Category Archives: General Information

Exercise for Chronic Disease Relief

May 25, 2017 Teresa Stockton - Blog, General Information

For people in need of chronic disease relief, exercise can decrease discomfort, improve daily functioning, and enhance overall quality of life. There are many activity choices. Overall, find something that you enjoy doing and a place that is comfortable for you to do it in. Although being physically active is good for anyone, some exercises provide specific benefits. Here is how different types of exercise can help people with specific chronic diseases.

CHRONIC DISEASE RELIEF : TYPES OF EXERCISE
There are 3 basic categories of exercise:

Aerobic Exercise
These are exercises that raise your heart rate through repetitive movement of large muscles groups. The 2 types of aerobic exercise are:

Weightbearing exercise —Your muscles work against the force of gravity. Examples include jogging, walking, and dancing.
Non-weightbearing exercise —The force of gravity does not play a major role. Examples include biking, swimming, and rowing.

Strength Training Exercise
These are exercises that increase the power, tone, and efficiency of individual muscles by contracting isolated muscles against resistance. An example is lifting weights. The increase in heart rate is short-lived compared to aerobic exercise.

Stretching
These are exercises that improve or maintain the flexibility of your muscles. Good flexibility is important to keeping a full range of motion and decreasing your chances of injury. Ideally, you should stretch after each exercise session.

DISEASE IMPACT
Overall, all 3 types of exercises are important in a chronic disease relief program. However, the list below demonstrates how a certain types of exercise can directly impact your specific health condition.

Heart Disease
Researchers and healthcare professionals have found that regular exercise reduces the risk of having a heart attack, particularly for people with coronary artery disease (CAD).

Specific benefits of exercise for people with heart disease include:

Stronger heart muscle
Reduced cholesterol
Reduced plaque build-up inside the arteries
Better weight and blood pressure control

Type of exercise that can reduce risk of heart disease and heart attack: Aerobic

High Cholesterol
Cholesterol is found in cells throughout your body. Although it tends to get a bad rap, cholesterol is actually essential for life. It only contributes to heart disease when you have too much of certain types of cholesterol or too little of other types.

Exercise can help reduce cholesterol, and even better, it can help raise your HDL (good) cholesterol. Aim for at least 30 minutes of exercise most days of the week. Even short, 10-minute spurts of exercise can help. Exercise also has the added benefit of weight loss, which can also help to lower cholesterol levels.

Type of exercise that has been shown to improve cholesterol levels: Aerobic

Diabetes
Diabetes is a disorder of the body’s insulin production and usage, and it is a major risk factor for coronary artery disease. If there is not enough insulin, glucose (fuel for all cells) cannot get from the blood to the cells. As a result, the body is essentially starved and the glucose builds up in the blood. Exercise can make the cells more sensitive to insulin, and more glucose can move from the blood into cells.

Since exercise changes the way your body reacts to insulin, you may need to check your blood sugar before and after exercising. Talk to your doctor before you begin an exercise program to learn about what your levels should be.

Types of exercise that influence insulin sensitivity and cardiovascular risk factors: Aerobic and strength training

High Blood Pressure
The risk of high blood pressure increases as we age. Exercise can help to lower your risk and even control your blood pressure if it’s already high. Exercise helps with blood pressure by making your heart work more efficiently. This means your heart does not have to work as hard to pump blood, so there is less pressure on your arteries.

A good target for blood pressure is 120/80 mm Hg. Adding moderate physical activities to your normal routines can help you get there. You should aim for at least 30 minutes of aerobic activity on most days of the week. Even several 10-minute spurts throughout the day can help.

Types of exercise that have been shown to lower blood pressure: Aerobic and strength training

Stroke
A stroke occurs when not enough blood is reaching part of the brain. This causes the cells in that area to die. People who have already had a stroke are at increased risk for recurrent stroke or other cardiovascular problems.

A stroke can create some physical impairments. Exercise may improve strength and coordination of the affected muscles. Exercise recommendations may vary depending on the severity of the stroke and the person’s limitations.

Type of exercise for stroke recovery: Aerobic, strength training, and stretching

Cancer
Studies suggest that people with cancer who do not have depression have a better chance of survival than those who do. Exercise is a great way to avoid depression and improve your overall mood. It’s not clear exactly how exercise impacts mood, but it probably works by causing the brain to release chemicals, like endorphins, and increase body temperature, which can have a calming effect.

Types of exercise found to boost energy and mood: Aerobic and strength training

Lung Disease
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is the most common form of lung disease in adults. Exercise improves activity levels and decreases symptoms.

Types of exercise shown to improve respiratory ability: Aerobic

Arthritis
Continuous motion is essential for the health of your joints, especially arthritic ones. Regular exercise promotes strength and flexibility, and helps preserve the resiliency of joint surfaces.

Types of exercise shown to improve joint health: Nonweightbearing aerobic, strength training, and stretching (water exercises are ideal)

Osteoporosis
Osteoporosis is a bone-thinning disease that can lead to fractures. Weightbearing exercises maintain bone density and strength by tipping the balance in favor of bone formation. Weightbearing activities include walking, jogging, hiking, dancing, stair climbing, tennis, and other activities that you do while on your feet.

Type of exercise shown to improve bone density: Weightbearing aerobic and strength training

In any condition, a well-rounded exercise program will have all 3 types of exercise involved. Aerobic exercise will increase your endurance and ability to get through longer workouts. Strength training will build muscle strength and allow you to tolerate higher intensities as well improve balance and agility. Stretching can decrease stiffness and increase mobility.

Talk to your doctor before beginning any exercise program. You can also consult with an exercise specialist to help you develop a routine.

by Carrie Myers Smith, BS

RESOURCES:
National Institutes of Health
http://www.nih.gov

The American Orthopaedic Society for Sports Medicine
http://www.aossm.org

CANADIAN RESOURCES:
Canadian Society of Exercise Physiology
http://www.csep.ca

Healthy Canadians
http://www.healthycanadians.gc.ca

REFERENCES:
Depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2016. Accessed March 23, 2016.

Exercises for arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/living-with-arthritis/exercise/. Accessed March 23, 2016.

Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 33. S484-S492; 2001.

Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T. AHA scientific statement: Physical activity and exercise recommendations for stroke survivors. Circulation. 2004;109: 2031-2041. Circulation website. Available at: http://circ.ahajournals.org/content/109/16/2031.full. Accessed March 23, 2016.

Junnila JL, Runkle GP. Coronary artery disease screening, treatment, and follow-up. Primary Care: Clinics in Office Practice. 2006 Dec; 33(4).

Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006 Sep; 28(5): 396-402.

Physical activity for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed March 23, 2016.

Physical activity guidelines for Americans. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2013. Accessed March 23, 2016.

Weightbearing exercise for women and girls. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00263. Updated October 2007. Accessed March 23, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 5/8/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Want to be a Physical Therapist?

May 9, 2017 Teresa Stockton - Blog, General Information

PHYSICAL THERAPIST
WHAT DO THEY DO?
PTs are health care professionals who provide rehabilitation for musculoskeletal issues.
Rehabilitation includes programs focused on:

Strengthening
Range of motion
Balance training
Functional training
Gait training
Return to work programs
Pain reduction

Physical therapist’s goal is to return patients to a normal life, that is pain free.

HOW TO BECOME A LICENSED PHYSICAL THERAPIST?
1.) Bachelor’s degree, that includes required Prerequisites for PT schools of your choice.
2.) Doctorate degree from credited school which includes a number of hands on clinical experiences.
3.) Apply & sit for licensure exam in state, you choose to work.

PHYSICAL THERAPIST ASSISTANT
WHAT DO THEY DO?
Work as part of the Rehabilitative team to provide physical therapy services under the direction and supervision of the physical therapist.
PTAs implement:

Selected components of patient/client interventions (treatment)
Obtain data related to the interventions provided
Make modifications in selected interventions either to progress the patient/client as directed by the physical therapist

HOW TO BECOME A PTA?
1.) Attend CAPTE – accredited associated program
2.) Apply & sit for licensure exam

JOB SETTINGS: Any setting in which a PTA can work

CERTIFIED ATHLETIC TRAINER
WHAT DO THEY DO?
Certified Athletic Trainers (ATCs) are health care professionals who work alongside physicians to provide:

Preventative services
Emergency care
Clinical diagnosis
Therapeutic intervention
Rehabilitation of injuries and medical conditions

Certified Athletic Trainers can help you avoid unnecessary medical treatment and disruption of normal daily life.

HOW DO I BECOME A CERTIFIED ATHLETIC TRAINER (ATC)?
1.) Graduate from a bachelors or master’s degree program accredited by the Commission on Accreditation of Athletic Training Education (CAATE).
2.) Pass the certification examination conducted by the Board of Certification (BOC).
3.) Once certified, he/she must meet ongoing continuing education requirements in order to remain certified.
4.) Athletic trainers must also work under the direction of a physician and within their state practice act.

JOB SETTINGS

Colleges & Universities
Hospital & Clinical
Occupational Health
Military
Performing Arts
Physician Extender
Professional Sports
Public Safety

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy practice with locations in Georgia and Florida, that focuses on providing the highest quality rehabilitation services. For more information click here.

Clinic Spotlight: PT & Me Therapists

March 23, 2017 Teresa Stockton - Blog, General Information

This month we are featuring stories from some of our PT & Me therapists. We asked them how they got into the awesome world of physical therapy and what they enjoy about it. These are their stories…

Name:
Kelly Wilson, PT, DPT at University Physical Therapy – 8 locations conveniently located throughout the New River Valley in Virginia

Why did you chose physical therapy as a career?
I took an anatomy class in high school with a teacher who absolutely changed my life. I could not get enough of the curriculum and wanted to learn more about how we work and how we can make ourselves better. I stayed after school one day to ask how I could learn about this topic forever. My teacher suggested that I look into physical therapy. I started shadowing a PT in my hometown and loved it! I was hooked!

What is your favorite thing about going to work each day?
I get to work with the absolute best people on the face of the planet.

Name:
Lea Ann Rumlin, PT, Clinic Owner at DeKalb Comprehensive Physical Therapy – Lithonia, Georgia

Why did you chose physical therapy as a career?
I had an opportunity to observe a PT in high school and found it was very interesting. I thought it was cool to observe a diverse variety of ailments in people.

What is your favorite thing about going to work each day?
I’ve been doing physical therapy for a long time, but it still feels new. I feel blessed to have the opportunity to help people.

Name:
Wendy Richards, MSPT, DPT at Port City Physical Therapy – Portland, Maine

Why did you chose physical therapy as a career?
I wanted to be in a helping profession. Growing up in rural Maine most of the careers were either in healthcare or nursing. That is why I was drawn to physical therapy. I especially liked the stroke patient rehab and spinal rehab aspect of it. Helping people with paralysis was especially fulfilling.

What is your favorite thing about going to work each day?
I enjoy working in a team environment. Working in an outpatient climate and helping patients to get better. Being able to resolve their limitations and improve their lives.

Name:
Jocelyn Zolna-Pitts, PT, Director at Metro Spine & Sports Rehabilitation – Chicago, Illinois

Why did you chose physical therapy as a career?
It combined my interest of medicine with sports. I was always interested in medicine and helping others.

What is your favorite thing about going to work each day?
The daily satisfaction of watching people get better. The challenge and variety of problems patients face and solving their problems through critical thinking with them. I enjoy the fact that you get to play every day at work and it’s a lot of fun!

Weight Loss: What Are Your Options?

February 28, 2017 Teresa Stockton - Blog, General Information

The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States.

Being overweight is closely linked to many very serious health conditions. It is a significant risk factor for coronary artery disease (CAD), stroke, high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein—the “good” cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help reduce the risk or improve these conditions. Plus, practicing the behavioral changes of a healthier diet and regular exercise may actually reduce these risk factors whether weight loss occurs or not.

Energy Balance: The Simple Principle of Weight Loss
Scientists often explain weight loss quite simply in terms of the energy balance equation: energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.

This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medications, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.

Using Strategies to Get Started
Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.

The following 5 strategies are crucial to successful weight loss and can help to overcome some of these barriers:

• Set and commit to realistic goals and monitor your progress toward achieving these goals
• Slowly modify your eating and exercise behaviors, as well as habits influencing both
• Examine and restructure unrealistic, negative thoughts, or expectations
• Reduce stress
• Develop a network of social support and information

Looking at Weight Loss Aids
There is a great deal of interest in whether prescription medications or supplements can facilitate weight loss. Some medications suppress appetite by interfering with brain chemicals that affect mood and appetite. Others reduce fat absorption from the gut. Here are examples of medications that may be recommended for weight loss:

• Diethylpropion
• Lorcaserin
• Orlistat
• Phendimetrazine
• Phentermine—can be taken alone or in combination with another medication

Some studies have supported the use of these medications when combined with lifestyle changes. For example, as part of a review of weight loss drugs, researchers analyzed 15 trials involving almost 10,000 people who were either taking orlistat or placebo. Compared to the placebo group, those taking orlistat had a higher chance of achieving a 5% or 10% weight loss. These types of medications, though, are usually prescribed only for people who are severely obese when other methods of weight loss have not worked. Accordingly, these medications are not without side effects or potential adverse events and should only be used with careful monitoring by your doctor.

The same goes for dietary supplements. Supplements do not undergo the same rigorous approval process as drugs. That being said, certain supplements may provide weight loss benefits since they may contain similar mechanisms of action as drugs. Along the same line, some of the same risks and side effects may be present, as well, which is why you should talk to your doctor before taking any over-the-counter weight loss products.

Also, be sure you know what is in diet medications and supplements. Some medications and supplements that were used in the past have been pulled from the market as it was found that the dangers of taking them were higher than the benefits. Whenever you are considering taking a diet supplement, know exactly what is in the product and share this information with your doctor.

The question is: when should you consider taking these weight loss aids? While it depends on your overall health and medical history, the best approach may be a conservative one. For example, adopt lifestyle changes for 6-12 months before trying a drug or supplement. Your doctor can give you guidance as to which weight loss options you should try first.

by Jackie Hart, MD

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:
Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:
Choosing a safe and successful weight-loss program. National Institute of Diabetes and Digestive and Kidney Disorders. Available at: http://www.niddk.nih.gov/health-information/health-topics/weight-control/choosing-safe-successful-weight-loss-program/Pages/choosing-safe-successful-weight-loss-program.aspx. Updated December 2012. Accessed January 14, 2016.

Diets for weight loss. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335(7631):1194-1199.

Weight loss medications for obesity in adults. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2015. Accessed January 14, 2016.

7/6/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Seo DC, Sa J. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults. Prev Med. 2008;47(6):573-582.

10/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm. Updated Sepember 9, 2013. Accessed January 14, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 1/14/2016

Recommendations to Help Prevent High Blood Pressure

February 14, 2017 Teresa Stockton - Blog, General Information

Hypertension is abnormally high blood pressure. High blood pressure puts extra strain on the heart, lungs, brain, and kidneys. It carries with it an increased risk of death and disability from coronary artery disease (CAD), stroke, heart failure, and kidney disease.

High blood pressure is very common but can’t be seen or felt. Many people with high blood pressure don’t know they have it. The best way to know if you have high blood pressure is to keep track of your numbers. You can get your blood pressure checked at your doctor’s office, at home, or at your local pharmacy. It’s important to get your blood pressure checked regularly.

Defining High Blood Pressure
High blood pressure is defined by 2 numbers (systolic and diastolic). The systolic or top number measures the pressure in your blood vessels when your heart beats. The diastolic or bottom number measures the pressure in your blood vessels when your heart rests between beats.

The normal blood pressure varies with age, usually increasing as we get older. In general, systolic blood pressure (SBP) less than 120 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg are considered normal and prehypertension is a SBP120-139 mm Hg or DPB 80-89 mm Hg. Abnormal levels include:
• Stage 1 hypertension—SBP 140-159 mm Hg or DPB 90-99 mm Hg
• Stage 2 hypertension—SBP more than 160 mm Hg or DBP more than 100 mm Hg

In people with diabetes or kidney disease, the targets numbers are lower. Check with your doctor to see what your target range should be.

Common Risk Factors
There is no single cause for high blood pressure, but there are several factors that can increase your risk.

Some risk factors for high blood pressure include:
• Age: middle-aged or elderly—onset generally happens at 20-50 years, but likelihood increases with age
• Race: African American
• Gender: Male

Medical factors, such as:
• Diabetes
• Obesity
• Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
• A family history of high blood pressure
• Sleep apnea
• Prehypertension

Lifestyle factors, such as:
• Smoking
• Being physically inactive
• Taking birth control pills
• Having diet high in red meat, salt, and saturated and trans fats
• High alcohol intake

Risk factors don’t mean you will get high blood pressure, but that you have an increased chance of developing it. Fortunately, there are also factors that can help you prevent high blood pressure or lower your blood pressure if you already have elevated blood pressure.

Lifestyle Guidelines to Prevent or Reduce High Blood Pressure
The National Heart, Lung, and Blood Institute’s recommendations to help prevent or lower high blood pressure include:
• Losing weight if you are overweight
• Increasing levels of physical activity—Aim for 30 minutes per day on most days of the week.
• Eating a diet rich in fruits, vegetables, and low-fat dairy products
• Eating a diet that is low in saturated and total fat
• Limiting consumption of sodium (salt) to less than 2,300 milligrams per day
• Drinking alcohol only in moderation—This means 1 drink or less per day for women and 2 drinks per day or less for men.

Another approach endorsed by National Heart, Lung, and Blood Institute is use of the DASH diet. This is a special low-salt diet which has been shown effective in both preventing and treating high blood pressure.

High blood pressure is a major player in heart disease and stroke. Protect yourself and know your numbers. The next time you take a trip to the pharmacy, check your blood pressure. If you do it on a regular basis and follow the lifestyle guidelines, you may be able to avoid future problems.

by Michael Jubinville, MPH

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Heart & Stroke Association
http://www.heartandstroke.ca

REFERENCES:
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.

How can high blood pressure be prevented? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/prevention. Updated September 10, 2015. Accessed August 2, 2016.

Hypertension. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 12, 2016. Accessed August 2, 2016.

Hypertension treatment in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2016. Accessed August 2, 2016.

Preventing high blood pressure: Healthy living habits. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/bloodpressure/what_you_can_do.htm. Updated July 7, 2014. Accessed August 2, 2016.

Understanding your risk for high blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp#.V6CgG02FPIU. Updated June 29, 2016. Accessed August 2, 2016.

Whelton PK, He J, Appel LJ, et al. Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-1888.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 8/2/2016

A Healthy Start in 2017

January 5, 2017 Teresa Stockton - Blog, General Information

It’s time to get a healthy start in 2017! We provided some general health and wellness tips to get you on your way to an amazing year! We call it the Pearls of Longevity!

PROTEIN
Eat 25 grams of protein each meal especially breakfast to prevent being hungry from carb cravings and crashes, help maintain and build muscle, and improve your immune system.

DID YOU KNOW?
For every 100 calories of protein you eat, it takes 25 calories to digest meaning you really only ate 75 calories! This is a 25% discount! For carbs and fat, you get less than a 10% discount.

EXERCISE
Exercise at least 30 minutes a day to burn calories and decrease stress. Lift weights or use body weight strengthening exercises to increase lean muscle and boost your metabolism.

DID YOU KNOW?
Exercise relieves symptoms of depression as well or even better than medication. Losing 10 lbs. decreases your risk of knee arthritis by 50%, while losing 10% of your body weight decreases joint pain by 50%!

ANTI INFLAMMATORY & ANTIOXIDANT-RICH FOODS
Fill half your plate at every meal to ensure you eat enough of these power foods.

DID YOU KNOW?
Eating lots of fruits, vegetables, nuts, olive oil, beans, salmon, spices, and even dark chocolate helps reduce inflammation and stress, decreases joint and muscle pain, and reduces your risk heart disease, hypertension, diabetes, cancer and stroke.

RELAXATION & STRESS REDUCTION
Practice inhaling slowly through your nose until you feel your belly button move out and then slowly exhale through your mouth feeling your belly button move in. Practice at least 5 minutes a day while driving, at your computer, while watching TV or when in bed. Smile, laugh and hug someone once a day.

DID YOU KNOW?
Deep breathing reduces stress, muscle pain, and blood pressure, while improving memory, concentration and performance. Happiness and affection are considered by many experts to be the fountain of youth as it lowers stress and releases hormones that help fight aging.

LIQUIDS
Drink 2 cups of water or tea when you wake up and drink 1-2 cups in between meals. Coffee does not count as it can lead to dehydration.

DID YOU KNOW?
Water reduces hunger, improves metabolism, brings nutrients, and hydrates your muscles and connective tissue. This can reduce inflammation and scar tissue which can lead to decreased muscle and joint pain.

SLEEP
Sleep at least 7-8 hours per night consistently going to bed and waking up the same time even on weekends.

DID YOU KNOW?
Sleep releases growth hormone which helps keep you young, increase lean muscle and decrease body fat!

A healthy start can lead to great endings. Best of luck to you and yours and Happy New Year!

Elf Injuries and How PT Can Help: Part 3 of 3

December 21, 2016 Teresa Stockton - Blog, General Information

It’s that time of year, when we check in on Santa’s helpers to see if they can use some physical therapy. With their heavy lifting and high demand job they’re always experiencing injuries. Our new elf friend Ziggy, is the perfect patient for PT.

Previously…

Ziggy was at one of PTandMe’s partnering physical therapy clinics awaiting the arrival of one of our trusted physical therapists.
Our therapist first performed some stretching techniques on Ziggy to help relieve his aches and pains (Don’t worry Santa said it was okay to touch our “elf on the shelf” friend).

Then so more stretching techniques to help out our little friend…

Now the therapist has Ziggy doing some pulls ups on our wonderful clinic’s pull-up bar to help Ziggy get back to working shape.

Time for deep tissue massage on Ziggy’s aching back…

Thanks to the great physical therapy Ziggy got at our wonderful PT & Me clinics he is now ready to lift all the toys into Santa’s sleigh just in time for the holiday!

THE END.

See Ziggy’s complete physical therapy experience here!

Special thanks to Action Physical Therapy, in Houston, TX, for accommodating the demanding work schedule of Santa’s elves. Click Here for more information about Action Physical Therapy.

Tips for Reducing ADHD Related Holiday Stress and Anxiety

December 21, 2016 Teresa Stockton - Blog, General Information

Ah, the holidays. The lights. The carols. The food. The family. It’s the most wonderful time of year. Right? Well, for many of us, the holidays are far more jangled nerves than joyful noise. And if you or a loved one suffers from ADHD, the stress of the holidays can be almost too much to bear. If you have ADHD, you already know how lonely and frustrating it can be when the holidays roll around, and it seems that everyone in the world is in the holiday spirit but you.

Increased Stress, Fatigue, and Sadness are Common During the Holidays
The truth is, though, that the season of celebration is also the season of stress. No one is immune to the pressures of the season. But the disruption of normal, daily routines, the added responsibilities of social engagements and familial obligations, and the abundance of symptom-exacerbating holiday foods make the stresses of the holidays particularly acute for ADHD sufferers.

Nevertheless, whether you or someone close to you has ADHD, or you are just seeking to navigate the season with more pleasure and less pain this year, there are some simple things you can do to manage holiday stress. The following techniques, derived primarily from cognitive-behavioral therapy (CBT), might just help you relax and enjoy the magic of the season.

1. Make a Plan
As much as we hate to admit it, there are only so many hours in a day and there’s a limit to what we can accomplish in those hours. So take some time before the rush and tumult of the holidays begin to prioritize what you want, need, and must do for the holidays. Figure out what matters most to you and yours and set up a clear, incremental strategy for getting it done. Knowing you have a doable action plan in place and working a little each day on your holiday tasks can minimize stress, worry, and fatigue, leaving you with the time and energy to actually enjoy the season. Whether it’s allotting five minutes a day for writing holiday cards or two hours of online gift shopping each Saturday, the best way to eat the elephant is one bite at a time.

2. Be Realistic
Yes, you’re good. You’re a rock star. But as awesome as you are, you’re still just one person. And trying to do it all is just not possible—and it’s also just not fair. The answer? Delegate! Have a sister who is a Mozart in the kitchen? Put her in charge of the meal preparation. Have a spouse who’s a Picasso of design? Let him handle the holiday decorating. Not only will this take some of the pressure off you, but it will enable you to enjoy what the holidays are really all about anyway: spending time and making memories with those you love.

3. Forget Perfection
Face it, life is not a Frank Capra movie (and even good old George Bailey had it pretty rough there for a while). So let go of the fantasy of a Capra Christmas or a humdinger of a Chanukah. Inevitably, something is going to get lost or broken; invariably someone’s going to burn the bread or forget the cookies. And, yes, somebody is going to hurt anyone’s feelings. But that’s life. Real life—the good, the bad, and the ugly. Just remember that the imperfections are what make it real, unique, and, in the long run, beautiful. These screw-ups and squabbles that we put such desperate pressure on ourselves to prevent in our pursuit of some fictitious “perfect” holiday are exactly the things we will remember so fondly, and laugh about most heartily with our dear ones, in the years to come.

4. Practice Extreme Self-Care
No matter what the greeting card companies say, the holidays are not the time for self-sacrifice. The only thing playing the martyr will get you is stress, exhaustion, and resentment. Ho, ho, ho. Instead of running yourself ragged, make sure that you do what you need to do to recharge your batteries, to nourish your mind, body, and spirit. Take an hour each day to do something that gives you joy: a warm bath, a long walk, a good book—a nap.

While you’re at it, don’t forget about exercise and nutrition. Indulging in holiday treats is fine. Complete denial will only lead to resentment. But everything in moderation. Rich, highly processed, sugary, and fatty foods can worsen ADHD symptoms. Be selective about what, when, and how much you eat, and remember that exercise, whether an hour of yoga or a brisk bike ride, can help to dispel the brain fog borne of these less-than-healthy foods—not to mention working off some of that holiday stress when it does come!

Begin Reducing Your Stress Today!
Whether you or a loved one has ADHD, or you only want to thrive and not just survive this holiday season, these few simple techniques can make it possible. For more information about ADD/ADHD in adults, please read: https://openforest.net/attention-deficit-disorder-adults/, Wishing you and yours less stress and more joy this holiday season!

Looking for a way to help manage ADHD? You can find natural remedies here.

Written by Terri Beth Miller, MA, PhD. She is freelance writer and contributor to Open Forest, the online mental health self-help website.

Elf Injuries and How PT Can Help: Part 2 of 3

December 16, 2016 Teresa Stockton - Blog, General Information

When we last left off…

Ziggy was at one of PTandMe’s partnering physical therapy clinics.
He first had to check in with our friendly and helpful receptionist.

Then Ziggy warmed up on one of our many clinic’s treadmills to help strengthen his aching back.

Now Ziggy is awaiting the arrival of one of our trusted physical therapists, who will provide him with stretching techniques and exercises to help relieve his back pain.

To be continued…

See Ziggy’s complete physical therapy experience here!

Special thanks to Action Physical Therapy, in Houston, TX, for accommodating the demanding work schedule of Santa’s elves. Click Here for more information about Action Physical Therapy.

Type 2 Diabetes (Diabetes Mellitus Type 2; Insulin-Resistant Diabetes; Diabetes, Type 2)

November 10, 2016 Teresa Stockton - Blog, General Information

Definition
Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy.

Diabetes is a condition that makes it difficult for the body to use glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes, and it is the most common.

Medication, lifestyle changes, and monitoring can help control blood glucose levels.

Causes
Type 2 diabetes is often caused by a combination of factors. One factor is that your body begins to make less insulin. A second factor is that your body becomes resistant to insulin. This means there is insulin in your body, but your body cannot use it effectively. Insulin resistance is often related to excess body fat.

Risk Factors
Type 2 diabetes is more common in people who are aged 45 years and older. It is also common in younger people who are obese and belong to at-risk ethnic groups. Other factors that increase your chance for type 2 diabetes include:
• Prediabetes — impaired glucose tolerance and impaired fasting glucose
• Metabolic syndrome — a condition marked by elevated cholesterol, blood glucose, blood pressure, and central obesity
• Excess weight or obesity, especially central obesity
• Lack of exercise
• Poor diet — high intake of processed meats, fats, sugar-sweetened foods and beverages, and calories
• Family history of type 2 diabetes
• High blood pressure
• History of cardiovascular disease
• Depression
• History of gestational diabetes, or having a baby that weighs over 9 pounds at birth
• Endocrine disorders, such as Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, or glucagonoma
• Conditions associated with insulin resistance, such as acanthosis nigricans
• Certain medications, such as glucocorticoids or thiazides
• Certain ethnic groups, such as African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander

Symptoms
You may have diabetes for years before you have symptoms. Symptoms caused by high blood sugar or include:
• Increased urination
• Extreme thirst
• Hunger
• Fatigue
• Blurry vision
• Irritability
• Frequent or recurring infections
• Poor wound healing
• Numbness or tingling in the hands or feet
• Problems with gums
• Itching
• Problems having an erection

Diagnosis
The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.

Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:
• Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
• Fasting blood sugar test is done after you have not eaten for 8 or more hours—showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
• Glucose tolerance test measures blood sugar 2 hours after you eat glucose—showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
• HbA1c level of 6.5% or higher—indicates poor blood sugar control over the past 2-4 months

* mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

Treatment
Treatment aims to:
• Maintain blood sugar at levels as close to normal as possible
• Prevent or delay complications
• Control other conditions that you may have, like high blood pressure and high cholesterol

Diet
Food and drinks have a direct effect on your blood glucose level. Eating healthy meals can help you control your blood glucose. It will also help your overall health. Some basic tips include:
• Follow a balanced meal plan. It should include carbohydrates, proteins, and fats.
• Be aware of appropriate serving size. Measure your food to help understand ideal serving size.
• Do not skip meals. Plan your meals and snacks through the day. Having meals throughout the day can help avoid major changes in glucose levels.
• Eat plenty of vegetables and fiber.
• Limit the amount of fat (especially saturated and trans fats) in your foods.
• Eat moderate amounts of protein and low-fat dairy products.
• Carefully limit foods containing high concentrated sugar.
• Keep a record of your food intake. Share the record with your dietitian or doctor. This will help to create an effective meal plan.

Weight Loss
If you are overweight, weight loss will help your body use insulin better. Talk to your doctor about a healthy weight goal. You and your doctor or dietitian can make a safe meal plan for you.

These options may help you lose weight:
• Use a portion control plate
• Use a prepared meal plan
• Eat a Mediterranean-style diet

Exercise
Physical activity can:
• Make the body more sensitive to insulin
• Help you reach and maintain a healthy weight
• Lower the levels of fat in your blood

Aerobic exercise is any activity that increases your heart rate. Resistance training helps build muscle strength. Both types of exercise help to improve long-term glucose control. Regular exercise can also help reduce your risk of heart disease.

Talk to your doctor about an activity plan. Ask about any precautions you may need to take.

Medication
Certain medications will help to manage blood glucose levels.

Medication taken by mouth may include:
• Biguanides reduce the amount of glucose made by the body
• Sulfonylureas encourage the pancreas to make more insulin
• Insulin sensitizers to help the body use insulin better
• Starch blockers to decrease the amount of glucose absorbed into the blood
• Sodium-glucose co-transporter 2 (SGLT-2) inhibitors to increase glucose excretion in urine
• Bile acid binders

Some medications needs to be given by injection, such as:
• Incretin-mimetics stimulate the pancreas to produce insulin and decrease appetite, which can assist with weight loss
• Amylin analogs replace a protein of the pancreas that is low in people with type 2 diabetes

Insulin
Insulin may be needed if:
• The body does not make enough of its own insulin
• Blood glucose levels cannot be controlled with lifestyle changes and medications

Insulin is given through injections. There is one short-acting inhaled insulin which may be available for select persons.

Blood Glucose Testing
You can check the level of glucose in your blood with a blood glucose meter. Checking your blood glucose levels during the day can help you stay on track. It will also help your doctor determine if your treatment is working. Keeping track of blood sugar levels is especially important if you take insulin.

Regular testing may not be needed if your diabetes is under control and you don’t take insulin. Talk with your doctor before stopping blood sugar monitoring.

An HbA1c test may also be done at your doctor’s office. This is a measure of blood glucose control over a long period of time. Doctors advise that most people keep their HbA1c levels below 7%. Your exact goal may be different. Keeping HbA1c in your goal range can help lower the chance of complications.

Counseling
Depression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your depression and diabetes.

Decreasing Risk of Complications
Over a long period of time, high blood glucose levels can damage vital organs. The kidneys, eyes, and nerves are most affected. Diabetes can also increase your risk of heart disease.

Maintaining goal blood glucose levels is the first step to lowering your risk of these complications. Other steps:
• Take good care of your feet. Be on the lookout for any sores or irritated areas. Keep your feet dry and clean.
• Have your eyes checked once a year.
• Don’t smoke. If you do, look for programs or products that can help you quit.
• Keep track of your moods and be alert for persistent depressive symptoms.
• Plan medical visits as recommended.

Prevention
To help reduce your chance of type 2 diabetes:
• Participate in regular physical activity
• Maintain a healthy weight
• Drink alcohol only in moderation (2 drinks per day for a man, and 1 drink per day for a woman)
• Eat a well-balanced diet:
– Get enough fiber
– Avoid fatty foods
– Limit sugar intake
– Eat more green, leafy vegetables
– Eat whole fruits, especially apples, grapes, and blueberries

by Debra Wood, RN

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

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6/1/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457-2471.

7/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132.

12/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2008;28(2):341-347.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336(7642):491-495.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141-146.

6/18/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572.

2/24/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009;32:263-268.

5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:972-977.

8/19/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB. Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr. 2009;139:1333-1338.

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7/2/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283.

10/5/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.

1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Pan A, Lucas M, Sun Q, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010;170(21):1884-1891.

5/6/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Muraki I, Imamura F, Manson J, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001.

4/14/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Xi B, Li S, et al. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2014;9(3):e93471.

7/21/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Afshin A, Micha R, et al. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(1):278-288.

9/11/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Tovote KA, Fleer J, Snippe E, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37(9):2427-2434.

9/16/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Zhou D, Yu H, He F, et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2014;100(1):270-277.

Last reviewed January 2016 by Kim Carmichael, MD