9)

Providing motivation to embark on an exercise regimen and stick with it presents a challenge, though. Suggesting participation in activities patients don’t want to do requires patience and skill. Focus on ways to make the activities appealing while preventing injury. Matching the exercise routine to a person’s personality and physical abilities often is more of an art than a science. A good coach/teacher can motivate a patient to do something he or she doesn’t want to do—and thank the coach for it later.(4,8,9)

It’s wise for health care professionals to provide patients with guidelines of indications and contraindications related to exercise. If possible, try to match patients with suitable options within the community that match their physical abilities, personalities, and social and economic issues. Some long term care facilities offer in-house and/or programs available to local older adults.(4,6,7)

An exercise program for patients at risk of becoming frail should aim to improve functional activities of daily living. An assessment by an occupational therapist, physical therapist, or nurse should provide some direction on the major areas to be addressed. While the aim of the intervention is to improve function, make sure the person leading the session keeps some fun in functional. This may require some socializing and interacting with patients. If patients are unmotivated to perform activities or exercise, even the best program will have low compliance rates and not produce the desired outcomes. All programs should follow some type of evidence-based guidelines.(8,9)

Improving muscular strength and endurance helps enhance patients’ functional muscular endurance and strength to perform daily activities without becoming fatigued. The basic concept of progressive resistance training, commonly called strength training, weight training, or weight lifting, is to begin with a resistance that can be comfortably performed six to eight times and then continue increasing the number of times (reps) until he or she can perform the movement easily between 10 and 15 times.(6)

Once that level is attained, patients can add small amounts of resistance to again challenge the muscles. As an individual advances, another set (a grouping of reps) can be added. The number of reps and sets varies depending on the objective. Matching activities to the functional tasks a person needs to perform can involve lifting a milk jug, opening jars, getting up from the toilet, or walking outside to get the mail, for example. The goal should be to build up a reserve of strength so patients can engage in any necessary activities.(4)

Strength training can include the use of resistance bands that come in varying levels of resistance. Light water bottles, hand weights, or attachable wrist/ankle weights work well. For patients who are particularly weak, simply using the weight of their limbs is a fine starting point.(4)

Cardiovascular Fitness

Aerobic simply means with oxygen. Most exercise physiologists use the example of anything you could do while holding your breath as anaerobic while the opposite characterizes aerobic exercise. Running a 100-yard dash could be called anaerobic and walking a mile aerobic. The goal of aerobic exercise is to improve the ability to move freely without becoming winded or to execute activities that facilitate locomotion, whether it’s propelling a wheelchair farther or safely walking unassisted to the dining room. This addresses breathing function as well as aerobic exercise to assist in reducing cardiovascular diseases and burning calories. Seated aerobics, peddling a stationary bike, and even walking exercise can be suitable options.

Balance and posture exercises should aim to improve the muscles that influence posture, such as the core muscles and muscles that retract the scapula as well as muscles that promote proper neck alignment. There is evidence that improved posture translates into standing erect and improved balance.

Balance activities should include both static and dynamic movements. Physical therapists can offer recommendations on exercises to enhance balance. Experts suggest patients can begin balance work in a chair, similar to activities for spinal cord-injured and post-stroke patients, as a safe exercise method.

Comprehensive Program Design

Attempting to include all of the aspects listed above would be ideal; no one element supersedes another. However, it’s often advisable to establish a baseline of patient stamina. A comprehensive exercise class can easily include each element. An example of such a class could include five to 10 minutes of warm-up moves, five to 10 minutes of upper and lower body strength training, and five to 15 minutes of light aerobic exercise followed by some light flexibility moves. All of these can be done safely if the activities match a patient’s ability. Individualization is the key even for a group exercise class.(4)

Ideally, providers can perform individual patient assessment. Utilizing a group assessment method such as the Senior Fitness Test also can provide information on fitness levels and achievable goals.

The bottom line is that exercises and activities should be adapted to a patient’s abilities and should never exacerbate an existing condition, as patient safety is more important than any exercise. If an instructor cannot appropriately adapt the movements, then he or she is not qualified to be teaching this segment of the population.

Basic Activities

A sample exercise program to prevent and improve the status of frailty should include the following:

• Range of motion/flexibility: Motion is lotion to stiff joints. A warm-up that addresses the major joints and helps prepare the body for physical activity should last between five and 15 minutes. Include gentle range-of-motion/flexibility activities that foster functional movements, such as putting on socks and shoes or getting dressed. In the early stages, this may be the limit of a patient’s capability, so stopping here is fine.

• Muscular strength and endurance: The focus is to improve functional muscular endurance and strength to enable a patient to perform daily activities without becoming fatigued. The activities should be matched to the tasks an individual needs to perform, such as lifting, dressing, and walking.

Plan of Action

There are not enough physical and occupational therapists nor insurance dollars available to provide all the functional fitness needs of this burgeoning group of older adults. We need to have a stable of well-trained fitness professionals prepared to serve the fitness requirements of today’s elders. The medical community needs to have confidence that when they refer someone to a fitness class, the instructor will do no harm. The fitness trainers of the future should understand the diversity within this group and understand how to assess and train older adults with varying degrees of ability and fitness. It’s essential to adapt fitness methods to a patient’s abilities and conditions and focus goals on improving functional wellness.

Ideally, this article will serve as a wake-up call, not only to the fitness industry but also to health care professionals to work toward establishing national standards for trainers who work with older adults. A great opportunity will be lost if there are not enough trained fitness professionals available to serve this burgeoning demographic.

The field of gerontology promotes aging in place as a viable option. If early and comprehensive frailty prevention programs can be conducted in senior centers, hospital settings, or assisted-living communities, it could possibly delay the onset of frailty along with the associated costs.

In Conclusion

The evidence is convincing that elders’ chronic illness is a powerful driver of medical costs. Research shows that a proactive lifestyle can lessen the challenges often seen in old age. Think of prevention as wholesale and treatment as retail in helping patients understand physical maintenance of their bodies. The goal is to inspire patients to be internally motivated to take positive steps toward becoming the best they can be, no matter what their age or disability.

Originally published in Today’s Geriatric Medicine. Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.

 

References

1. Rose DJ. Fallproof! A Comprehensive Balance and Mobility Training Program. 1st ed. Champaign, IL: Human Kinetics; 2003.

2. Durstine JL, Moore G, Painter P, Roberts S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. 3rd ed. Champaign, IL: Human Kinetics; 2009.

3. National Institute on Aging. Exercise & Physical Activity. Bethesda, MD: National Institutes of Health; 2009. NIH Publication No. 09-4258.

4. Knopf K. Total Sports Conditioning for Athletes 50+: Workouts for Staying at the Top of Your Game. Berkeley, CA: Ulysses Press; 2008.

5. National Institute on Aging. In Search of the Secrets of Aging. 2nd ed. Bethesda, MD: National Institutes of Health; 1996. NIH Publication No. 93-2756.

6. Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:1-49.

7. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ. Clinical Exercise Physiology. 2nd ed. Champaign, IL: Human Kinetics; 2009:135-146.

8. Knopf K. Creating wellness. Paper presented at: Wellness Conference at the Palo Alto Medical Foundation Annual Meeting; October 2012; Palo Alto, CA.

9. Knopf K. Grow well, not old. Paper presented at: El Camino Hospital Aging In-Service; May 2013; Mountain View, CA.

fdn-pregnancy-article

Pregnancy, Hormones and Mood Swings

/22 April 2019/ All MFN blog/

Why are women hormonal when they are pregnant?  And are there different types of food that can help alleviate the symptoms?

By “hormonal”, we are referring to the severe mood swings that many women experience during pregnancy. Mood swings are also a common symptom of PMS, and in both cases, hormone imbalance is a likely cause. Unfortunately, hormone imbalance is quite common and is often a result of the unhealthy habits that our modern lifestyles promote. While there are many health factors that can cause moodiness, female hormone imbalance will be the focus of this discussion.

Female Hormone Imbalance

Estrogen and progesterone are the primary hormones involved in menstruation and pregnancy. In general, estrogen promotes tissue growth and progesterone regulates it. As such, when an imbalance between these hormones develops, serious problems can result.

Low progesterone is the most common form of female hormone imbalance and typically results in a condition called “estrogen dominance.” Even if estrogen levels are normal, they’ll still be high in relation to the low level of progesterone. This can cause mood swings, breast soreness, migraines, irregular menstruation, water retention, weight gain and much more. If left untreated, some of the major problems it can lead to include fibroids, infertility, endometriosis, cancer, heart disease and stroke.

Although the production of both estrogen and progesterone are dramatically increased during pregnancy, the severity of estrogen dominance can increase if the body is not able to meet the increased demand of progesterone. In extreme situations, this can even result in miscarriage.

What Causes the Imbalance?

The two primary factors that contribute to progesterone deficiency have to do with how it’s made and its involvement with stress.

Progesterone is synthesized from another hormone named pregnenolone which is created from cholesterol. Because we’ve been programmed to fear dietary cholesterol, many people follow a low fat and low cholesterol diet. This deprives them of the materials needed to synthesize important hormones such as progesterone. Furthermore, because cholesterol is important to the function of the brain and nervous system, the body will always sacrifice hormone production in favor of these more important areas.

Another dietary factor that contributes to estrogen dominance is the consumption of xenoestrogens and phytoestrogens. Respectively, these are chemical and plant based substances that mimic estrogen in the human body. Xenoestrogens are commonly found in plastics, pesticides, and other agricultural chemicals while soy products are notorious for containing phytoestrogens. This is just one of many reasons why it’s important to eat organic food, avoid storing your food or water in plastic, and minimize your consumption of soy products.

The Contribution of Stress

Finally, stress is a major contributor to progesterone deficiency. Cortisol, the body’s primary stress and anti inflammatory hormone, is derived from progesterone. As such, chronic exposure to stress will greatly reduce the availability of progesterone for other purposes. Furthermore, common sources of chronic inflammation such as infection and food sensitivities will do the same.

Many of us live with excessive stress, eliminate saturated fat and cholesterol from our diets, eat conventionally farmed foods that are laced with chemicals, and unknowingly eat foods that we’re sensitive to. In fact, this typically occurs on a daily basis. Each of these factors can cause estrogen dominance and modern society promotes all of them!

Adrenal fatigue is another example of how modern living promotes hormone imbalance and poor health. And it plays a role in estrogen dominance as well.

Regaining Balance

The question asked assumes that eating specific foods can resolve all of this. While diet is part of the solution, it’s far from being the complete solution. Searching for a particular food or supplement to resolve a specific problem is nothing more than a natural form of chasing symptoms. As always, the solution to all health problems begins with living a lifestyle that incorporates the 7 foundational factors of optimal health.

Because cholesterol is a precursor to many essential hormones, it’s important to get past the fear that dietary cholesterol and saturated fat cause heart disease. For further information about the fallacies of this belief, read The Cholesterol Myths by Uffe Ravnskov MD, PhD.

A few good sources of saturated fat and cholesterol include beef, pork, butter, ghee, and eggs. Be sure to get these foods from quality sources, and consider following the Metabolic Typing Diet to understand what quantities of these foods would be best for you.

In chronic cases of hormone imbalance where progesterone is used excessively to produce the cortisol needed to handle frequent stress and inflammation, the body’s preferred pathways of hormone synthesis can become altered indefinitely. In such cases, lifestyle improvements are still necessary, but often not enough.

Supplementation of bio-identical hormones is often needed to re-establish the proper pathways. However, for this to happen, any existing food sensitivities or chronic infections must be addressed as well. For this type of treatment to be effective, and also safe, proper testing is absolutely essential.

Hormone Balance is Just One Part of Functional Nutrition. 

Integrate Functional Nutrition Into Your Services. Functional Diagnostic Nutrition (FDN) offers a certification for professionals with a passion for helping others and who is willing to walk-the-talk. Helping others to regain health, regardless of their starting point, requires only the proper training and leadership. Click here to learn more about the FDN Certification course.

Originally printed on the Functional Diagnostic Nutrition blog. Reprinted with permission.

The mission of Functional Diagnostic Nutrition is to educate as many people as possible about how to get well and stay well naturally, so that they may, in turn, educate others. FDN founder Reed Davis is a Certified Nutritional Therapist and Founder of the Functional Diagnostic Nutrition® (FDN) Certification Course. Reed is known as one of the most successful and experienced clinicians in the world today, having provided functional assessments to over 10,000 clients for hormone levels, bone density testing, adrenal function, digestive problems, immune system and detoxification issues as well as testing for pathogens, food sensitivities and many related health problems.

mountain

What Will You Leave Behind?

/19 April 2019/ All MFN blog/

I can’t quite remember where I heard it, but somewhere I once heard someone say that their deepest desire in life is to not leave an ounce of potential behind when they’re gone.

It made me re-evaluate how I live in each major area of my life – health/fitness, relationships, business, finance, and much more. It still helps me focus on constant improvement in each area.

Also, it’s important to consider the legacy you will leave behind. Likewise, how do you want to be remembered?

If you get one body in this lifetime, do you want to give it the best care and the attention that it deserves? Or do you want to neglect it, to take it for granted?

I want you not only to leave an incredible legacy behind in every area of your life, but I also want you to feel the magic of tremendous self-care, much of which happens through fitness and the choices we make regarding our health every single day.

So, tell me, what do you want to be your full legacy? And how, specifically, do you want to care for this amazing human body you have?

In conclusion, are you giving your body the chance to live up to its full potential?

Originally printed on Move Well Fitness blog. Reprinted with permission.

Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD. With almost two decades in the industry, he’s worked with a wide range of clients, including those with health challenges like diabetes, osteoporosis, multiple sclerosis, hypertension, coronary artery disease, lower back pain, pulmonary issues, and pregnancy. Maurice is also a fitness educator with Move Well Fit Academy and NASM.  

sweetener

The Not So Sweet Truth About Artificial Sweeteners

/18 April 2019/ All MFN blog/

As of 2014, approximately 2.1 billion people – nearly one-third of the world’s population – are overweight or obese; with Americans tipping the scales at over 160 million. This includes nearly 75% of American men, more than 60% of women and over 30% of children under 20 years old (1).

It’s likely you know someone who may choose to regularly consume artificial sweeteners as part of their daily meal pattern in an effort to decrease total caloric intake in order to promote weight loss or manage their blood sugar (possibly you’ve tried them in the past as well). Are they the answer to the obesity epidemic and disease prevention? What are the differences in those different colored packets anyway?

What are they?

An artificial sweetener, or sugar substitute, is any food additive that provides a sugary taste, but has significantly less associated calories, or food energy (2).

Some sugar substitutes are derived from natural sources, like stevia and monk fruit, while others are synthetic, coining the term “artificial sweeteners”.

Because they can be 200-20,000 times sweeter than sugar, smaller amounts are needed to achieve the same level of sweetness.

There are currently six artificial sweeteners approved for use in the U.S. by the Food and Drug Administration (FDA) (3). Saccharin (including the brand Sweet’N Low® and packaged in pink packets) was the first to be discovered in 1878, and after a sugar shortage following WWI, the popularity and use of artificial sweeteners skyrocketed.

The remaining five include aspartame (found in blue packets like Equal®), sucralose (marketed under the trade name Splenda® in a yellow packet), acesulfame potassium (with a brand name of SweetOne® in a light blue sachet), neotame and advantame; which are not as commonly used.

Where are they found?

  • diet sodas
  • juices and other drinks
  • reduced-calorie dairy products
  • cereal
  • condiments
  • desserts and baked goods
  • chewing gum
  • toothpaste
  • mouthwash
  • lip balm
  • medications and supplements

What are the risks?

While sucralose usage is possibly the greatest in the country (4), aspartame has been the most studied artificial sweetener.

To that point, although the FDA has said artificial sweeteners are generally recognized as safe (GRAS) for human consumption and the National Cancer Institute has concluded from research they are not linked to cancer (5), we still don’t really know if there are long-term health consequences to their use.

Sucralose may actually raise blood sugar and insulin levels, particularly in obese individuals who do not regularly consume artificial sweeteners (6). However, small research studies have determined it may not have an increased effect on people who already typically use them (7).

The CDC found that 67% of consumer complaints regarding aspartame in the 1980’s involved neurological or behavioral symptoms, primarily headaches, but also included mood changes like depression and anxiety, sleep disturbances, confusion, dizziness, seizures, abdominal pain, nausea, diarrhea and irregular menses (8).

Other studies found no connection between artificial sweetener consumption and body weight or fat mass, but some of them reported a small increase in body mass index (9).

Artificial sweeteners have also been shown to drive the development of glucose intolerance negatively impacting the microbiome (10) and reduce the amount of healthy gut bacteria (11).

In addition, they may reset our taste perception, therefore foods that are naturally less sweet tasting may not offer the same satisfaction, or “reward”, as they did before. This phenomenon may result in a person seeking out more food in an attempt to please the pleasure centers of their brain, thus potentially promoting an overweight or obese status, as well as blood sugar irregularities (12).

What to do?

As a mindful-eating practicing dietitian, I promote all foods fitting in moderation. However, I highly emphasize consuming whole foods for optimal health and wellness. If you are looking to decrease your caloric intake, but still want some added sweetness, currently stevia (found in green packets) and monk fruit (in orange) are the closest natural sugar substitute choices on the market.

Since long-term studies are still lacking on how these artificial sweeteners may ultimately be affecting us, what we want to consider more is listening to what our bodies are saying after consuming them. Do we experience any negative side-effects, like a headache, bowel pattern changes or the desire to eat more of something since it may claim to be sugar-free, even though we are no longer physically hungry?

Get more on this topic! 

Join Regina for her upcoming webinar, The Not So Sweet Truth About Artificial Sweeteners.

Regina Saxton is a Registered Dietitian Nutritionist specializing in intuitive eating behaviors helping women develop a healthy relationship with food and their bodies while managing weight and disease for optimum health. She has a private practice out of Georgia and offers virtual nutrition coaching nationally. Visit her website for more information, reginasaxton.com

Exercising woman

Lymphedema: Personal Trainer Perspective

/17 April 2019/ All MFN blog/

Cancer surgery and treatment often results in survivors suffering debilitating physical impairments. These can often be ameliorated by a good exercise program that has the added benefit of helping survivors to engage in those activities in which they participated prior to their diagnosis. This article addresses some of the physical side effects cancer survivors may face, including lymphedema and a series of safe and effective techniques to restore functional fitness for those with or at risk for lymphedema.

feel better

Surgery, chemotherapy, radiation, and hormonal therapy have side effects, which exacerbate the problems faced by cancer patients. Surgery can create adhesions that can limit range of motion, and cause pain, numbness and tightness. Removal of lymph nodes creates scars and may decrease range of motion. Radiation can cause fatigue, tightness and stiffness. It also can increase the risk of developing lymphedema. Chemotherapy may affect balance, a patient’s immune system, and cause neuropathy, fatigue, sarcopenia, and anemia. Hormonal therapy can cause joint pain and early menopause and the side effects associated with menopause.

Before beginning a cancer exercise program, a patient must receive medical clearance. A medical history, base line range of motion and girth measurements, and a general fitness assessment are taken. It is important to note that many exercises and movements may be contraindicated based on a person’s fitness assessment, medical conditions, and particular surgery. There are different exercises necessary for each type of reconstruction. For those who were active prior to surgery it is imperative to slowly work back up to the previous level of activity. It is not wise to go back to a gym and immediately continue with a pre-cancer exercise routine.

Research has shown that exercise is safe for cancer survivors, even those with or who are at risk for lymphedema. Dr. Schmitz stresses the importance of starting slowly and using proper form with a well trained certified professional. Her study demonstrates the importance of exercise after cancer with slow progressive improvement in order to decrease risk of lymphedema. The research shows that breast cancer survivors no longer have to give up activities that they enjoy doing and avoid activities of daily living. Aerobic exercise is essential to good health and we advise a patient to walk as much as possible. Initially, one might start by walking around their house or up and down their block and then slowly increasing the distance walked. Many physicians recommend that their patients try to walk during chemotherapy. This may decrease fatigue. If using aerobic equipment, make sure not to grip on the railing.

Unfortunately, there is no way to know which patients with lymph node dissection will get lymphedema. This makes it imperative to follow the established guidelines and take a prudent approach to exercise. Patients who have lymphedema need to progress slowly and use a properly fitted garment. Our goal is to promote physical activity without exacerbating lymphedema. Severe range of motion issues and cording problems are referred to lymphedema specialists. Moreover, measurement of the limbs that are at risk for lymphedema are performed frequently to make sure they have not changed in size. Symptoms can be managed easier if they are addressed promptly. Progress is monitored in order to make appropriate modifications to a patient’s program. It is important to learn the right exercises for a patient’s particular situation and how to do them properly and with good form. The patient should learn which exercises to perform, the sequencing, and quantity of repetitions. Exercise smartly and under professional guidance!

Lymphedema can be debilitating and painful and can affect the emotional health of the patient. Our bodies work better if engaged in regular physical activity, but it must be done in a safe manner if lymph nodes have been removed or radiated. A cancer fitness program for someone with lymphedema should begin as an individualized program. The patient must be supervised to make sure there are no subtle volume changes to the limb. Ultimately, we want a patient to be able to exercise on his or her own.

The starting point is a low impact exercise program, performing range of motion stretches and techniques to improve venous drainage. First, we elevate the affected area above heart level. Over time, stretches are incorporated until a patient can achieve 80% of range of motion. At that point, we start adding strength training. A stretching program for those with upper body lymphedema begins with moving or stretching the neck and shoulder areas. If a patient is still healing from breast cancer surgery, begin with pendulum arm swings. The arm is then moved and stretched in all directions, going across the chest and behind the head and back. Stretches that move the arms in shoulder flexion, extension, abduction, and adduction are added. Finally internal and external rotations are addressed. Patients suffering from fatigue can perform many of the stretches while in bed. An easy-to-follow DVD is Recovery Fitness Simple Stretching, which can be found on www.recoveryfitness.net.

All of the exercises incorporate abdominal breathing, which can stimulate lymphatic drainage. This intra-abdominal pressure may help move sluggish lymph fluid, stimulate lymph flow, and act as a lymphatic system pump. This type of breathing enables oxygen to get to the tissues. Abdominal breathing and relaxation breathing, along with the proper exercises can also reduce stress, a common cancer side effect. If weak, it may be best just to stretch and breathe deeply.

Strength training may help pump the lymph fluid away from the affected limb. Exercise helps the lymphatic fluid to April / June 2013 ~ NATIONAL LYMPHEDEMA NETWORK 13 move. Muscles pump and push the lymph fluid and can help move the lymph from the affected area. Strength training may also strengthen the arm so that it can handle those activities that may have otherwise led to swelling with a greater level of ease. Always wear a sleeve and stop if there is swelling or pain. Start with light weights and slowly increase repetitions and eventually weight.

Cancer survivors should follow a systematic and progressive plan. Exercise starts with a warm-up and cool down. Begin with deep breathing. Keeping a strong core should be emphasized. It is important to remember that following treatment the body may have become weaker. Even if a patient had exercised using 10 pound weights before surgery, if one is at risk for lymphedema they must start with a light weight. We teach patients to always listen to their bodies and to stop if they feel tired or if their limb aches or feels heavy. Patients must be aware of any changes in their body.

Exercising womanProgression of exercise should be gradual. A deconditioned person should start without using any weight and concentrate on proper technique. If 8-10 repetitions can not be executed, repetitions should be decreased or the weight lowered or resistance band used changed to less resistance. The exercise routines have to be adapted for the day-to-day changes that that can affect the ability to work out. Our program will start using a very light weight, with few repetitions, typically 10. In subsequent sessions, patients can add repetitions. After performing 2 sets of 10 repetitions with no problem then a small amount of weight may be added in 1 pound increments. We also alternate between a strength training exercises with a stretch for each muscle group and to alternate an upper body and lower body exercises. Pilates exercises are great way to incorporate deep breathing with strengthening the core. The deep breathing helps to pump lymphatic fluid and will also help reduce stress.

Every patient is unique. Many patients have pre-existing medical issues. The exercise program should be modified to accommodate all body types and needs. Some might need pillows for comport or postural problems. Also if osteoporosis is an issue, a cancer therapist should have experience working with this population. Always monitor the affected limb. Look for feelings of fullness or aching. We do not want to overwhelm the lymphatic system. Drink plenty of water and stop immediately if any pain. Lymphedema patients should elevate their limbs after a session.

Learn which aerobic exercises are considered safe. Walking, biking, and swimming are considered very safe. Hot tubs, pools, and warm lakes may increase risk of infection. In choosing an activity, consider the risk of injury, prior medical condition, and fitness level. Injuries can create further complications for those with lymphedema. It is still unclear whether certain sports can be safe. For example, tennis can put a lot of stress or repetitive activity on one’s limbs. It is important to know if the activity was something performed prior to lymphedema. If the patient wants to resume the activity in order to exercise, have fun, and to have good quality of life, a sports fitness program can be instituted. This should be performed under medical guidance. In a sports fitness program, the muscles used in the sport are progressively strengthened so that the sport can be resumed. Patients must use caution as they return to a sport.

One of the most important things that can be done to decrease the risk of lymphedema is to keep weight at a good level. Those individuals with whom I have worked who have had lymphedema typically see a marked reduction of swelling in conjunction with weight loss. My students who are successful in losing weight have the most success in lymphedema control. Proper nutrition is important and decrease salt intake. Evidence suggests numerous benefits of exercise: improved fitness level, physical performance, quality of life, and less depression and fatigue. Exercise is part of a healthy lifestyle and will help in weight control and emotional health. There are exercise programs that are targeted at cancer survivors but not all of them will meet the needs of someone at risk for lymphedema.

My goal is for cancer survivors to participate in individually structured and group exercise programs at all cancer centers or facilities close to their homes.

Article reprinted with permission from Carole J. Michaels.

Carol J. Michaels is the founder and creator of Recovery Fitness® LLC, located in Short Hills, New Jersey. Her programs are designed to help cancer survivors in recovery through exercise programs. Carol, an award winning fitness and exercise specialist, has over 17 years of experience as a fitness professional and as a cancer exercise specialist.

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Nutrition Myths | Part 2

/16 April 2019/ All MFN blog/

Check out Part 1 of this article for more nutrition myths.

Looking for weight loss and overall health in the digital age can be a mixed blessing. Technology, on one hand, is a threshold to endless potential weight loss diets, nutrition facts, health and fitness approaches.

But, on the flip side, it can be difficult to know what to follow and what activities could supercharge your health and fitness.

Take a look at some common nutrition myths…

Myth#6: All sugars are bad.

Fact: Go for natural sugars over artificial sugars. Natural sugars are already present in whole foods, such as milk (Lactose), plain yogurt (Lactose), and fruits (Fructose).

Natural sugars are a better alternative to added sugars as they are packed with health-promoting nutrients such as calcium, iodine, magnesium, potassium and fiber, along with natural sugars.

Added sugar sabotages your metabolism leading to heart disease, type-2 diabetes, cancer, weight gain and other inflammatory diseases. You will be surprised to know that, even if you don’t eat sweetened foods like dessert and cookies. your foods have hidden sugar in it.

Added sugars present in your diet include high fructose syrup, maple syrup, honey and glucose. Around 70% of processed and packaged foods (breakfast cereals, soups, flavored yogurt) have added sugar in it.

As per a CDC report (1), 14% of total calories are comprised of added sugars in the Western diet. Consumption of added sugars should be less than 10% of 2000 calories/day (<200 calories).

According to the American Medical Association, 6 teaspoons of sugar (25g) for a woman and 9 teaspoons of sugar (36g) for a man is enough to add sweetness to your diet.

The Takeaway: Try to add fruits to your breakfast for sweetness. Buy plain oats over flavored oats, which are loaded with added sugar and excess sodium.

Also, you can enhance your meal with the addition of plain yogurt, not flavored yogurt. Then you can enjoy more natural sugars. Reconsider your diet and lifestyle.

Myth#7: Drink 8-ounce glasses of water daily to stay hydrated.

Fact: Our body comprises of 60% of water. You can’t store water; you need to continually replenish your body with water throughout the day.

Drinking those bland and boring 8-10 glasses of water is now revamped to include flavor-infused water, along with herbal tea and green tea.

Along with a glass of water and beverages (tea, coffee), you can add foods rich in water. Water-rich foods (pineapple, strawberry, celery, watermelon, oranges, and spinach) not only keep you hydrated, but are packed with vitamins, minerals and antioxidants.

During summer, you can drink smoothies that have a blend of fruits, vegetables, and healthy fats for a morning go-getter.

Myth#8: Organic foods are better than conventional foods.

Fact: Despite the high prices of organic foods, its consumption has increased over the last few years. Organic, as the name suggests, means more natural, ethical, and healthy, without artificial GMO seeds, pesticides, and fertilizers.

Unlike conventional processing of foods organic farming involves traditional ways and uses organic compost.

We tend to buy organic foods as they are touted to be high on antioxidants, vitamin C, and omega-3 fatty acid. There is mixed evidence about it. Hence, there’s not a significant difference in its nutritional value compared to conventional foods.

Organic cultivation has less use of pesticides, like sulphur, natural vegetable oils, and copper sulphate.

Toxic content in any food depends on concentration and vulnerability of toxins, not on how natural that food is grown.

It is healthy to eat a variety of fruits and vegetables judiciously with little significance on how it is produced.

In respect to the environment, conventional foods are better than organic foods. A study showed that organic farming requires more land to produce and emits more greenhouse gas compared to the same crop grown from conventional methods.

The Takeaway: A healthy eating approach boils down to two factors viz. expectation and personal choice.

Research says to include more fruits and vegetables in your diet to attain health benefits. Buy locally grown foods that are in season to avail every nutrient.

The organic tag is not a guarantee for your food security. Moreover, the difference in taste and quality of organic and conventional foods are minimal if any at all.

Tip: In practice, rinse the food thoroughly before consumption to remove bacteria, pesticides from outside.

Myth#9: Multivitamins protect you from diseases.

Fact: Multivitamin intake should never interfere with a nutritious, varied and regular diet. Consumption of multivitamins daily for disease prevention is a double-edged sword.

As per Harvard led Physician Health study for a period of ten years in 1000 men showed that multivitamins lowered the risk of developing a diagnosis of cancer by 8%, but not death.

In another Harvard led PHC study no beneficial effect of multivitamin supplements were observed in the prevention of heart disease and related symptoms such as heart attack, stroke or death from cardiovascular disease.

The physicians in the study had a more nutritious diet, were more physically active and were involved in less unhealthy routines compared to the general population.

The Takeaway: More than spending time and money on supplements, focus on getting essential nutrients from healthy foods that are seasonal, locally grown and home-cooked.

According to the American Medical Association (AMA) and the American Cancer Society (ACS), a healthy diet is superior to taking a multivitamin. If you already eat a healthy diet, you are less likely to benefit from extra multivitamin pills, says Dr. Kormos.

Overall optimal health is not based on a single nutrient, rather a synergy of varied nutrients from the food we eat.

Choosing nutrient-dense foods such as plain yogurt, whole grains, salmon, leafy greens, nuts and seeds, and lentils helps you meet nutrient and vitamin needs.

But, people who eat a vegan and a vegetarian diet, vitamin D may be recommended if the intake cannot be met through foods. Vitamin D supplements (600-800 IU) are good, as sources of vitamin D are of animal origin (such as tuna, fatty fish, salmon, cod liver oil, and mackerel).

Hint: You can also add Vitamin D fortified foods in your diets such as orange juice, soy milk, some dairy products, and cereals.

The decision to include supplements in your diet is personalized based on your diet and your risks. Review the recommendation of supplements with your doctor to make the important health choice, says Dr. LeBoff.

Reprinted with permission from Akanksha Srivastava. Originally printed on healthrewardz.com.

Akanksha Srivastava is a Nutritionist, content writer & a food blogger. She is a life member of the Nutrition Society of India (LM No. LM-2018-0284). Her website, healthaadhar.com, is not just a hub of information which imparts views on health & nutrition related topics backed with scientific research papers, but a journey where everyone associated is a part of an endeavor through educative article beyond health. With a significant focus on the holistic approach to health and well-being, her blog successfully forays into empowering people with healthy eating behavior.

References

  1. https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html
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Change, Habits, Comfort Zones and the Power of Fear

/12 April 2019/ All MFN blog/

I am a creature of habit. I have always struggled with change throughout my life. I fought it and rarely embraced it until I was forced to acknowledge I was on the wrong path and needed to make a change. In my personal life, I held onto my marriage long after it ended creating unnecessary pain and anguish for all of us. I have learned that to RESPOND to the changes in my life is a far less traumatic way to live than always REACTING to the “fluid” circumstances and uncertainties of life.

Comfort zones, habits, and fear – the “Big 3” of life’s impediments to lasting and positive change in our lives need to be embraced for what they are: “False Evidence Appearing Real” – FEAR.  I see this today as I have seen it repeatedly over the past 2 decades with my clients. We seem to end up being FORCED to change our ways rather than willingly and knowingly taking the steps necessary to move us forward to a more fulfilling life. Let’s take a look at a model for change that has begun to work for me.

The principle behind change is that the universe is always in a state of flux. Nothing in this reality remains the same – especially as we age. One of my former teachers stated that “the only constant in the natural order is change” and yet we fight the changes in our lives and often label them “bad” or “good”. Even positive change brings new stresses into our lives – stresses that can fuel our creative “juices” and enable us and empower us to grow in ways that we could barely imagine. Being willing – and ready – to embrace change allows us to imagine with feeling what is possible. This can create new paths to a future that can embolden and encourage not only ourselves but others as well.

We all have to understand that we can’t control what is NOT ours to control and “let go” while embracing what it is that we DO have the power to influence. The next steps in my journey are being written RIGHT NOW as I type these words. The same holds true for each of us so let’s be BOLD and embrace change as a friend and see what can happen when we partner with change for a higher purpose.

Habits and comfort zones rely on each other to keep us from fulfilling our promise. I have lived for years with the notion that I didn’t possess the “right stuff” to leave a lasting mark on this world.

My daughter Lisa is a “big thinker” and strives for excellence in all aspects of her life even as she has had to struggle over the past three years with life’s inevitable challenges at a very crucial time in her life. I am proud to say that she is confident and hopeful and continues to trust her instincts making me feel very proud of her at this critical moment in time in her life. She has what I didn’t have at her age – an indomitable spirit that continues to believe in her own innate ability and talent. To her comfort zones are only “resting places” – not residences.

I have learned that my fears were of my own making and today I know that we can only improve our lot in life if we are willing to risk acting “in spite of our fears”.  Remember that fear is nothing more than “false evidence appearing real” and our clients need that reassurance every day as they attempt to change something significant in their lives.

We need to KNOW deep inside ourselves that we indeed CAN make a difference and move our clients – and all those we want to serve – one step closer to their OWN new reality. May we each benefit from the changes that we are experiencing right NOW in our OWN lives so that we can help others achieve their own victories as well!

Article 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.

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3 Common Grocery Shopping Nutrition Tips that are NOT Better

/11 April 2019/ All MFN blog/

Are your grocery store habits keeping you from getting better health? We are all trying to grocery shop better and the tips out there currently are supposed to help you shop smarter – but are they really better? Here are 3 common grocery shopping “hacks” that actually won’t help you make better choices, and a better nutrition tip to help you shop better, more often.

Choose products with fewer (less than 5) ingredients.

This tip was created to help you make better, not perfect, packaged food choices. The idea is that if there are fewer ingredients, it should be better for you, right? Wrong. An organic frozen dinner with 25 ingredients that are whole foods, includes herbs and spices, balances nutrients etc. can be a better choice whereas there are plenty of 5 even 3 ingredient items that aren’t (hello a certain “energy” drink with artificial colors, artificial sweetener, and caffeine).

Shop the perimeter of the grocery store.

This tip was created to emphasize the ready-to-eat fruits and vegetable section (a better idea for sure), but then retailers heard this tip and saw where their customers were shopping and started planting chips and/or candy in the produce aisle (I’m not kidding, this occurred in my neighborhood grocery store!). Now, let’s not make retailers the bad guys, there is even more reason to NOT follow this tip: If you only shop the perimeter, you are missing out on a lot of better nutrition choices like organic frozen fruits/veggies (frozen is as fresh as ready-to-eat, lasts longer, and costs less typically), whole grains, spices, oils, and so much more. Every grocery store is also set up differently – so get to know where the better options are in your store.

The Veggie Choice is Always a Better Choice.

Better nutrition better be plant-based because humans (like all animals) need the nutrients that plants provide to build and repair our bodies. BUT not all plant-based products in a store are better nutrition options. Better nutrition needs to provide a balance of nutrients, from better quality ingredients. So make sure your plant choice is a) packed with whole or kitchen-processed plant ingredients b) doesn’t overdo your better amount of one nutrient group serving c) doesn’t pack in the salt, sugar or other preservatives. Some veggie burgers and bars use highly processed plant proteins or pack in 3-4 servings of carbs, now that’s not better!

Got a grocery shopping tip you are wondering about – is it better or not for your health and your wallet – share it with us on Facebook / Instagram — @thebetternutritionprogram — and we will answer it in our next round-up.

Want more Better Nutrition? Join nutrition expert Ashley Koff, RD for her webinar with MedFit:

Originally printed on ashleykoffapproved.com. Reprinted with permission.

Ashley Koff RD is your better health enabler. For decades, Koff has helped thousands get and keep better health by learning to make their better not perfect nutrition choices more often. A go-to nutrition expert for the country’s leading doctors, media, companies and non-profit organizations, Koff regularly shares her Better Nutrition message with millions on national and local television, magazines and newspapers. Visit her website at ashleykoffapproved.com. Ashley is also available for nutritional consultations.