Knee Joint Health

Yes!  You can exercise before and after Gastric Bypass Surgery - learn why & how to do it safely.

Asking a severely obese person (more than 100 pounds overweight) to exercise can be like suggesting a spicy meal to someone with a stomachache.  Obesity takes a toll on almost every system in the body from your heart and blood vessels to your organs, bones and joints.  This often leads to a vicious cycle of sedentary behavior; the less you move the more you gain ...the more you gain the less you feel like moving. When you spend years being inactive you lose important physical abilities and muscle properties that allow you to stay active for life. More and more people are turning to gastric bypass surgery as a solution when traditional diet and exercise are not working. This medical intervention can offer a fresh, new start but won’t be the full solution unless coupled with a healthier lifestyle, including proper nutritional and exercise habits. 

Research studies on obesity and weight loss continue to support exercise as a key component to weight loss maintenance. A recent study done out of Brown Alpert Medical School and Miriam Hospital in Providence, Rhode Island found that of 199 patients who underwent gastric bypass, those who became more active after surgery lost more weight over one year than those who remained relatively inactive. (Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM, Maher JW, Wing RR. Becoming physically active after bariatric surgery is associated with improved weight loss and quality of life. Obesity 2009;17:78-83.(2009).

Below is a three-phase approach to exercise for those considering or recovering from a gastric bypass surgery.

Phase 1: Pre surgery (ideally 4 weeks)
Assuming you are currently inactive, the first step is to prepare for surgery by performing a pre-op ‘no sweat’ exercise program.  Now don’t let this phase scare you off, because I really mean ‘no sweat’.  This phase is simply to establish the ‘activity’ dream that lives deep down inside of your genes.  It is the preparation phase to the exercise program you will follow after surgery.  The main goal is to help you establish an exercise habit.  It starts with simply setting aside the time to exercise. It is ideal if you start this phase a month before surgery, but any amount of time will benefit you. 

Start with 10 minutes a day (most if not everyday of the week).  During those 10 minutes you can do whatever activity feels comfortable.  This might include limbering movements, light stretching, breathing exercise, chair exercise, contract and release muscle exercise, or simple closing your eyes and picturing yourself doing exercise. The key is to schedule the time like an important appointment and stick to your schedule.  It is not about the movement or exercise during this phase, it is about the commitment which will evolve into a new exercise habit in your post surgery lifestyle.  The more seriously you take this phase prior to surgery, the easier it will be to build upon it after surgery. 

Phase 2: Post Surgery (typically 4 to 6 weeks)
You will be taking in far fewer calories directly following surgery, which can sometimes cause the body to react as you were on a starvation diet. This can signal the body to burn muscle instead of fat. This is the last thing we want in the long run because it leads to a downward turn in ones natural metabolism (ability to burn calories). Regular exercise alters the metabolism so that the body burns fat instead of muscle. This is why you want to get back to regular exercise as soon as possible. Initially post surgery you can get right back to your pre-surgery ‘no sweat’ workout commitment and only perform those movements or exercises that are easy to do without interrupting the healing process. This may be limited to light stretching, deep breathing and simple contract/relax exercises in your bed.

Once you have your doctor’s permission to exercise a bit out of bed you will want to add in some light walking on level surfaces. Start off slow and easy building up to 10 minutes non-stop. You may need to wait a good four to six weeks before you can get a bit more aggressive with your cardio routine.  Always check in with your physician for approval before increasing your workout intensity.  At this point you want to focus on extending your scheduled exercise time from 10 minutes to 30. Choose activities you like that will exercise your heart and lungs while burning additional calories.  Walking and non-jarring stationary equipment like a recumbent bike or elliptical trainer will feel the most comfortable. Water exercise may also be a good option but only after all incisions have heeled completely.

Phase 3: Beyond Recovery  (a life-time commitment)
Once you have been given the green light to engage in a more complete training program you will want to include some muscle strengthening work to your cardio routine.  This is one of the best ways to insure your body maintains it’s lean mass.  When you train your muscles they get the stimulation and nutrients they need to thrive. This contributes to stronger, healthier bones and joints.  An increase in muscle strength and mass will make all of the activities you do seem easier.  This in turn will increase your ability and desire to work harder.

So during phase 3 you will want to add muscle strengthening to your weekly workouts. You can continue with your 30 minutes of cardio, most if not all days of the week and simply add in the strength training exercises on 2 to 3 of the days (non-consecutive) extending those workouts to about 50 or 60 minutes; or you can alternate your workouts and spend 30- 45 minutes everyday in either a cardio or strength routine.  Below is a sample of a balanced strength routine:

Perform 8 to 15 reps of the following exercises (choosing a resistance that allows you to sense fatigue within the final few reps)  

1. Bench chest press
2. Bent over row or seated row 
3. Overhead press
4. Biceps curls
5. Triceps kick backs 
6. Squats
7. Hamstring/leg curls
8. Calf/heel Raises
(Perform 2 to 3 sets of exercise 1- 8)
9. Supine Abdominal (compression) press into the floor – avoid traditional abdominal curls until given doctors approval – see picture A below
10. Prone opposite arm and leg reach  – see picture B below

A. Hold for 3 to 5 breaths, repeating several times
 

B. Hold for 3 to 5 breaths, repeating several times one each side 
 

• Note: To maximize muscle growth be sure to include a nutrient dense diet with enough calories, calcium and protein to support muscle development – check with a physician or dietitian familiar with your condition for specific recommendations. 

During a weight loss-training program you may find you occasionally hit a weight loss plateau.  To break a plateau try increasing the time you spend in each cardio session (moving towards 60 minutes) or increasing the intensity (moderate to vigorous). You can also choose to do a bit of both. 

• Note extending your cardio workout time and or intensity will encourage faster weight loss.  If doing so be sure to stay properly hydrated by drinking a minimum of 4 oz. of water for every 20 minutes of vigorous exercise.

The good news is that the body is a miraculous machine when in comes to damage control. Given proper nutrition and physical motion it will rebuild itself. The damaged systems can become strong and vital again. 

You will need to take certain vitamin and mineral supplements for the rest of your life because your body will have a tough time absorbing certain nutrients.  Doctors recommend that you take a multivitamin-mineral supplement and calcium, iron, vitamin B-12 and vitamin D.  For example, when it comes to calcium and vitamin D supplements, these are typically quite big in pill form.  By opting for a liquid supplement, you can take them at any time during the day (just a few teaspoons worth at most).  Many physicians recommend liquid supplements for these reasons – they are convenient and much easier for your digestive tract to handle.

When choosing a calcium supplement, make sure it has calcium citrate and not calcium carbonate.  After weight loss surgery, the body cannot absorb calcium carbonate.  Calcium citrate is water soluble and can be easily absorbed, especially in liquid form.

Liquid supplements  are easier to swallow and fast absorbing.  The stomach does not have to "dissolve" the tablet or pill, making it a perfect choice for anyone who has had weight loss surgery or who has trouble swallowing pills.  Try a liquid calcium with vitamin D3 and take the liquid vitamin D3 for additional nutrition.  Doctors are now recommending 2,000 IU of vitamin D3 per day.


If you have had gastric bypass surgery or are planning to, please tell us your story and how it has affected your life. 

 

It’s Heart Health month – a topic I am absolutely passionate about!  Why? Because cardiovascular disease (CVD) is the number one cause of death in both men and women in the U.S. In fact, it kills more women than the next five causes of death combined!  But, here’s the part I love - there are many steps you can take to prevent CVD and reverse existing CVD. 

According to the American Heart Association, controllable risk factors include:

• Maintain a healthy weight
• Don’t smoke
• Exercise regularly
• Eat a heart health diet
• Manage blood pressure
• Manage blood lipids including triglycerides and cholesterol
• Keep blood sugar at health levels

Maintain a Healthy Weight
There are no “quick fixes” when it comes to weight loss. Every weight loss surgery comes with it’s own set of complications and risks.  And, prescription drugs for weight loss also have side effects, some of which are very serious. So what’s the bottom line? Exercise and a sound, healthy diet are the best tools you can use for weight loss and, they are a lot cheaper than any other weight loss method. 

One of the top predictors of success with weight loss is your attitude. You have to believe that you can do it and surround yourself with others who also believe and are there to cheer you on. Once you have this mindset, it’s time to create a road map detailing how you are going to get there.  You can use a one-size-fits all approach like Weight Watchers or something individually tailored to meet your needs. And, you don’t have to stick with the initial program you start with. If it isn’t working, don’t be afraid to explore other ways to reach your goal.

Get creative, explore what motivates you and take advantage of the change in seasons to try a variety of outdoor activities.  Whatever path you take, its important that you believe you can do it and you persevere through all minor setbacks and detours.

Continued in next post...

Why you need more Vitamin D...

"We have known for many years that we need vitamin D to facilitate calcium absorption and promote bone mineralization. But newer research has shown that we also need it for protection against a number of serious diseases. In recent years, scientists have discovered that it may help to prevent several cancers, cardiovascular disease, autoimmune disorders, psoriasis, diabetes, psychosis, and respiratory infections including colds and flu.

...Don't be concerned that a vitamin d supplement of 2,000 IU will give you too much. With exposure to sunlight in the summer, the body can generate between 10,000 IU and 20,000 IU of vitamin D per hour with no ill effects. In addition, no adverse effects have been seen with supplemental vitamin D intakes up to 10,000 IU daily."   Read rest of article here

Source:
http://www.huffingtonpost.com/andrew-weil-md/new-recommendation-why-yo_b_446580.html


What do you think?  How much vitamin D are you currently taking?  Be sure to have your blood levels checked first to find out how much you may need to take. 

Are you achieving them or were they too hard to begin with?

We are more than a month into 2010 and many people have already given up on their New Year’s resolution to get fit and healthy.  Some have decided to put off today what they can do tomorrow. Others think they’ll hit that ready stage when their baby is potty trained, their first child is off to college or {insert life event here}.

If you are among the many people who have tossed their hopes of better health to the wayside, ask yourself why.  What has gotten in the way of putting your own health first?  Instead of making promises to yourself that you can’t keep (for me that would be something along the lines of getting up at 5 am to workout), try looking at your goals a little differently.

Focus
Think of each goal like a 10-mile trail run.  There will be twists and turns along the way, you may feel tired or sore at times, face an uphill battle, feel like quitting, have to jump over fallen trees that are blocking your path or take a detour along the way. But, if you keep your mind focused on making it through one-half mile or one mile at a time and your eyes focused on the next 15 feet at any given time (instead of the top of the hill), you’ll make it to the finish. 

We all face different life events that knock us off course from time to time. And none of us will finish that 10-mile run without a few scrapes; sweat dripping down our cheeks and our body feeling at least a little tired (or beat up and exhausted!).  To reach our goal, we must endure and realize that we aren’t perfect and a detour doesn’t mean we should give up. Get back on track and finish that run. You can walk, jog or sprint – just persevere toward the finish line.

If your painful joints are slowing you down, try taking a gluocosamine and chondroitin supplement for joint health and flexibility.  It may help you go that extra mile and help you stay on track to reach your goals.
 

Just because it is cold outside that doesn’t mean you can’t stay fit this winter.

Though gyms (home gyms and those you pay a membership fee to go to) are fantastic, you don’t necessarily need a full gym to get fit. You can walk indoors at the mall (bonus – good sightseeing), or exercise at home with DVDs, simple equipment or Wii Fit.

If you are having a tough time getting motivated, buddy up with a workout partner, or hire a personal trainer to help you develop a plan. Also, try putting your gym bag in your car so you don’t go straight home after work but instead hit the gym, yoga class or dancing, tai chi or any other form of exercise. Or, join a league. There are many adult leagues that include people of all levels including masters swimming, walking/running, softball and much more!

Exercising at Home
There are many exercises you can do at home to stay in shape and most if not all require very little equipment (other than a good pair of shoes). If you don’t want to invest in fitness-related DVDs. Jumping jacks, walking the stairs, dancing and jumping rope will all get your heart rate up. 

Push-ups, leg lifts, crunches, squats and lunges (only if you know good technique and don’t have knee problems) will also raise your heart rate a bit and increase your strength.  You can also use light free weights and bands to get a great workout in. For a great guide to exercises that work specific body parts, click here.

If you have on demand cable or satellite, there are not many fitness channels you can watch whenever you want on anything from yoga to ab workouts.  It's convenient and you don't have to buy any workout DVD's that you only get bored with after using a few times.  There are also a lot of videos available online now as well on YouTube and others.  Just do a Google search on "fitness videos" or on specific exercises. 

Most important - Have Fun!

Are you at risk for having serious joint pain and even osteoarthritis later on in life?  There are several risk factors that can play a role in how healthy your joints are or will be as you age.

What is your age?
Primary osteoarthritis, a degenerative joint disease, usually develops gradually after age 40.  As you age, cartilage degenerates and loses its elasticity.  In fact, an astounding 75% of people over the age of 65 suffer from osteoarthritis.   But don’t let age slow you down, staying physically fit and healthy is an important way to protect your joints.  Strong, fit muscles support joints more effectively, protect joints from undue strain and injury, and help you perform everyday tasks more efficiently and with less pain.

Do you fit any of the following?
•      Have you experienced repeated trauma or surgery to the joint structures?
•      Were you born with abnormal joints?
•      Do you have gout, diabetes, and other hormone disorders?

All of these life factors can cause secondary osteoarthritis.  Repeated trauma can increase the mechanical stress placed on joints.  People with gout may also experience crystal formation in their joints causing damage to the cartilage tissue.  Diabetes, some hormone disorders and congenital (at birth) abnormalities of the joints may also lead to increased wear and tear.

Are you male or female?
Osteoarthritis is more common in men before age 45, but more prevalent in women after age 45.    Though the symptoms of osteoarthritis can vary between patients, the most common symptom is pain in the affected joint, which may worsen later in the day or after repeated use.  The joints may also be tender, swollen and warm and you may hear or feel creaking.  Osteoarthritis can also cause pain after an extended period of rest.

What is your BMI (Body Mass Index) underweight, normal, overweight, obese?
Excess weight can also contribute to secondary osteoarthritis. Weight control and injury prevention measures can lower a person’s risk of developing osteoarthritis. Weight loss also can reduce symptoms for people with knee osteoarthritis. Excess weight can place undue stress on our weight bearing joints. Therefore, it is important for the health of your joints (and your overall health), that you maintain a healthy weight. If you find weight maintenance difficult, a registered dietitian (RD) can help you achieve your goal weight.
Read more

Risk of Developing Painful Knee Osteoarthritis Increases with Weight 
Healthy Weight 30%
Overweight 47%
Obese 61%

Source: Arthritis Care and Research 2008; 59:1207-13

How often do you experience joint pain?
Joint pain is often the first sign of osteoarthritis. Pain is a signal from your body that something is wrong. Osteoarthritis causes some chronic joint pain. Though your joint pain may make you cringe at the thought of exercising, exercise can actually help relieve some of your pain, ensure that you maintain a good range of motions, make the joint more stable, help you lose weight or maintain your weight and keep your spirits up. Which type of exercise should you choose? That depends on what joints are involved, whether you’ve have surgery on any of your joints and your current range of motion. A combination of strength training, aerobic exercise and proper stretching are often recommended for osteoarthritis patients. And, a physical therapist can prescribe a program tailored to meet your needs and goals.

Read about stretching for joint pain


Have you had any serious joint injuries in your life?
Damage to a joint can contribute to the development of osteoarthritis in that joint.  This is especially common in athletes who have repetitively injured their joints over the years.  If you are an athlete try switching sports or taking time in between your soccer matches and running for non-impact activities such as swimming and stationary cycling.  You’ll still obtain the benefits of exercise but give your joints a break.

Does your family have a history of osteoarthritis?
A history of arthritis in your family can put you at higher risk for also getting the disease.  More and more doctors today believe in a hereditary cause behind several forms of arthritis. As with many other conditions, a mixture of environmental and genetic factors is attributed to the onset of disease or disorder. Most current research, though, focuses on showing substance behinds models of hereditary arthritis.  A recent study found that a form of knee osteoarthritis is the newest addition to the collection of genetically-caused arthritis.  Rare variants in the GDF5 gene have been associated with disorders of skeletal development, and more common variants recently have been tied to susceptibility to osteoarthritis of the hip and knees.  If anyone in your family has a history of osteoarthritis, it is even more important to take preventative measures to help prevent the onset or at least postpone it and make it more manageable.

Do you currently or have in the past, engaged in heavy physical activity for 3 or more hours per day such as heavy lifting, standing or bending?
Athletes and people who have jobs that require doing repetitive motion, such as landscaping, typing or machine operating, have a higher risk of developing OA due to injury and increase stress on certain joints.  Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee.  If you are experiencing joint pain or have been diagnosed with arthritis, it may become necessary to alleviate or decrease the amount of heavy physical activity you do.  Repetitive motions for long periods of time can accelerate the onset of osteoarthritis.

Do you experience joint stiffness in the morning or do your joints ache more if there is a change in the weather?
Stretching when you first get up is a great way to alleviate joint pain.  According to the Arthritis Foundation website, stretching will keep your body limber and improve flexibility. Gentle stretching exercises should be done every day and are the most important of all your exercises. Flexibility exercises can help you protect your joints by reducing the risk of joint injury, help you warm-up for more strenuous exercise by getting your body moving, and help you relax and release tension. These can be done on land or in water such as a pool, hot tub or warm bath. These exercises can be particularly useful for easing those stiff joints in the morning. Good range-of-motion exercises include tai chi and yoga. Work up to 15 minutes of flexibility exercises a day. Once you can do 15 continuous minutes, you should be able to add strengthening and aerobic exercises to your routine. 

Get more exercises here

It’s never too late to start a preventative maintenance program for your joints.  Maintaining a healthy weight and exercising are very important and you can also take a liquid glucosamine and chondroitin to help maintain joint flexibility.  See here

Read more about how glucosamine and chondroitin work here

This is the 3rd post in my Digestion Series.  Also see article on Prebiotics and Digestive Drugs 

Americans typically fall short on meeting their dietary fiber needs. We need about 14 grams of fiber for every 1,000 calories we consume yet, most Americans get just 15 grams per day! Fiber plays an important role in digestive system health, alleviating constipation and it may help reduce your risk of developing heart disease and diverticular disease.

Types of Fiber
There are two types of fiber and both are vital to good health.  Soluble fiber is found in a variety of foods including oat bran, oatmeal, beans, pears, apples, lentils, nuts, seeds, peas, bran, citrus fruits and barley. It can help decrease LDL cholesterol (the kind associated with an increased risk of cardiovascular disease) and make your stools softer so going to the bathroom isn’t so painful.

Insoluble fiber intake is also associated with a decreased risk of cardiovascular disease. In addition it provides “bulk” which means it can help slow the rate at which food moves through your digestive system keeping you full for a longer period of time and increasing stool bulk thereby alleviating constipation.  Foods high in insoluble fiber include whole-wheat products, the skin from fruits and vegetables, brown rice, wheat bran and seeds.


Tips for Increasing Your Fiber Intake
If you think you need to increase your dietary fiber intake, always do so slowly at first so your body adjusts. Try these steps to slowly boost your fiber intake:

1. Swap out the “whites” in your diet for high fiber foods. White foods include regular pasta, white bread, white rice and white flour products. Start looking for whole grain or whole-wheat versions of these foods.

2. Add fruits and/or vegetables to every meal and consider adding these to snacks as well.

3. Substitute dishes made with legumes for some of your meat-based dishes.

4. Eat whole fruits and vegetables instead of drinking juice.

5. Try new grains that you don’t normally consume including bulgar, quinoa, and barley.

6. Sprinkle high fiber cereals such as Fiber One and All Bran in your dishes.

7. Try a fiber supplement (some of the unflavored ones can be added to your food or taken separately).


 

Walking is one of the most underrated forms of exercise.

It’s convenient, low impact (not hard on your joints), can help you manage your weight, blood pressure and blood sugar levels and, walking can decrease your risk of developing some chronic diseases. And the best part about walking?  It requires little equipment and people of all fitness levels can benefit.

Get Proper Shoes
If you want to take up walking or if you walk now, the most important equipment you’ll need is a good pair of walking or running shoes. Go to your local running shoe store (these stores tend to have employees trained in fitting you for walking, jogging and running) and get a good pair of shoes.  Read more on shoes here

Next, consider your attire. Though you don’t need special attire to walk, having comfortable workout clothes, reflective tape (if walking at night) and the necessities to walk outside in the winter (gloves, a hat, face mask if it is very cold) will make your experience both more enjoyable and safe.

Warm Up and Stretching
Always remember to warm up slowly and stretch if you need to (stretching is especially important after you are finished exercising). And, monitor your technique - your head should be held up, eyes looking forward, chin parallel to the ground, shoulders relaxed and arms bent and swinging naturally with each step. With each step, your foot should strike the ground in front of you and push off for the next step on the balls of your feet.

Once you feel very comfortable with walking, try varying your routine by walking hills, walking faster and changing your route. Also, a few simple tools will help you get the most from your workouts – a pedometer, the Wellesse walking challenge and a heart rate monitor. A pedometer will measure how many steps you get each day and a heart rate monitor can ensure that you are exercising at a good pace so you make the most of your workouts.

If you are experiencing painful joints from walking try a liquid glucosamine and chondroitin supplement for improved joint health and flexibility and for muscle and joint pain.


Have you signed up for the Wellesse Walking Challenge yet?  It's a great way to stay motivated to walk and you can win prizes too including a $500 Wellness Package!  Join today!

Eating Right

• Yogurt contain probiotics that help support the immune system
• Garlic contains allicin, a potent bacteria fighter
• Black Tea or Green Tea to help produce more interferon, a protein that battles cold and flu infections
• Mushrooms such as shiitake, maitake and reishi contain immune-boosting chemicals
• Fatty fish like salmon, mackerel and herring contain omega-3 fatty acids and vitamin D and selenium that benefit the immune system

• Wash hands often and well with soap and water for at least one minute or use a hand sanitizer gel if no sink is available, like at the grocery store.
• Don't share toothpaste tubes with anyone
• Use paper towels instead of cloth towels at home in the kitchen and bathrooms
• Spray or wipe disinfectant everywhere - phone, keyboard, desktop, door handles, weights, remote controls, etc.
• Use gloves if possible when pressing buttons on ATM machines and the like
• Keep a 5 feet away from anyone who is coughing or sneezing

• Omega-3 fatty acids, especially if you do not like fatty fish
• Vitamin D3 supplement - people who took 2,000 IU of vitamin D daily had 70% fewer colds and flu, according to a 3 year study published in Epidemiology and Infection.  This time of year its almost impossible to get enough vitamin D from the sun and food just doesn't have enough.
• Vitamin C
• Echinacea
• Zinc taken at the very start of a cold may help shorten the duration

• 20 or 30 minutes of moderate exercise a day will help increase blood flow, which speeds nutrient absorption and decreases stress hormones, which dampen immune response.
• Get at least 7 hours of sleep every night.  Lake of sleep depresses the immune system making your more susceptible to bacteria that causes viruses
• Try Yoga or Tai chi for relaxation and exercise.
• Don't hide out - be social.  People who are socially active get fewer colds because they tend to be more positive and happier which also strengthen immunity. 

Let's focus on the legs!

How are your treads holding up?  As you pick up the pace or mileage of your walking program you may find that your legs need a bit of a tune up.  It is not uncommon to feel some pain or discomfort in the muscles of your lower leg when you get more aggressive with your walking technique.  Let’s take a look at why this happens as well as how to prevent and recover from this potential performance barrier. 

In order to pick up your fitness walking pace it takes a more exaggerated ankle action and forward body lean. This technique creates a greater demand on the muscles of the lower leg.  The front of the lower leg or anterior tibialis muscle group must dorsi flex your ankle (which mean pulling the forefoot up closer to the shin) on the forward heel strike.  Then the back of your lower leg or gastrocnemius muscle group must plantar flex your ankle (which means pushing your forefoot away from your shin) to propel you forward and into the next step.  The greater the action the faster you walk.  This increase in ankle action can takes its toll on the lower leg muscles and their attachments, causing a general sense of pain in the shin, calf and ankle areas.  This is especially true when you first start a more aggressive walking program.  In most cases the muscle pain you sense is due to a condition know as DOMS or delayed onset muscle soreness. 

DOMS is your muscles way of telling you that you have introduced it to something new and challenging.  It is nature’s way of slowing you down so that the muscle tissues can progressively get stronger without getting injured.  Keep in mind that any pain that results in swelling or bruising or lasts for more than a week, should be checked out by the appropriate medical professional. 

So what can you do to avoid or treat DOMS in the lower leg muscles? 

Let’s start with a list of ways to minimize or avoid DOMS:
1. Make sure you have proper, supportive footwear.
2. Progress into your program goals gradually.
3. Warm up properly before your walk, including lower leg movements that mimic the positions your ankle will travel through (i.e. walking on your toes then heels for approximately 30 seconds each).
4. Stretch the muscles of the ankle after the walk, holding each stretch for at least 20 seconds (i.e. ankle circles, and calf stretches).
5. Keep the muscles of your ankle strong by doing lower leg condition exercises (i.e. calf raises and dorsi flexion with foot resistance).

 

Now what can be done once you are feeling a bit of lower leg DOMS:
1. Take a few days off from your walk and if possible cross train by doing an activity that does not use the same foot pattern (i.e. swimming or cycling).
2. Massage and stretch the front and rear leg muscles daily.
3. Ice the affected areas.
4. Stay well hydrated and keep your joint lubrication up with the appropriate joint supportive nutritional supplements such as a glucosamine and chondroitin liquid supplement that's easy to take and fast absorbing.

Have a great Walking Challenge!
 

This is a repeat of a previous post, but with the increasing importance of vitamin D, I thought it would be appropriate to post again.

When it comes to nutrition, the media often finds an ingredient, supplement or product that steals the spotlight for a period of time.  Sometimes the ingredient is lambased to the point where it becomes an outcast at warp speed, this happened with partially hydrogenated oils (man made trans fats).  Other times, the news is good.   And this is what has happened with vitamin D.  This vitamin has gone from the kid at the back of the class to center stage in a short period of time. 

Vitamin D
When it comes to bone health, many of us automatically think of calcium and milk/dairy.  However, calcium alone can't do its job without adequate vitamin D.  Think of vitamin D as the gatekeeper to bone tissue, it aids in the absorption of calcium.  Vitamin D may also decrease our risk for certain types of cancer.  Most notably, colon, prostate and breast cancer.  And, a deficiency in vitamin D can lead to osteopenia, osteoporosis, chronic pain, muscle weakness, fractures and autoimmune diseases.
 
Vitamin D is manufactured in the skin upon exposure to sunlight.  Past recommendations have indicated that just a little exposure - say 15 minutes a day, will give us all the sunlight we need to make vitamin D.  However, recent studies have shown that many of us fall short.  Even people living in climates sunny throughout the year like southern Arizona.  How can this be the case?  Individuals with darker skin and older individuals just don't produce vitamin D as well as fair-skinned, younger people do.  And, people who live in less than sunny climates simply aren't exposed to the sun's rays often enough.  Lastly, many people have had skin cancer (basal and squamous cell carcinoma is on the rise) and are avid sun block users and therefore don't manufacture adequate vitamin D.
 
Calcium
Now, on to calcium. Aside from its role in bone health, calcium also aids in:  muscle contraction, blood vessel contraction and expansion, hormone secretion, heartbeat regulation, conducting nerve impulses and blot clotting.  And, all of these functions are considered more vital than keeping our bones strong.  So, when we fall short on our calcium intake our body leaches it from our bones. If this process occurs frequently, over time we end up with weak, porous bones, osteopenia and osteoporosis.
 
How to Get It
It's clear we need to take in adequate levels of calcium and vitamin D daily.  Calcium is more easily obtained from foods, especially dairy foods.  Greens like spinach are often noted for their calcium but, this calcium is bound to the oxalic acid present in these greens and therefore, not readily absorbed.  The same thing goes for calcium that is fortified into grain products - it is bound to phytic acid and not easily absorbed in the body.  Vitamin D is a bit harder to find in foods.  Salmon, mackerel, canned tuna, canned sardines, and milk are your best options.  If you don't drink 4 glasses of milk a day or a combination of other dairy and the fish mentioned above, try a liquid calcium and vitamin D supplement.

 

Women with breast cancer should be given high doses of vitamin D because a majority of them are likely to have low levels of vitamin D, which could contribute to decreased bone mass and greater risk of fractures, according to scientists at the University of Rochester Medical Center.

In a study of 166 women undergoing treatment for breast cancer, nearly 70 percent had low levels of vitamin D in their blood, according to a study being presented Thursday, Oct. 8, at the American Society of Clinical Oncology's Breast Cancer Symposium in San Francisco. The analysis showed women with late-stage disease and non-Caucasian women had even lower levels.

"Vitamin D is essential to maintaining bone health, and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It's important for women and their doctors to work together to boost their vitamin D intake," said Luke Peppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester's James P. Wilmot Cancer Center. He is a member of the National Cancer Institute's Community Clinical Oncology Program research base in Rochester.

Scientists funded by the NCI analyzed vitamin D levels in each woman, and the average level was 27 nanograms per milliliter; more than two-thirds of the women had vitamin deficiency. Weekly supplementation with high doses of vitamin D -- 50,000 international units or more -- improved the levels, according to Peppone's study.

The U.S. Institute of Medicine suggests that blood levels nearing 32 nanograms per milliliter are adequate.

This problem is not unexpected, Peppone said, because previous studies have shown that nearly half of all men and women are deficient in the nutrient, with vitamin D levels below 32 nanograms per milliliter. Vitamin D, obtained from milk, fortified cereals and exposure to sunlight, is well known to play an essential role in cell growth, in boosting the body's immune system and in strengthening bones.

Symptoms of Vitamin D deficiency include muscle pain, weak bones/fractures, low energy and fatigue, lowered immunity, symptoms of depression and mood swings, and sleep irregularities, many of which are common for women undergoing breast cancer treatment.

Source:  EurekAlert Press Release, University of Rochester Medical Center


A daily liquid vitamin D supplement of at least 1,000 IU per day is recommended to maintain healthy blood levels.  Everyone should have their blood levels tested to see where they are at and to find out how much vitamin D they should be taking.  To find out if you are at risk for vitamin D deficiency, take this quiz now 

Stretching is a must especially if you are experiencing joint pain and for managing arthritis for better joint health.

Have you ever wondered how to get the most out of a stretch?  Well try a little self-PNF.

PNF stands for proprioceptive neuromuscular facilitation and it simply means that our muscles receive messages from our nerves that can facilitate a better stretch reflexively.  Our muscles have sensor nerves (proprioceptive neurons) that pick up sensations like a strong contraction or a rapid bouncy movement and react by sending a message to the muscle to relax or contract in response.  When it comes to enhancing a stretch your goal is to get the muscle to relax as much as possible, thus you want to stimulate the sensor nerve with a 10 to 15 second held contraction (called and isometric contraction). 

Immediately following this contraction the muscle will reflexively respond by releasing and relaxing.  This reflex allows for an immediate gain in range of motion and extensibility.  Many physical therapists use a technique called the ‘contract/release method’ to rehab chronically tight muscles.  You can try it on your self with the help of a bath towel or stretch strap.  Lie down on your back and use the towel or strap (wrapped around your thigh) to pull your leg towards your chest.

Next press your leg away from your body into the towel, while holding the towel firmly in pace and forcing the back of the leg and hip to contract.  Hold that contraction for three deep breaths.  Release the pressing action and use the towel to pull your leg back towards your body into a deeper stretch position.  You should notice an immediate increase in range and flexibility. You can try to perform this same contract then release type stretching for various parts of your body.  Keep in mind that the contraction happens by moving and holding in the opposite direction of the stretch position. 

So for another example, if your target is your lower leg (calf muscle), stretch the muscle by wrapping a towel around the bottom of your forefoot and pulling your toes towards your shin; to contract, point your toe away from your shin while pressing into a towel, hold for 3 deep breaths, then repeat the stretch position. 

Here is a quick list of moves to stretch the major body parts:

• Chest- open arms outward and behind the body
• Upper back and neck – move head towards the opposite shoulder
• Front shoulder – open arm out or behind body 
• Rear shoulder: move arm across the chest
• Spine – round spine forward, side ways or rotate
• Buttocks – flex hip by moving the thigh forward towards torso or across the torso
• Front thigh – extend hip by moving the thigh back behind the body and bending the knee
• Rear thigh – hip flexes by moving forward towards torso and extending knee
• Low leg or calf – move forefoot towards shin

Remember to use the stretch/contract method, you need to move the body part in the opposite direction of the stretch and hold it in a static contraction for 3 deep breaths.

Try it ... to take your stretch routine to a new limit.  Stretching is a great treatment for joint pain and can help keep your joints on the move.  Be sure to take your liquid glucosamine and chondroitin supplement too for improved joint health and flexibility.

Vitamin D has a number of vital functions within our body. 

Recently published review suggests one more thing – supplementation may enhance athletic performance in vitamin D deficient athletes.  This review examined studies looking at physical performance and vitamin D levels and they found that some measures of physical performance were directly related to vitamin D levels in the body.  The authors of this review indicate that vitamin D may help prevent stress fractures, chronic musculoskeletal pain, respiratory tract infections (those who exercise heavily are at an increased risk) and several chronic diseases related to vitamin D deficiency.  Older adults, in particular, may benefit from adequate vitamin D levels through improved neuromuscular functioning, including better balance.

Vitamin D Deficiency
Unfortunately, vitamin D deficiency is a widespread problem, even among healthy adults.  How do you know if you are vitamin D deficient?  Get tested for 25(OH)D.  Though deficiency is commonly quantified as having a 25(OH)D concentration of <20 nanograms per milliliter (ng/mL), some scientists believe that level needs to be raised and that ideal levels may be above 50 ng/mL.  Indoor athletes – gymnasts, wrestlers, basketball players etc. need to be especially cognizant of their vitamin D levels.

Athletes should include a vitamin D supplement in their daily regimen of at least 1000 to 2000 IU of vitamin D3.  A multivitamin with just 400 IU is not enough and it can be very difficult to get enough vitamin D from food.  A liquid vitamin D3 supplement could easily be added to a daily protein shake or smoothie.

Source:  Med Sci in Sports & Exerc 2009;1102-1110.
 

The Joy of Gardening...

By the end of the winter I am itching to get in the garden.  I've forgotten all about how much I hate to weed and my aching back after bending all day.  All I remember is the feel of the dirt and the satisfaction of planting new flowers and plants.  I can't wait to go to the nursery and carefully pick out my next addition - usually to replace the ones that didn't make it over the winter.

Gardening is a wonderful way to get outside and soak up some vitamin D from the sun and get a little exercise at the same time.  However, there are a few things us weekend warriors need to remember as we return to the great outdoors.

1.  Dress to protect. 

This is a lesson learned after tangling with blackberry bushes or re-potting a very poky pine tree.  Wear gloves, goggles and clothing as needed.  Don't stay out in the sun very long without a hat and sunscreen.  A little is OK (10 to 15 minutes) to get vitamin D, but you don't want to burn.
 

2.  Put safety first. 

Be very careful when operating tools and equipment.  Pay attention to what you are doing and others around you! I was once so excited about using my new electric powered hedge trimmer, that I forgot to pay attention to the cord itself and proceeded to chop it in half!  I tried to hide the cord in the garbage can, but my husband found it anyway.

3.  Watch our for heat-related illness.  

If you live in an area with high temperatures, make sure to work outside in the early morning or late evening when it is cooler.  Drink plenty of water and do not over exert yourself.  Running through the sprinkler occasionally feels great too.

4.  Know your limits.

If you have arthritis, use tools, benches, wagons, or anything that makes it a bit easier.  Gardening is a great way to get those joints moving and actually relieves arthritis pain.

5.  Enjoy the benefits of physical activity.

As noted above, gardening is just a great way to get physical exercise while enjoying yourself.  Active people are less likely than active people to be overweight and have many other diseases.  Start slow and gradually build up your time and intensity levels. 


For more information see http://www.cdc.gov/family/gardening/ for the complete article.

Don't forget to take your liquid glucosamine and chondroitin supplement to help with those joints while gardening.  

Do you have any great gardening stories?  I would love to hear them - send me a comment and I may post your story in by next blog post!
 

Dark skin means less Vitamin D absorbed.

Dark skin works as a natural shield against the sunlight.  Consequently, many people with darker skin are less likely to wrinkle or develop sunburn or skin cancer (though those of Asian and African decent are more likely to have advanced skin cancer by the time it is diagnosed and melanoma is frequently fatal for African Americans, Hispanic Americans and Asian Americans). 

Because their skin naturally blocks out more sunlight, people with darker skin also absorb less sunlight and therefore produce less vitamin D.  Studies show that African Americans are one group that is very likely to have low circulating levels of vitamin D.  Studies have even shown that a high percentage of African American teenage boys have low vitamin D levels.  And, as we know, teenage boys tend to eat everything in site and yet in some groups studied they still did not’t meet their vitamin D needs! 

A nationwide study found levels considered:

Extremely low
• African Americans: 29%
• Mexican Americans: 7.5%
• Non-Hispanic whites: 2.5%

Too low for optimum health
• African Americans: 97%
• Mexican Americans: 90%
• Non-Hispanic whites: 71%

Source: National Health and Nutrition Examination Survey of more than 13,000 teens and adults from 2001 to 2004


Moral of the research story – if you are an African American and you don’t consume 3-4 glasses of milk or vitamin D fortified soy or almond milk daily, make sure you take a vitamin D supplement.  Getting enough sun can be very difficult as it takes much longer for a dark skinned individual to make enough vitamin D compared to light skin.  Vitamin D is vital for bone health and the immune system and may even help prevent some types of cancer and chronic pain.  Vitamin D supplements for children are especially important.  A liquid vitamin D supplement is the perfect way to make sure children get their vitamin D also.

Read recent article in USA Today for more information on this important topic.

Don’t let joint pain keep you from springing forward in life.

One great thing about spring is the weather.  Warmer weather can make life a lot easier on arthritic joints.  If you have arthritis (in particular the wear and tear related osteoarthritis) you will undoubtedly feel more like moving once your body and joint tissues have warmed up. 

So lets discuss a spring forward warm up plan that can reduce the twinges from your hinges during a workout. Your spring forward warm up for joint health includes
1) environmental, 2) temporal and 3) physical tips
  
1. Your joints will feel better when working out in warmer environments.  This can be accomplished by staying indoors or keeping the cooling system low, or by wearing workout gear that keeps your body well insulated (i.e. sweats and wraps).  You can also enhance your body temperature pre-activity by taking a hot shower or sitting in a Jacuzzi.

2. In terms of the best time to exercise, your joints will feel best around midday.  This will give your body a chance to naturally loosen up and warm up with your daily routine without feeling overtaxed by a full day of life tasks. 

3. Last but not least are some physical tips that can help prepare sensitive joints for various types of physical exercise. 
 
In terms of your cardio-vascular exercise, be sure to start off slowly with modest range of motion.  Gradually increase your movement range in both your upper body and lower body movements until you are working at near full range capacity.  This could take a good 10 to 15 minutes.  So for example, start your fitness walk with small steps and minimal arm swinging, as you warm up and loosen up try rolling the shoulders up, back and down while you walk.  Also add in some ball and heel walking.  By this I mean, walk on the balls of your fee for about 10 seconds followed by walking on your heels for 10 seconds.  Go back to a normal footfall and gently reach a bit further with each step.  Once you feel your overall body temperature has elevated (usually noted by a desire to take off your outer jacket) you can stop and hold a few hip and leg stretches, if those areas still feel restricted.  Keep those stretches light (8 to 10 seconds in length).  Then continue with your walk, using the best arm swing and leg stride that you can.  

Your muscle-conditioning workout should follow a similar warm up plan of action.  When performing strength training exercises always do the first set of any exercise with limited range and very light resistance.  Then for the second set you can gradually increase the range and/or resistance.  Keep in mind that strength training is important but so is joint sense.  Use resistance loads that you can safely handle for about 15 repetitions even if that means no resistance other than the weight of your body or body part. 

All stretches should start off light, never force or bounce. Once your muscles are warm they have better give therefore you get the best results from your stretches after you have completed more active exercises (i.e. walking or strength exercises).  These stretches should be held to a point of slight or mild discomfort for 10 to 30 seconds.

Progress slowly and always stay in the pain free range of motion.  If your joints are experiencing more pain or discomfort than typical two hours after a workout is over, you have probably worked too hard.  Back off a bit and don’t forget to take your joint healthy glucosamine and chondroitin supplements.