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Prenatal Exercise: Training for the Main Event

Sheila Watkins/5 June 2019/ All MFN blog/

Say good-bye to the myth of the “delicate” condition and hello to pregnancy in the 21st Century!

Current research continues to show that women can safely exercise and maintain their fitness level during the perinatal period. The mom who laces up her sneakers instead of heading to the couch will be rewarded with a healthier pregnancy and a healthier baby.

Pregnant woman doing yoga with a personal trainer Pregnancy is a time of excitement, uncertainties, fears, and many profound physical and emotional changes. This “season in life” affords mom a wonderful opportunity to adopt a healthier lifestyle. Starting an exercise program during pregnancy is a great way to begin and continue this healthier lifestyle for herself and subsequently for her child. With obesity on the rise in the US, it is important for everyone to increase their current level of physical activity. This is especially important for pregnant women as the results of obesity and excessive weight gain have been shown to be detrimental to both mom and baby long term.

A Historical Perspective on Prenatal Exercise Guidelines

Moms today are inundated with information regarding pregnancy and exercise. Unfortunately, a great deal of this information is outdated. It is important for women to have a working knowledge of the most current guidelines so that they can make intelligent choices regarding their exercise programs. For many years, pregnant women were advised to “take it easy” during pregnancy. Mom was advised to rest and gain weight in order to ensure a healthy pregnancy. In the 1950’s women were “allowed” to walk a mile a day for exercise and this mile was preferably “broken up” into smaller segments. The American Congress of Obstetrics and Gynecology (ACOG) issued the first formal guidelines for perinatal exercise in 1985 (1). These guidelines were highly restrictive as they were not based on extensive research and were designed for the majority of pregnant women without regard to pre-pregnancy fitness levels. Four of the original guidelines are highlighted below:

Mom should exercise at a heart rate <140 bpm.
Strenuous exercise should not exceed 15 minutes
Maternal core temperature should not exceed 38 degrees C
No supine exercise after the first trimester

A great deal of research involving both sedentary and trained subjects was published

after the release of the 1985 guidelines. This prompted ACOG to publish a revision of the original guidelines in 1994 which lifted specific limitations for prenatal exercise (2). ACOG said, “There are no data in humans to indicate that pregnant women should limit exercise intensity and lower target heart rate because of adverse effects.” In this revision, there was no mention of the 140 bpm maximal heart rate or an exercise limit of fifteen minutes. Women were advised to use the “talk test” and “perceived exertion” as ways to measure exercise intensity. We were making progress! Although the 1994 guidelines were a refreshing change in the right direction for ACOG, they still did not address the pregnant athlete. In 2002, ACOG published “Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion 267” (3). In this publication, which was reaffirmed in 2009, ACOG recognized that “in the absence of contraindications, pregnant women should be encouraged to engage in regular, moderate intensity physical activity to continue to derive health benefits during their pregnancy as they did prior to pregnancy.” This revision focused more on the athlete as well and was the first formal recommendation by an American physician group to include prenatal exercise. The major points of the 2002 update include:

Previously sedentary women and those with any medical or obstetrical problems should obtain medical clearance before embarking on an exercise program; NO PRENATAL CLEARANCE, NO EXERCISE, NO EXCEPTION.
Thirty minutes or more of moderate exercise daily, or on most days of the week is recommended. This brought the exercise guideline for pregnancy more in line with the ACSM guidelines for the general population.
Competitive and recreational athletes with routine pregnancies can remain active, “listen to their bodies” and modify their exercise routines if medical necessity arises.
Physically active women with a history of or risk for preterm labor or fetal growth restriction should reduce their activity in the second and third trimesters.

In 2006, the “ACSM Roundtable Consensus Statement: Impact of Physical Activity During Pregnancy and Postpartum on Chronic Disease Risk” was published (4). This report, based on an analysis of the most current research by a panel of scientific and clinical experts, supported the safety and long term benefits of prenatal and postpartum exercise for both mom and baby. Some of the benefits highlighted in this report and other studies show that exercise:

Reduces the risk of preeclampsia (a condition marked by high blood pressure, protein in the urine and marked fluid retention in the mom which can lead to serious maternal and fetal complications).
Treats or prevents gestational diabetes, the diabetes of pregnancy. For some women exercise alone may stabilize blood sugar. Moms with gestational diabetes are more prone to Type II diabetes later in life.
Helps manage or alleviate pregnancy related musculoskeletal issues. Exercise may help with low back pain, urinary incontinence, abdominal muscle and joint and muscle issues.
Links breastfeeding and postpartum weight loss. Weight loss can occur with moderate exercise and caloric restriction without affecting the quantity and quality of breast milk or infant growth.
Positively impacts mood and mental health. Exercise is a “mood elevator.” It reduces stress, fatigue, anxiety and improves self-image.
Baby’s health and development: The panel advised that beginning or continuing a prenatal exercise program had both short and long term positive effects.

Beautiful pregnant woman thinking of her baby The most recent guidelines for prenatal exercise were included in the 2008 US Dept. of Health and Human Services Physical Activity Guidelines (5). Women who are not currently active should strive for at least 150 minutes of moderate intensity cardiovascular activity per week. This translates to 30 minutes of exercise 5 days a week, very similar to the ACOG guideline. They recommend that those women who are currently active may continue their normal routine providing there is an open line of communication with their healthcare providers

The latest research continues to showcase the benefits of prenatal exercise. A 2013 review of the international evidence reinforced the fact that women who engage in prenatal exercise have a decreased risk of developing gestational diabetes and other hypertensive disorders during their pregnancies. They are also less likely to deliver big babies (> 9 pounds). Other studies suggest that babies born to active moms are lighter and leaner at 1 and 5 years of age (6). Additional research has supported these findings and has extended the benefits to older children (8-10 year olds) (7). This is quite significant considering the fact that childhood obesity is on the rise. We now have exciting evidence that the in utero environment of exercising mothers may provide long term effects for their offspring with regards to bodyweight and body fat. Prenatal exercise may also boost babies’ brain activity. Canadian research has shown that babies of exercising moms had greater brain activity 8 – 12 days after they were born, as evidenced by an increased ability to process repeated sounds (8). This was the first study to link prenatal exercise with babies’ brain development.

In 2015, ACOG released two new publications, “Obesity in Pregnancy,” Bulletin Number 156 (9) and “Physical Activity and Exercise During Pregnancy and the Postpartum Period,” Committee Opinion Number 650 (10). Both publications emphasize the need for regular exercise to prevent or combat excess weight gain and /or obesity in the perinatal population. Greater than half of the women of childbearing age in the US are overweight or obese. Obesity in pregnancy is associated with significant risks for both mother and baby. Bulletin 156 authors wrote, “Optimal control of obesity begins before conception. Weight loss before pregnancy, achieved by surgical or nonsurgical methods, has been shown to the most effective intervention to improve other health problems.” The updated Bulletin 156 recommendations include:

Behavioral interventions that utilize both diet and exercise can improve postpartum weight loss better than exercise alone
BMI should be calculated at the first prenatal visit and used to counsel women on diet and exercise utilizing the Institute of Medicine Guidelines for prenatal weight gain
Small preconception weight losses in obese patients can improve pregnancy outcome
Losing weight between pregnancies in obese patients may decrease the risk for a large-for-gestational-age baby in a subsequent pregnancy

Pregnant women doing squatting exercise. Pregnancy is an ideal time for maintaining or adopting a healthy lifestyle. Recommendations from ACOG Committee Opinion Number 650, “Physical Activity and Exercise During Pregnancy and the Postpartum Period” include:

Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.
A thorough clinical evaluation should be conducted before recommending an exercise program to ensure that a patient does not have a medical reason to avoid exercise.
Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.
OB-GYN’s and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.
Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being.
20-30 minutes of moderate intensity exercise per day, on most or all days, is recommended.
Exercise intensity should be monitored by RPE and the “talk test.” Suggested RPE is 13-14 on a 6-20 scale.
Women are encouraged to stay well hydrated, avoid long periods of lying supine and cease exercise if they have any warning signs (see below).
Women who were sedentary before pregnancy should gradually progress their exercise programming
Women who were regular exercisers prior to pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high-intensity exercise programs, such as jogging and aerobics, with no adverse effects. High-intensity or prolonged exercise in excess of 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the exercise session, is essential to minimize any risk.\Contact sports, activities with a high risk of falling, scuba diving, sky diving and “hot yoga” are not recommended

Warning Signs and Symptoms to Discontinue Exercise (11)

If a woman experiences any of the following, she should cease exercise and contact her health care provider as soon as possible:

Vaginal bleeding or fluid leakage
Shortness of breath prior to exertion
Pelvic pressure or cramps
Dizziness
Headache or any vision problem
Pain of any kind
Uterine contractions
Muscle weakness
Calf pain or swelling
Preterm labor
Decreased fetal movement
Chest pain
Temperature extremes (hot or cold; clammy)
Nausea / Vomiting

As a result of almost 30 years of research showing the benefits of prenatal exercise, we have seen a substantial increase in the number of motivated personal trainers who are certified to work with this very special population. No two pregnancies are the same and no two prenatal fitness programs should be the same. Trainers certified in perinatal fitness and wellness possess the knowledge and skills to design and implement individualized programs to help mom prepare for the “marathon of labor” and the “tasks of mothering” after the baby is born.

Join Sheila for her upcoming webinar:

Sheila Watkins is a perinatal fitness specialist with over 25 years of experience training 2500+ pregnant and new moms, and educating hundreds of fitness instructors, health professionals, and childbirth educators on the rapidly changing field of perinatal fitness. She is the creator of Healthy Moms® Fitness Programs to provide safe and effective group exercise classes and personal training for new and expectant moms, as well as education and training in the field of perinatal exercise for fitness professionals, childbirth educators and other health professionals.

References

ACOG. The ACOG Guidelines for Exercise During Pregnancy and Postpartum; Home Exercise Programs, 1985.
ACOG. Exercise During Pregnancy and the Postpartum Period. ACOG Technical Bulletin, No.189, February 1994.
ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee Opinion, No. 267, Washington, DC: ACOG, January 2002 (reaffirmed in 2009).
Pivarnik, J. et al. American College of Sports Medicine Roundtable Consensus Statement, June 2006.
http://www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html
Mudd LM, Owe KM, Mottola MF, Pivarnik JM. Health benefits of physical activity during pregnancy: an International Perspective Med Sci Sports Exerc. 2013 Feb;45(2):268-77.
Pivarnik. J. and Kuffel, E. ACSM Sports Medicine Bulletin; Active Voice: More Maternal Physical Activity May Lead to Leaner Pre-Adolescent Children; June 20, 2010.
http://www.nouvelles.umontreal.ca/udem-news/news/2013-exercise-during-pregnancy-gives-newborn-brain-development-a-head-start.html
ACOG. Obesity in Pregnancy. ACOG Practice Bulletin, No.156, December, 2015.
ACOG. Exercise During Pregnancy and the Postpartum Period, ACOG Committee Opinion, No. 650, December 2015
Watkins, Sheila S. “Healthy Moms@ Perinatal Fitness Instructor Training Manual.” 2013.

Why Exercise When You Have Cancer?

Robyn Kade/22 May 2019/ All MFN blog/

Exercise is important for everyone even individuals who have cancer. It is important to understand your body and know what you can do. An Exercise Specialist can help you to figure out an exercise plan that works for you. Everyone is unique and therefore needs an individualized exercise program.

It is important to notify your Exercise Specialist when you have treatments. The exercise program may need to be modified for a few days after treatment. Modification is important to help preserve energy and wellbeing. You may need to do two sets of an exercise instead of three for a training session or two. Exercise can help you to stay strong and relieve stress even if you are only able to do twenty minutes every other day.

There are also some precautions to take. While exercising, you may want to wear gloves. Wearing gloves helps you to keep your hands clean during workouts. This is important because the immune system is already weakened. Wiping equipment before use will also help you to be as clean as possible. It is important to wipe mats and dumbbells as well.

Start your exercise program slowly and progress when you are ready. Fitness is an individual journey and everyone starts at a different place. It is important to not compare yourself to others and keep focused on your goals. Your exercise prescription will depend on which phase of cancer you are in.

There are many ways that exercise can benefit individuals during treatment such as: maintaining your physical capabilities, lessen nausea, maintaining independence, improve quality of life, control weight, decrease anxiety and depression, and improve self-esteem.

When you are recovering from treatment you may notice that the side effects linger. Your Exercise Specialist will adjust your program according to how you feel. Eventually, you will be able to progress and feel less fatigued. It is important, however, to continue to be active after treatments have been discontinued. Research shows that there is less chance of cancer recurrence in active individuals.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness. Contact Robyn by email at: tsmi.caruso@aol.com

References

American Cancer Society (2014). Physical Activity and the Cancer Patient. Retrieved http://www.cancer.org/treatment/survivorshipduringandaftertreatment/stayingactive/physical-activity-and-the-cancer-patient

Web MD (2007). Exercise for Cancer Patients: Fitness After Treatment. Retrieved http://www.webmd.com/cancer/features/exercise-cancer-patients?page=3

Exercise: A Must for Both MS Patients to Partake In and Healthcare Providers to Promote

Jeff Segal/21 May 2019/ All MFN blog/

Exercise is an essential component of the Multiple Sclerosis patient’s treatment plan. Unfortunately, until the 1990s, exercise was highly regarded as contraindicated to MS patients. In 1993, the first medicine was approved by the FDA for MS and in 1996; the first research showing the benefits of exercise was published by the University of Utah. These were two major breakthroughs which have given hope to a population consisting of the most common disabling neurological disease of young adults (most common onset between ages 20 and 50).

Multiple Sclerosis is a neuroinflammatory autoimmune disease of the central nervous system (CNS), consisting of the brain, spinal cord and optic nerve. The immune system attacks the myelin sheath of the nerves which insulates, protects as well as affects the signal speed from the CNS to the affected body part. Presentation of initial symptom of MS include optic nerve inflammation, poor balance (ataxia), dizziness (vertigo), weakness, double vision (diplopia), bladder/bowel dysfunction, pain, sensory loss, cognitive impairment, fatigue (most common) and a host of others including but not limited to gait impairment, depression, tremors, thermoregulatory dysfunction (autonomic) and spasticity. Because many symptoms are invisible (not outwardly visible), most notably fatigue, pain and cognitive impairment, they can affect confidence, relationships, and discourage patients from seeking treatment or help.

Currently, with more than 16 FDA approved disease modifying treatments, as well as exercise being greatly encouraged by health care providers treating MS, the face of MS is changing for the better. While exercise will not change the course of the disease progression, both aerobic and anaerobic conditioning have greatly helped reduce secondary and tertiary symptoms such as falls, injuries, anxiety/depression, impaired activities of daily living (secondary) and increase self-esteem, and independence while reducing social isolation and family disruption (tertiary).

The benefits of a safe, progressive/adaptive exercise program are improved overall fitness, ability to perform activities of daily living, moods, sense of well-being, strength while decreasing spasticity, fatigue and may prevent a host of co-morbidities. Because MS patients may be less mobile and underweight/overweight, coupled with the possibility of side effects from the use of corticosteroids, it increases the likelihood of developing conditions such as osteoporosis and diabetes mellitus. This is an even a greater reason those affected with MS should work with professionals who understand the disease.

Although many patients are still hesitant to begin an exercise program because of fear of exacerbating their condition, lack of confidence or inability to find professionals skilled to work with them, now is the best time in the history of MS treatment for both patients and professionals to be on the same page. Exercise no longer has to be an activity of an MS patient’s past. It is simply a must of the present and future.

Jeffrey Segal, owner and chief operator of Balanced Personal Training, Inc., since 2004 is a personal trainer, motivational speaker and educator who has been working in the fitness industry for over 20 years.

At the age of 25, Jeff was diagnosed with Multiple Sclerosis. He was told fitness was not going to be part of his future as an activity. Within a couple of years, Jeff was unable to walk, was visually impaired and barely able to speak. Rather than succumb to his prognosis, he fought for the life he once knew while burying his head in research. Within a year, not only could he walk, see and speak but he used his knowledge, skills and abilities to physically train others in both sickness and in health with an emphasis on Multiple Sclerosis patients.

An Intro to Chronic Conditions for the Fitness Professional

Karl Knopf/15 May 2019/ All MFN blog/

With the future of health being unknown, one thing is known — that Americans are living longer and with age often comes a chronic condition. Living with a chronic disease/condition is often an exhausting and frustrating ordeal. Too often the person may feel burdened and burned out! When the stress of pain and fatigue, coupled with normal life stresses, the client may feel overwhelmed. When the client is overwhelmed, they often don’t take care of themselves and that only contributes to more fatigue and pain. Just a few weeks of neglecting themselves can contribute to further disability. What is the goal of the fitness professional – be positive and supportive and don’t contribute to making they condition worst.

The 3 E’s of Fitness Therapy

Your job as a fitness therapist is the 3 E’s: Educate, Empower and Encourage.

Educate yourself and client about their condition and effects their medications may have on exercise performance. Stay abreast of corrective exercise research. Knowledge is power!

Empower clients to be their own best advocate and to take control of their life not become a victim of their condition. Empower them to take the “dis” out of disability.

Encourage clients about ways to be the best they can be. Think of all methods to foster healthy lifestyles, provide hope and set realistic attainable goals

The purpose of this article is that knowledge is power, and the more you know about a condition, the more you will be an equal partner on your client’s health care team. Not every application is perfect for every client. Always stay alert that what is accepted as a “norm” today can change tomorrow with new research. That is why it is strongly encouraged that your client discuss their fitness plan with their medical professionals. You are not expected to know everything, but you are expected to know when to seek advice!

The Fitness Therapist is first and foremost an educator of the psychomotor domain.

Do NO Harm!

Sometimes clients with a chronic condition will be afraid to embark on an exercise program in fear that it will cause them injury or more pain. They may know intellectually that they should, but the apprehension about what might occur can be paralyzing. They might tell you I know how I feel now and if I feel worst I might not be able to work or take care of my family. Your first and foremost job as a fitness therapist is to DO NO harm and NOT make matters worse. This is why having the client get prior approval and recommendations from their health professional can go a long way in motivating the client. In order to overcome a chronic condition, ask your clients to re-define their paradigm and focus on what they can do rather than what they cannot do! Ask them to think about the benefits of your successes.

Unfortunately, many people with a chronic condition are fearful that exercise may aggravate their condition, so they play it safe and do nothing. Too many people give up on an exercise program long before they experience the benefits of what regular exercise can provide. Be sensitive to your client’s concerns. Never minimize their condition, by saying, “You do not have it so bad I have a friend with ______ and she is doing fine.” What might be a small issue to one person could be a major issue to another. Always start the person where they are at and progress with care from there.

Very often improved fitness empowers the person with a chronic condition to live a richer and fuller life. Ask the client to decide what they want as an end goal of their exercise program and then design the program with small attainable steps to match their goals and abilities. Too often when a person with a chronic condition has lost control of their lives, everybody is telling them what medications to take, what to do and not do. Remind the client that they are the Captain of their wellness ship. You, their doctor and their family can be cheerleaders but they are the Captain.

As their personal trainer, do your best to make their body the best it can be. Never make promises that your program will cure them. Stay alert that many chronic conditions will ebb and flow with periods of exacerbations and remissions. While study after study supports that exercise, when done properly and prudently, produces good outcomes, exercise is never a replacement for medical care.

Regular exercise is therapy for the mind and body.

Some experts project that soon the integration of health care, fitness and wellness will intersect. The anticipated model of wellness and healthcare foresee the role of medicine will be to heal and fitness/wellness to restore health and vitality to those who participate in pro-active lifestyle.

Working definition of Wellness includes attention to the mind, body and spirit.

Today, doctors understand the importance of both passive therapies and rehabilitative exercise. While medical science continues to make great advances in surgical and pharmacologic treatments, exercise physiologists are also proving that simple interventions, such as proper body mechanics and corrective exercise, can play a significant role in decreasing the incidence and severity of orthopedic conditions and other chronic conditions. One of the goals of fitness therapy is to maximize the potential for full function and minimize the chance of re-injury.

Keep in mind that not every exercise is correct for every person or every condition. Depending upon diagnosis, certain movements will not be best for your client. Every program for a person with a chronic condition should be individualized and adapted as needed.

One size does NOT fit all in Fitness Therapy. The cookie cutter approach has no place in fitness therapy! Make the corrective exercise session a positive experience so the client will want to continue to make fitness an important aspect of their treatment plan.

It is important to stay mindful that “Recovery” of a condition may take weeks or even months depending upon the diagnosis or severity of the problem. Also, in the case of some chronic conditions, maintaining is all that can be hoped for. Slow and steady is the best approach. Progressing too quickly will only set the person up for re-injury. As the client embarks on the recovery process, you need to encourage clients to be their own health advocate and wellness trainer.

Exercise: The Miracle Cure All?

It can:

reduce cardiac mortality by 30%
improve self-image
reduce prostate cancer progression by 50%
assist in decreasing hypertension
reduce the risk of type-2 diabetes by greater than 50 %
reduce bowel cancer by 45%.

For more information see aomrc.org.uk/publications/reports.

Some General Guidelines for Working with Clients with Chronic Conditions

The world of health and fitness is a complex one. Lack of exercise contributes to diabetes, high blood pressure and other assorted sedentary health concerns, but too much exercise causes overstress and injury to joints and muscles. While exercise can make us feel good, too much can bring on pain and soreness. The answer is to train smart. If a client is hurting, let them know it is OK to back off.

Consider asking the client to consult their health professional for suggestions regarding exercise and their condition. The information given by their health professional supersedes the information in any textbook, because the health professional is familiar with their unique situation.
Perform their exercise program when they are having the least amount of pain/discomfort. Teach the client to listen to your body and heed what it says. Keep in mind the 2-hour rule; if the client hurts more 2 hours post-exercise, back off until they are pain-free, but don’t quit. Avoid any activity that aggravates your client’s condition. If they say, “I am fatigued”, don’t force one more repetition. If they say, after a workout, “I hurt!” Back off!
Never allow the client to mask pain with pills or lotions. Pain is the body’s way of informing them that something is going on inside. To prevent a re-injury or unnecessary pain, execute motions in a pain-free range of motion with proper form. If you suspect a re-injury, ask them to schedule an appointment with their doctor. If you suspect the person is abusing pain medications, seek advice. The client is more important than any exercise program!
Encourage them to carry ID and medical information with them to sessions.
Always teach and ideal proper posture and proper body mechanics in all movements when possible given their health status.

Exercise Do’s And Don’ts for Your Clients

DO carry identification when you exercise.
DO check heart rate before, during, and after exercise.
DO listen to your body, if it hurts, STOP!
Do prepare the body for movement and stretch and relax after a session.
DO drink plenty of water before, during, and after each exercise session.
DO consider solitary versus social aspects of your chosen program.
Do teach mindfulness when exercising.
DON’T bounce when stretching, and stop a stretch if it hurts.
DONT squeeze a week’s worth of exercise into one day.
DON’T overestimate your client’s capacity to exercise. However, DON’T underestimate it either. Remind the client that the body is designed for movement, but let it adapt slowly and gradually.
DON’T allow the person to hold their breath during exercise.
DON’T allow the person to go directly into a sauna, hot whirlpool (Jacuzzi), or steam bath after exercising.
DON’T use perspiration (sweating) as an indication of how good (or bad) your workout is: we all perspire at different rates and in different amounts.

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.

Reference:

Arthritis Today Sept/Oct 2015

Chronic Pain – Healing with Release

Dr. Maria Sykorova Pritz Ed.D/3 May 2019/ All MFN blog/

Healing with release is based on the fundamental idea, backed by research, that stress, tension and trauma are both psychological and physical. Twentieth-century science is moving forward to a better understanding of the body’s deterioration. Hans Selye recognized that physiological disease could arise from psychological causes, such as stress (Somatic viewpoint). The pathology of chronic pain is associated with numerous losses such as a decline in physical fitness, disturbance of sleep, strained relationships, loss of energy and fatigue. Social isolation, loneliness and anger are often evident in people suffering from chronic pain. These negative emotions exacerbate pain and increase suffering. An estimated 33 to 35 million U.S. adults are likely to experience depression at some point during their lives.

In 2011, in the USA alone, a hundred million Americans suffer with chronic pain and the cost of lost wages translated to $ 600 billion due to employees with chronic pain calling in sick because of a pain–related condition such as:

Headache—$14 billion, only $1 billion of which consists of health care costs (Hu et al., 1999), partly because most people with migraine stop seeking medical care for the condition (Silberstein, 2010)
Arthritis—$189 billion, less than half ($81 billion) of which is for health care costs (Yelin et al., 2007)
Spine problems—$2,500 average in incremental medical costs (Martin et al., 2008); and low back problems—$30 billion (Soni, 2010) Opioid pain medication use presents serious risks, including overdose and opioid use disorder
Between 1999 and 2015, more than 183,000 people in USA died from overdoses related to opioids.

By having a flexible spine with strong hips and thighs, the human body is ideally designed for movement such as walking, running, squatting, and claiming- throwing objects and swimming. Unfortunately, during the course of a person’s life, the sensory-motor nervous system continually responds to daily stresses and traumas with specific muscular reflexes. These reflexes, triggered repeatedly, create habitual muscular contractions which cannot be relaxed–at least not voluntarily.

If stressed, traumatized, overused and repetitively used muscles are required to continue to work, the muscle begins to tighten. Once this happens the contraction of the muscle constricts the blood vessels. This reduction of blood flow reduces the oxygen to the tissue. Once a tissue is oxygen deprived, it will shut down and tighten more. This creates a negative pattern of tension, oxygen deprivation, and more tension that ultimately results in rigid muscle tone. This results in one’s postural misalignment and muscular asymmetry with symptoms such as:

Chronically hard, tight muscles
Chronic tightness or chronic inflammation of a tendon(tendinosis)
Chronic joint tension or chronic inflammation
Limited range of motion in a joint
Impingement of a nerve resulting in numbness or a tingling sensation
Compression of a disc resulting in neck or back pain
Muscle weakness in one area especially if the muscle feels tight
Consistent muscle cramping
Joint instability while performing daily tasks
Recurring muscle strain or injury to the same muscles

Muscles needed to perform regular, daily tasks (such as sitting and standing) are what we call “functional muscles”. It is more important in daily life to have functional muscles than it is to have big, hard muscles. Functional muscles require more endurance than pure strength. The focus of restoring to maintain a healthy body is to increase the endurance of those muscles which are needed to function throughout the day.

The exercises which safely activate a natural reflex mechanism calming down the nervous system which releases muscular tension are based on restoring blood flow and oxygen to tissue.

Muscular tension release can be done by manual pressure that is applied to the most superficial layer of tissue where dysfunction appears (pain, tension or rigidity). Once the tight tissue is stimulated, blood flow to the area increases and the tight tissue will become suppler. This allows the therapist to access the next layer of tissue without applying excessive pressure. This pattern is repeated until all layers of dysfunctional tissue are restored and the tight, rigid tissue is replaced with supple and mobile tissue. Supple and mobile tissue will be free of pain and have a greater range of motion.

The ability to release muscular tension independently one must learn how to align their body and mind while experiencing an alert but relax state of awareness. The SykorovaSynchro Method℠ is a phenomenal educational tool with positive impacts to patients mentally, physically and emotionally and has three stages/ progressive levels:

To balance function of sensory-motor cortex via sensory stimulation mental imagery (sometimes called visualization, guided imagery), progressive muscular relaxation and control breathing. Result is relaxed but alert state of awareness.
To enhance sensory integration/ awareness of somatic movement (movement regulated by feeling, mental imagery, sensation). Result is ability to perform somatic/ intuitive movement.
Ability to perform conscious exercises – via mental imagery, sensation. Positive result is in neuro muscular conditioning/ function – postural improvement, balance, coordination, flexibility and agility.

Research has shown that when we imagine an experience, we often have similar mental and physical responses to those we have when the event actually happens. For example, if one recalls an upsetting or frightening experience, she/he may feel their heart beating faster, may begin to sweat, and hands may become cold and clammy.

In life it is very important to minimize the negative effects and maximize the healthy, healing aspects of the mind–body connection. Each person has a unique capacity for getting better, healthier, achieving peak performance and recovering from injury.

The mind-body connection means that one can learn to use his/her thoughts to positively influence the body’s physical responses, to create abilities to be aware of their own thoughts and actions in the present, without judging them self.

Physical activity has the potential to be not just an activity of the body, but a whole body-mind-spirit system. Exercise can create a unique, beneficial mental state; and the positive mental state can enhance the benefit of exercise as a part of muscular release tension plan, which reinforces the perception that exercise is just an out of body experience. We have to remember, that our bodies are made to feel good and has abilities to heal.

A unique water exercise program based and structured on those principles will teach you to release tension, increase mobility and build endurance in muscles, tendons and joints. Those physical exercises are performed with an intense focus to utilize four principles such as breathing, proper form, control and concentration.

Exercise is performed with controlled breathing that utilizes full inhalations and full exhalations that follow a specific number of counts or rhythm. The goal is to learn how to breathe at a pace of 6 breaths a minute, about 3 or 4 seconds inhaling and 6 or 7 seconds exhaling. Once we have the slow, deep breathing accomplished, we don’t have to worry about counting and imagine breathing out any tension in the body or thoughts that get in the way of comfort and relaxation. The benefit of the water environment is tremendous. Hydraulic pressure increases human vital capacity in shoulder depth immersion 7x more than air, which promotes deep breathing and natural relaxation.
Exercise is performed with proper form or in precision. Quality of movement counts more than quantity in a mind-body exercise. Precision requires mental control. The mind has to be wholly focused on the purpose of the exercises as you perform them. The sensation of water on the skin is enhancing biofeedback’s, which helps with proper form greatly.
Neuromuscular exercise always involves the control and balance of your own body-weight. In water exercise we have interplay between gravity and buoyancy, weight and weightlessness. Control of the body can become challenging and at the same time very beneficial for overall success. By implementing movement patterns in a variety of directions, we stimulate and enhance balance, coordination, and flexibility, and inspire the neuromuscular system to become more expansive and creative. Moving in different speeds is an aspect of our physical capabilities that must be practiced in order to maintain a sense of health and well-being.
Releasing Movement is performed with intense concentration on yourself, in the present moment. The mind-body exerciser is focusing on his/her body rather than on the instructor, or on other participants. One should never be day dreaming about other things. The point-of-focus in a self- sensing exercise will differ from most other forms of physical exercise. One should be thinking about stabilizing, or anchoring, the area of the body that is NOT in motion. This is contrary to the usual Western method of trying to isolate the muscles that we perceive to be performing the movement.

Working as a health-fitness professional for the past 30 years, I am sensitive to the overall health of students/clients, and I continue to put research developments into practice. The focus in fitness these days for “Active Aging”, “Athletic Recovery”, “Chronic Pain Management”, “Healing with Release” are functional exercises – exercises that simultaneously use multiple muscles and joints to improve muscular endurance, overall strength, coordination, balance, posture and agility – to get a challenging, effective and fun full-body functional workout as well as prepare the body for every day, real world activities.

Reprinted with permission from Dr. Maria Sykorova Pritz and the Aquatic Exercise Association (AEA). The AEA is the leading educational agency in water fitness and is reaching health-fitness professionals in aquatic field. This article first appeared in the August/September 2018 issue of their AKWA magazine.

Dr. Maria Sykorova Pritz Ed.D earned her doctorate in education (specialty in Physical Education and Sports) from University Comenius in Bratislava, Slovakia. Maria is an ATRI faculty member, member of AEA Research Council, author of health fitness articles and FLS CE class, presenter for national and international fitness conferences. In her 32 years of professional career Maria is combining academic knowledge with hands on experience in functional fitness, pain management via land based and aquatic fitness. Maria’s unique training method (SykorovaSynchro Method℠) involves integration of multidisplinery techniques to achieve overall health and optimized performance. Maria is an ATRI faculty member, member of the AEA Research Committee, FLS continuing education developer, author and presenter.

Resources:

BURDENKO I, MILLER J. (2001) Defying Gravity. www.Burdenko.com.
GREGOR T., SYKOROVA PRITZ M.: (2008) Pain management and psychophysical conditioning through water exercise. Revue Mediciny v praxi, Bratislava, MAURO Slovakia s.r.o. Rocnik 6, cislo 1, 2008, s.29, 30, 38 ISSN 1336-202X
Discovery writers. (2013): Mind – Body Exercise Connection. Discovery Fit &Health; http://health.howstuffworks.com/wellness/diet-fitness/information/mind-body-exercise-connection.htm
INSTITUTE of MEDICINE (2011): Relieving Pain in America. A Blueprint for Transforming Prevention, Care, Education, and Research
JOHNSON, L.S.(2009):”Therapist’s Guide to Posttraumatic Stress Disorder Intervention”, Academic Press is an imprint of Elsevier, San Diego, California, USA.Page146-148, ISBN:978-0-12-374851-5
RAMSEY L. (2018): As America fights opioid addiction, the healthcare system is failing people who live with chronic pain: http://www.businessinsider.com/people-with-chronic-pain-during-opioid-crisis-2018-1
SYKOROVA PRITZ, M. (2007):” The effect of water exercise on selected aspects of overall health on a fibromyalgia population”. Aquatic Fitness Research Journal, October 2007, Volume 4, Issue 2, Nokomis, Florida, USA: Aquatic Exercise Association. page. 6-13
SYKOROVA PRITZ, M. (2018):” Healing with Release” AKWA: Volume 32, No 2; Brunswick GA. USA; Aquatic Exercise Association, page 31-33,ISSN: 1536-5549
STOLNICK, D.: (2000-2008) Looking for joint pain relief. Vilage Inc.
VAN HOUDENHOVE, B, – EGLE, U, – LUYTEN, P. (2005): “The role of life stress in fibromyalgia”, Curr Rheumatol Rep. 2005 Oct; 7(5):365-70.
THEARMAN, B.H.: (2007) Simple solutions to Chronic Pain. New Habringer Publication, Inc. ISBN-13: 978-1-57224-482-5.

Why For Boomers and Seniors, Price Is Not An Issue

Dan Ritchie/26 April 2019/ All MFN blog/

Watch as Dan Ritchie, co-founder and president of the Functional Aging Institute, discusses why price is less of a concern for boomers and seniors and what is of more value to them than the price itself.

Exercise Combats Frailty

Karl Knopf/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.

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.

Lymphedema: Personal Trainer Perspective

Carol Michaels/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.

Progression 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.

Change, Habits, Comfort Zones and the Power of Fear

Nicholas Prukop/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.