Tag Archives: EBSCO

True or False: Changes in the Weather Can Make Your Joints Stiff or Achy

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For many people, the flare-up of an arthritic knee or shoulder appears to signal a change in the weather—usually hinting that a storm is imminent.

The belief that achy joints accompany a weather change is so widespread, in fact, that it has just about been accepted as reality. Many doctors listen to patients complain that they experience stiff or aching joints before, during, or after changes in temperature, barometric pressure, or humidity.

Yet, in spite of the widespread belief in a connection between aches and pains and inclement weather, medical researchers have come up with little evidence to support it.

Evidence for the Health Claim
Changes in the weather such as barometric pressure, humidity, and temperature could theoretically affect the synovial fluid that lines and lubricates the joints if, for example, they had a chemical effect on the fluid which somehow increased inflammation (which causes pain). However, there is no conclusive evidence that supports this theory.

Since at least the mid-1800s, a number of medical, and so-called bio-meteorologic research studies have been carried out in an effort to establish a connection between health and changing weather conditions.

The results of these studies have been varied. Based primarily on a compilation of patient anecdotes (reports of arthritis sufferers, for instance), increased barometric pressure (in fair weather conditions) has been associated with increased joint pain. Conversely, others studies have shown a relationship between increased joint pain and decreased barometric pressure (in stormier weather). Still other studies have suggested that changing weather conditions can cause immediate pain in some patients and delayed pain in others.

weather changes

Evidence Against the Health Claim

It is important to note that because most studies on this subject have been based on anecdotal reports rather than carefully designed observational studies, their conclusions don’t constitute reliable scientific evidence. Furthermore, many doctors claim that the wide variety of arthritic conditions and sheer complexity of atmospheric variability makes coming up with meaningful connections between joint pain and weather conditions next to impossible.

There is also a psychological aspect to this belief. What are the chances that the connection between health and the weather is simply coincidental? Is it possible that arthritis sufferers link their stiff and achy joints to changes in the weather as a way of explaining an otherwise mysterious exacerbation of their condition? Some doctors suggest that patients who observe weather conditions when they experience pain may pay little or no attention to the weather when they don’t have any pain.

Furthermore, there is no definitive evidence that moving to a warmer or drier climate provides a cure for aching joints. Some doctors report that many patients claim that the pain disappears for a while, only to return a few months later.

by Rhianon Davies

REFERENCES:
Aches and Pains Index. UK Weather Channel Interactive Web site. Available at http://uk.weather.com/activities/health/achesandpains/achesandpainsindex.html. Accessed July 25, 2006.

Cold Weather Can Cause More Aches and Pains for Arthritis Sufferers. Marshall University Orthopaedics Web site. Available at http://musom.marshall.edu/medctr/orthopaedics/cold weather.asp. Accessed July 25, 2006

Shmerling RH. Whether Weather Matters For Arthritis. Available at http://www.intelihealth.com/IH/ihtIH/8799/9273/35323/341624.html?d=dmtHMSContent. Accessed July 25, 2006.

Weather and Joint Pain. Any Connection? Mayo Clinic Web site. Available at http://www.mayoclinic.com/health/joint-pain/AN00102. Accessed July 25, 2006.

Weather and Our Physical Health. BBC News Web site. Available at http://www.bbc.co.uk/weather/weatherwise/living/effects/. Accessed July 25, 2006.

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.

Eat Well

Eat Well, Exercise Well, Be Well: Dietary and Fitness Guidelines

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Eat Well

When it comes to the secrets of living a healthy life, it seems that there are no secrets. From diet gurus to celebrities, everyone seems to have the answers on healthy living. Since the 1980s, the United States government has also weighed in, with dietary guidelines that it publishes every 5 years. The intent is to provide research-backed diet and physical activity recommendations to reduce the risk of diseases linked to poor diet and activity, such as high blood pressure, heart disease, and type 2 diabetes. Here is a round-up of the government’s latest key recommendations from the publication, 2015-2020 Dietary Guidelines for Americans.

EAT WELL

Calories, Calories, Calories
In recent years, obesity has been a national concern, since it has been associated with serious conditions like cancer, heart disease, and type 2 diabetes. Controlling total calorie intake is essential to maintaining ideal body weight. If you are trying to lose weight, you will need to expend more calories than you take in. This means getting plenty of exercise and cutting down on foods that are high in calories.

So how many calories should you be consuming? This depends on several factors, such as age, gender, height, weight, and physical activity level. To keep calories under control, you want to focus on eating foods full of many nutrients, especially potassium, fiber, vitamin D, and calcium. You may want to talk with your doctor or a registered dietitian about an eating plan that is right for you. In general, try to keep calories in check. Aim to meet calorie needs, but not exceed them. Reducing portion size and eating more meals at home are great ways to avoid exceeding calorie needs. In addition, eating foods high in nutrients but lower in calories can help.

Foods to Enjoy

  • Eat a lot of fruits and vegetables—Fresh fruits and vegetables are lower in calories compared to processed foods. Focus on color when eating fruits and vegetables. Dark green, red, and orange vegetables are especially packed with good-for-you nutrients. When preparing a meal, try and fill half your plate with fruits and vegetables.
  • Eat a lot of whole grains—Examples of whole grains are brown rice, oatmeal, bulgur, and whole-wheat pasta. Your goal should be to make half your grains whole grains.
  • Have more dairy—Focus on low- or non-fat milk, cheese, and yogurt.
  • It is okay to eat certain fats—Some fats are okay to consume in moderation. These are monosaturated or polyunsaturated fats, which are found in foods like nuts and fish.
    Power up on protein—Seafood, lean meats, poultry, beans, and soy products are good sources of protein. Be sure to choose protein foods that are low in saturated fat and calories.

Fruits and Vegetables

Food to Eat Less

  • Limit refined grains—Examples of refined grains are white bread, corn flakes, grits, regular pasta, and white rice. These foods tend to be high in calories and sugar but low in fiber.
  • Limit foods containing added sugars—This includes sugar-sweetened drinks and snacks.
  • Limit foods high in saturated fats—This includes certain kinds of meat and dairy products (whole milk, cream, and butter). Less than 10% of calories should come from saturated fats.
  • Keep trans fat consumption as low as possible—You can do this by limiting foods containing solid fats and partially hydrogenated oils, such as margarine and baked goods.
  • Limit salt intake—Too much of it can increase your risk for high blood pressure, which can lead to kidney damage, heart disease, and stroke. On a daily basis, adults should consume less than 2,300 mg of sodium.
  • If you drink alcohol, do so in moderation —Women should consume no more than 1 alcoholic drink a day, while men should consume no more than 2 drinks a day. Also, keep track of the calories in each drink. Mixed drinks tend to have higher calories.

Preparing Your Plate
Remembering which foods to limit, and which to eat more of, may be daunting. To help you remember, the United States Department of Agriculture created a simple image of a sectioned plate as a guideline for healthy eating. The Choose My Plate guidelines emphasize nutrient-dense foods and beverages, such as vegetables, fruits, whole grains, low- or non-fat milk, beans, and nuts. If remembering how much and what to eat is a chore, you can just keep these simple things in mind to ensure that you are eating well when you sit down for a meal:

  • Fill half your plate with fruits and vegetables.
  • When eating grains, make sure half your grains are whole grains.
  • Choose fat-free and low-fat (1%) milk products.
  • Avoid oversized portions.
  • Enjoy your food, but be mindful of how much you are eating. Try to eat less.
  • Drink water instead of sugary drinks.
  • When cooking, try to use less or no salt in the recipe. When you eat your meals, do not add any extra salt. Over time, you will adjust to less salt in your food.

You can find specific information on the ChooseMyPlate website.

Exercise Well
A nutritious diet and exercise go together for maintaining a healthy lifestyle. To achieve and maintain a healthy body weight, adults should aim for 150 minutes of moderate to intense physical activity each week. Some examples of activities are brisk walking, biking, and swimming. Before starting any kind of exercise program, be sure to check with your doctor if you have any health issues that may limit your exercise program.

Be Well
Guidelines provide the foundation for a healthy lifestyle. But living a healthy lifestyle takes discipline and a positive attitude. Working with your doctor and perhaps other professionals, like a dietitian or fitness trainer, can be helpful in keeping you motivated and on track for reaching your health goals. Also, a healthy lifestyle should not be a chore, but something enjoyable.

Make exercise fun—a weekend hike, a lunch-hour walk with co-workers, or a pick-up game of basketball with your neighbor are just some ideas. And when mealtimes roll around, put on your creative chef hat! Come up with new approaches to breakfast, lunch, and dinner menus that incorporate fresh, nutrient-dense foods, and get friends and family involved in preparing meals. Experiment with herbs and spices to flavor your meals instead of the old salt standby. Armed with guidance, support, and motivation, a healthy lifestyle is within your reach!

Written by Marjorie Montemayor-Quellenberg, MA

RESOURCES:
Choose My Plate—US Department of Agriculture
http://www.choosemyplate.gov

Eat Right—Academy of Nutrition and Dietetics
http://www.eatright.org

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

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

REFERENCES:

2015-2020 Dietary guidelines for Americans. US Department of Agriculture and US Department of Health and Human Services. Available at: https://health.gov/dietaryguidelines/2015/guidelines/. Accessed February 14, 2017.

BMI calculator. ChooseMyPlate—US Department of Agriculture website. Available at: http://www.choosemyplate.gov/weight-management-calories/weight-management.html. Accessed February 14, 2017.

Dietary interventions for cardiovascular disease prevention. EBSCO DynaMed Plus website. Available at: http://www.ebscohost.com/dynamed. Updated February 5, 2015. Accessed March 9, 2015.

What is MyPlate? US Department of Agriculture ChooseMyPlate website. Available at: https://www.choosemyplate.gov/MyPlate. Accessed February 14, 2017.

Last reviewed February 2017 by Michael Woods, MD, FAAP

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.

Exercise Diabetes

Role of Exercise in Type 2 Diabetes

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Role of Exercise in Type 2 Diabetes, Healthy Eating

Lifestyle changes play an important role in managing type 2 diabetes. Activity decreases blood glucose and regular exercise helps by improving the way your body uses glucose.It can also reduce the risk of diabetes complications like heart disease.

How it Works
Glucose is a type of sugar that is used for energy. It is present in the blood and stored in the muscle and liver. A hormone called insulin helps most of the glucose move from the blood into cells. For those with type 2 diabetes, the body is resistant to insulin and over time the body has trouble making insulin at all. As a result, glucose has trouble getting to the cells, the body doesn’t get enough energy, and glucose builds up in the blood.

During exercise your working muscles have a greater need for energy and therefore glucose. As a result, glucose can enter the muscles and cells with far less insulin. This leads to a drop in blood glucose levels during exercise and for a few hours after while the muscles recover. This causes an immediate though temporary decrease in blood glucose.

Over time, regular activity can make the body less insulin resistant during activity or rest. This can lead to more long term benefits and may lead to a decrease in the need for medication.

In addition to helping control diabetes, exercise can also improve your overall health by decreasing weight, the risk of cardiovascular disease, and blood vessel damage.

Role of Exercise in Type 2 Diabetes, Healthy Eating

Exercise Recommendations
It is important that you talk to a doctor before starting an exercise program. You and your doctor can work together to choose an exercise program that is right for you.

For greatest benefits, you will need to do both aerobic exercises and strength training. Aerobic exercises include things like walking, bicycling, and swimming. Strength training exercises and classes use things like weight machines, free weights, and resistance bands. Adults should aim for:

  • At least 150 minutes per week of moderate-to-vigorous intensity aerobic exercise
  • 2-3 days of strength training per week
  • Try not to go more than 2 days without some type of activity

Look for opportunities during the day to add to your overall activity level. Take the stairs instead of the elevator, take a short walk during the day, or walk instead of taking the car. Even 10 minutes of activity can provide some immediate benefits.

Safety Steps
Certain diabetes medication can lead to a dip in blood glucose called hypoglycemia. Talk to your doctor to understand if this may be a problem for you. Be aware of signs of hypoglycemia during exercise such as dizziness, shaking, or confusion. If you have these symptoms, stop exercising and manage hypoglycemia. Let your doctor know about any episodes, since your medication may need to be adjusted.

Diabetes can also affect the nerves and blood flow to the feet. Inspect your feet frequently, since diabetes can sometimes lessen your ability to feel pain from a foot injury.

Keep in mind that exercise is only one piece of an overall diabetes management plan. You will also need to control your blood glucose levels with good nutrition.

by Cynthia M. Johnson, MA

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

Centers for Disease Control and Prevention
http://www.cdc.gov

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

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

REFERENCES:

Physical activity for type 2 diabetes. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T270048/Physical-activity-for-type-2-diabetes. Accessed February 20, 2017.

Physical activity is important. American Diabetes Association website. Available at: http://www.diabetes.org/food-and-fitness/fitness/physical-activity-is-important.html. Updated December 27, 2016. Accessed February 20, 2017.

What we recommend. American Diabetes Association website. Available at: http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-we-recommend.html. Updated May 19, 2015. Accessed February 20, 2017.

Last reviewed December 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 12/22/2017

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.

opioid crisis physical therapy

CDC Launches Opioid Campaign in Hard-Hit States

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TUESDAY, Sept. 26, 2017 (HealthDay News) — The U. S. Centers for Disease Control and Prevention has launched a campaign to reduce overdose deaths from prescription opioid painkillers. Between 1999 and 2015, more than 183,000 people in the United States died from prescription opioid overdoses such as OxyContin (oxycodone) and Vicodin (hydrocodone). The goal of the CDC’s Rx Awareness campaign is to increase knowledge of the risks of prescription opioids and stop inappropriate use. Personal accounts from recovering opioid abusers and people who’ve lost loved ones will be featured. “It only takes a little to lose a lot” is the campaign tagline. It will be featured in videos, audio ads, social media ads, internet banners, web graphics, billboards and posters. Campaign ads are planned to run for the next 14 weeks in Kentucky, Massachusetts, New Mexico and Ohio. The campaign will expand to other states as more funding becomes available. “This campaign is part of CDC’s continued support for states on the frontlines of the opioid overdose epidemic,” CDC Director Dr. Brenda Fitzgerald said in an agency news release. “These heartbreaking stories of the devastation brought on by opioid abuse have the potential to open eyes and save lives,” she said. In 2015, 12.5 million people in the United States misused prescription opioids. Every day, more than 1,000 people are treated in emergency departments for prescription opioid misuse and more than 40 people die from prescription opioid overdoses. Prescription opioid abuse is also a major risk factor for heroin use. About three-quarters of new heroin users misused prescription opioids before using heroin.

Manage pain safely with Physical Therapy. Physical therapy is a safe non-invasive form of treatment for patients experiencing musculoskeletal pain or injuries. Great candidates to be referred to physical therapy instead of prescribing pain pills include:

  • A patient that has had pain for more than 90 days
  • A patient that complains of pain disturbing their sleep or daily activities
  • A patient that has a history of substance abuse or has been on pain medication for an extended period of time
  • A patient that expresses an interest in avoiding opioids

Try Physical Therapy and experience the difference. For more information about what physical therapy can treat. Visit the PTandMe Injury Center.

For more information, the U.S. Centers for Disease Control and Prevention has more on prescription opioids.

HealthDay News

Copyright © 2017 HealthDay. All rights reserved.
The information in this article, including reference materials, are provided to you solely for educational or research purposes. Information in reference materials, are not and should not be considered professional health care advice upon which you should rely. Health care information changes rapidly and consequently, information in this article may be out of date. Questions about personal health should always be referred to a physician or other health care professional.

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.

childhood obesity

Treating Childhood Obesity With Activity

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When talk focuses on childhood obesity in the United States, words like “critical” and “epidemic” are often used. The tried-and-true prescription of more exercise and better nutrition still holds true, but overweight children face unique challenges when it comes to weight loss.

Why Has Childhood Obesity Increased and What Are the Effects?
The statistics are disturbing. Not only are the overall obesity rates increasing, the heaviest kids are heavier than they were 30 years ago. Why is this happening? Experts who have studied childhood obesity attribute it to a change in lifestyle. The active lifestyle of the past—walking to school, playing outside, and engaging in after-school activities—has been replaced by a sedentary lifestyle of watching TV, playing video games, and using electronic devices like phones, computers, and tablets. Eating habits have changed noticeably, with convenience foods that are higher in fat and calories replacing fruits and vegetables.

The consequences of obesity are significant. A child who is obese may develop high blood pressure, high cholesterol, and type 2 diabetes. These conditions can increase the risk of cardiovascular disease such as a heart attack and stroke. In addition, older teens who are obese may have an increased risk of death during adulthood.

Obesity can also affect emotional health. A child who is obese may have emotional problems in school, and struggle with low self-esteem and depression.

What Is One of the Best Solutions?
Exercise is one of the main tools to fight childhood obesity. The US Department of Health and Human Services encourages children of all ages to be physically active. If your child is overweight, obese, or even of normal weight, recommendations to improve your child’s health include:

  • Encouraging your young child (aged 1-4 years old) to actively play daily in a safe environment
  • Encouraging your older child (aged 5 years and up) to participate in moderate to vigorous activity every day—Your child should aim for at least one hour per day of moderate to vigorous activity. At least 3 days out of the week should be vigorous activity.

Since children often engage in shorter bursts of activity throughout the day, it is okay to count these times as exercise.

Examples of different types of physical activity include:

Moderate-intensity: Brisk walking, hiking, skateboarding, baseball, rollerblading, and bike riding
Vigorous-intensity: Jumping rope, running, and playing sports like basketball, hockey or tennis

The main difference between moderate- and vigorous-intensity exercises is the demand on the body. Vigorous activities force the body to work harder. The heart beats faster and breathing becomes more rapid, but energy is used up faster.

  • Rollerblading
  • Learning karate
  • Playing organized sports (field hockey, soccer, football)
  • Swimming
  • Gymnastics
  • Strength training with weights
  • Rock climbing
  • Cross-country skiing

Before your child jumps into a new fitness routine, it is important that you work with your child’s doctor. Being obese can put a strain on muscles and bones, possibly causing back pain and foot or ankle problems. The doctor can assess your child’s overall health and recommend safe exercises.

What Else Can Be Done to Encourage Activity?
Another important piece to the puzzle is to focus on screen time. Screen time refers to how many hours per day your child spends in front of a screen—whether it be watching TV, playing video games, or using electronic devices. These are sedentary activities that contribute to obesity. The NHLBI recommends that screen time should be limited to less than 2 hours per day, which leaves more time for exercise. You can further encourage your child to be active by planning family outings, like going on a hike, riding bikes, or playing flag football. That way, the whole family can become healthier together.

by Patricia Kellicker, BSN and Rebecca J. Stahl, MA

RESOURCES:
American Council on Exercise
http://www.acefitness.org

Shape Up America
http://www.shapeupus.org

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

Healthy Alberta
http://www.healthyalberta.com

REFERENCES:
Aerobic, muscle, and bone-strengthening: What counts? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm. Updated June 5, 2015. Accessed March 2, 2016.

Chapter 3: Active children and adolescents. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/chapter3.aspx. Accessed March 2, 2016.

How much physical activity do children need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/basics/children/index.htm. Updated June 4, 2015. Accessed March 2, 2016.

Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7(4):352-356.

NCHBI integrated guidelines for pediatric cardiovascular risk reduction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 12, 2013. Accessed March 2, 2016.

Obesity in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 10, 2016. Accessed March 2, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 3/2/2016

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.

Protect Yourself from Tickborne Illnesses

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They may be small, but the bite from just one infected tick can cause symptoms that range from fever and chills to severe infections. However, you can protect yourself from tickborne illnesses, such as Lyme Disease and Rocky Mountain spotted fever, by avoiding areas where ticks are present and preventing ticks from getting on your body.

AVOID TICK HABITATS
Ticks can be found in the northeastern, northwestern, mid-Atlantic, or upper north-central regions of the United States. They are most active in warmer months from April to September. However, they can be active when temperatures are above 40°F (4.4°C).
Tips for reducing your exposure to ticks include:

  • Avoid moist, shaded, wooded, or grassy areas.
  • Stay on cleared, well-traveled paths, and walk in the center of trails to avoid overgrown grass and brush.
  • Avoid sitting on the ground or on stone walls.
  • You can discourage ticks from your property if you:
  • Remove leaf litter, brush, and woodpiles from around your home and the edges of your yard.
  • Mow the grass often.
  • Discourage animals that carry ticks from coming onto your property.

PREVENT TICKS FROM GETTING ON YOUR BODY
Proper clothing can help protect you from tick bites when you enter areas that may have ticks. When spending time outdoors:

  • Wear long pants and a long-sleeved shirt. Light-colored clothing will make it easier for you to see any ticks that may get on you.
  • Tuck your shirt into your pants and tuck your pants into your socks.
  • Wear a hat. Braid or tie back long hair.
  • Wear closed toed shoes.

Insect repellant can also prevent tick bites. Repellents containing 20%-30% N,N-diethyl-meta-toluamide (DEET) can be applied to clothes and exposed skin. Repellents that have 0.5% permethrin can be applied to pants, socks, and shoes, but not to skin. Be sure to read product instructions carefully. For example:

  • Do not apply near your eyes, nose, or mouth.
  • Do not apply to children’s hands.
  • Reapply as directed.
  • Wash your skin when you return indoors.

PERFORM TICK CHECKS
After you spend time outdoors in a high-risk area:

  • Use a mirror to do a full-body tick check on yourself. You should also check any children who are in your care. Make sure to check for hidden areas, such as the hair, around the ears, under the arms, and in skin folds.
  • Examine your clothing for ticks that may attach to you after you come home.
  • Take a shower and wash your hair within 2 hours of coming indoors.
  • Put clothes worn outdoors in the dryer on high heat for 10 minutes to kill any unseen ticks.
  • If you have pets that spend time in high-risk areas, perform daily tick checks to prevent them from spreading to humans.

REMOVE TICKS FROM YOUR BODY

  • If you do find a tick, remove it by doing the following:
  • Use a pair of fine-pointed tweezers to grasp the tick by the head, as close to the skin as possible.
  • Pull directly outward. Use gentle but firm force. Do not twist the tick out. Try not to crush the tick’s body or handle it with bare fingers. This can spread the infection.
  • Wipe the site with an antiseptic to prevent infection.

KNOW THE SIGNS OF TICKBORNE ILLNESSES

Symptoms of a tickborne illness can occur weeks after exposure. Even if you have taken precautions, be sure to contact your doctor right away if you have recently spent time in a high-risk area and have fever and chills, aches and pains, and a distinctive rash.

by Cynthia M. Johnson, MA

RESOURCES:
Centers for Disease Control and Prevention
http://www.cdc.gov

Healthy Children—American Academy of Pediatrics
https://www.healthychildren.org

CANADIAN RESOURCES:
Canadian Paediatric Society
http://www.cps.ca

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

REFERENCES:

Preventing ticks on your pets. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ticks/avoid/on_pets.html. Updated June 1, 2015. Accessed March 24, 2017.

Symptoms of tickborne illness. US Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/ticks/symptoms.html. Updated June 1, 2015. Accessed February 20, 2017.

Tick avoidance and removal. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T901539/Tick-avoidance-and-removal. Accessed February 20, 2017.

Michael Woods, MD June 2017

Last reviewed June 2017 by Michael Woods, MD

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.

Chronic Disease Relief

Exercise for Chronic Disease Relief

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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.

cracking knuckles

True or False: Cracking Your Knuckles Can Lead to Arthritis

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Crack. Pop. Click. These sounds jump from the joints of the many children and adults who are in the habit of cracking their knuckles.

If you cracked your knuckles as a child, you may have been warned that it could cause you to develop arthritis later in life. Is this true? Probably not, according to a handful of studies on the subject. While cracking your knuckles may not cause arthritis, some researchers believe that habitual cracking could create some problems later on. Not to mention that the incessant pops and clicks are likely to be a major annoyance to those around you.

Evidence for the Health Claim
Your knuckles are the joints in your fingers and toes. They are located where two bones meet, and they are bathed in a liquid called synovial fluid, which lubricates the joints. Sometimes a bubble of gas develops in the synovial fluid, and when the joint is manipulated in certain ways (eg, when a person is bending or compressing his or her hand), the bubble can burst, making an audible popping or cracking sound.

Arthritis is an extremely common problem for older adults, with the majority of people over age 65 having signs of the condition. There are two major forms of arthritis. Rheumatoid arthritis results from inflammation of the joints, and can cause pain, redness, swelling, and eventually deformity and loss of function. Osteoarthritis, the most common form, results from wear and tear on the joints over time, which is why it tends to affect older adults.

While there is no reason to believe that knuckle cracking would lead to rheumatoid arthritis, it makes sense that habitual trauma to a joint might eventually cause tissues to break down and wear away leading to osteoarthritis. In fact, some researchers have reported cases of people who habitually cracked their knuckles and went on to develop osteoarthritis or other joint problems. For example, in a case report published in the British Medical Journal, researchers report that a man who habitually cracked and popped many of his joints had damage in his right hand indicative of arthritis.

Another study published in the Proceedings of the Institution of Mechanical Engineers simulated the act of cracking knuckles and found that the energy used to crack your knuckles is enough to damage the cartilage in your joints.

Do these reports mean knuckle cracking can lead to arthritis? Or are they just chance findings, since so many people develop osteoarthritis whether they crack their knuckles or not?

Evidence Against the Health Claim
While individual reports may cite cases in which voracious knuckle crackers develop arthritis, other studies tell a different story.

In 1975, Dr. Robert L. Swezey and Stuart E. Swezey conducted a study of 28 nursing home residents who could recall whether or not they had cracked their knuckles earlier in life. After performing x-rays on the participants’ hands, the researchers concluded that there was no link between habitual knuckle cracking and arthritis.

Another study, published in the Annals of Rheumatic Disease, looked at a group of 300 habitual knuckle crackers. The researchers found that the participants who cracked their knuckles regularly did not experience more cases of osteoarthritis. Knuckle crackers, however, were more likely to have hand swelling and reduced grip strength in their hands. Whether the knuckle cracking caused the swelling and loss of hand function or those with hand problems were just more likely to crack their knuckles, the researchers could not say.

Researchers also compared a group of people with osteoarthritis in the hand with those who did not have the condition. The two groups were asked whether they cracked their knuckles and, if so, the duration and the frequency of this behavior. When the researchers analyzed the findings, they found no correlation between knuckle cracking and the development of osteoarthritis.

knuckles

Conclusion
Some people who crack their knuckles do it out of habit or boredom. Many others say it helps relieve joint pain and tension, and allows for greater range of motion in their joints. If you are in the habit of cracking your knuckles, the evidence available today suggests that it will not cause you to develop arthritis. While some insatiable knuckle crackers may go onto to develop problems down the road, the occasional painless cracking is probably harmless.

Keep in mind, though, that while cracking your knuckles seems like nothing more than an innocent, mindless habit, for the person sitting next to you, it may be just as irritating as the sound of fingernails on a chalkboard.

by Krisha McCoy, MS

More PTandMe articles about arthritis can be found here:

   

 

REFERENCES:
Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://nihseniorhealth.gov/arthritis/toc.html. Accessed November 10, 2008.

Brodeus R. The audible release associated with joint manipulation.J Manipulative Physiol Ther. 1995;18:155-164.

Castellanos J, Axelrod D. Effect of habitual knuckle cracking on hand function.Ann Rheum Dis. 1990;49:308-309.

Protapapas MG, Cymet TC. Joint cracking and popping: understanding noises that accompany articular release.J Am Osteopath Assoc. 2002;102:306.

Swezey RL, Swezey SE. The consequences of habitual knuckle cracking.West J Med. 1975;122:377-379. Available at: http://www.pubmedcentral.gov/picrender.fcgi?artid=1129752&blobtype=pdf. Accessed July 11, 2006

Watson P, Hamilton A, Mollan R. Habitual joint cracking and radiological damage.Br Med J. 1989;299:1566.

Watson P Kernohan WG, Mollan RA. A study of the cracking sounds from the metacarpophalangeal joint.Proc Inst Mech Eng. 1989;203:109-118.

3/17/2011 DynaMed’s Systematic Literature Surveillance DynaMed’s Systematic Literature Surveillance: Deweber K, Olszewski M, Ortolano R. Knuckle cracking and hand osteoarthritis.J Am Board Fam Med.2011;24(2):169-174.

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.

weight loss

Weight Loss: What Are Your Options?

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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

weight_loss

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

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.

heart healthy physical activity

Heart Healthy Physical Activity

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The heart is often used as a symbol of vitality for good reasons. The heart pushes blood and oxygen to every cell in the body to be used as fuel and carries waste away. Without this process, the body cannot function. The heart plays a role in many aspects of your health and wellness.

Efficiency Matters
The heart beats an average of 60-80 beats per minute, which can add up to millions of beats in just one month. When something works this hard, it is important that it also works efficiently. Well-conditioned athletes can have resting heart rates below 50 beats/minute. Even though their heart beats slower, it can do the same amount of work or more than a heart that beats 60-80 beats/minute. An athlete’s heart pumps stronger during each beat, needing fewer beats to get the job done. Over a lifetime, a difference of 10-30 beats/minute can add up to quite a few beats.

An Ounce of Prevention…
The heart can be affected by physical and mental stressors. You can feel your heart speed up when you sprint across a busy road or when you have a burst of emotion like anger or surprise.

Physical activity can decrease the effect of stress on the heart and body. A fit body and mind will help improve heart health. Regular physical activity can:

Improve physical abilities by:
• Improving the heart’s ability to pump blood
• Increasing energy levels
• Increasing muscle strength and endurance
• Improving agility

Change physical appearance by:
• Toning your muscles which gives you a tighter appearance
• Burning calories which helps with weight loss or maintenance

Improve overall wellness by:
• Helping with stress management
• Improving self-image
• Helping to decrease anxiety and depression
• Improving relaxation
Improving the ability to sleep
• Creating a social activity opportunity
• Promoting healthier cholesterol levels

If you have heart problems, physical activity can still play an important role. A strong and healthy body can help you manage your condition. Physical activity can help reduce the stress on a sick or weak heart and decrease secondary risks like obesity and diabetes. If you do have heart health issues, talk to your doctor before starting an exercise program.

Even if you are healthy, but have not exercised in a long time, you may need to talk to your doctor to make sure that you are in good physical condition to exercise.

heart veggies

Where to Start
For most people, you can begin right away. Find an activity program that you enjoy. Do not pick an activity that does not fit into your schedule, does not fit in with your personal preferences, or has too many obstacles, because you may lose interest quickly. A program that starts with too much intensity is also likely to lose your interest.

Work towards reaching these basic goals:
• 30-60 minutes of physical activity on most days of the week (total of at least 150 minutes/week)
• Include some strength activities at least 2 times/week

Make It Stick
Long-term regular physical activity will count more than a brief and spectacular burst of activity. Most people do not plan to become sedentary. It creeps up on you. Work to increase your physical activity the same way. Gradually add steps. Find activities you enjoy that can replace more sedentary activities.

Here are more tips that have been shown to be useful:
• Find an exercise partner. You are less likely to skip the activity if someone is waiting for you.
• Write it down or use a fitness tracker. Keep a log of your activities and how much you accomplished either by distance or time. It will help keep you honest.
• A long-term goal is fine, but also make short-term goals, because they provide quicker feedback.
• This is important, make it a priority. Plan it out. Find a time in your daily routine when you can regularly fit the activity in.
• Consider doing your activity in 10-minute spurts throughout the day. Spurts can be as effective as being active for 30 minutes straight.
• Be flexible. Life happens and you may find that you need to make adjustments to your routine. A rigid schedule and goal may not be worth the stress. Keep an open mind to new activities and schedules.

Make It Count
Any physical activity is better than none. But at least a few days per week you should aim for more than a leisurely stroll. A moderate intensity level is best to help you make health changes. Moderate intensity activity is enough to get your heart rate up and make you feel a little out of breath but not feel worn out when you are done.

Do not forget to enjoy your activity for the daily benefits it can bring and know that your heart appreciates it as well!

by Pamela Jones, MA

RESOURCES:
American College of Sports Medicine
http://www.acsm.org

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

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

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

REFERENCES:
American Heart Association guidelines for physical activity. American Heart Association website. Available: http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-Association-Guidelines-for-Physical-Activity_UCM_307976_Article.jsp. Updated September 10, 2014. Accessed October 22, 2014.

Guide to physical activity. National Heart and Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/phy_act.htm. Accessed July 21, 2016.

Haskel W, et al. Physical activity and public health, updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circ. 2007;116(9):1081.

How much physical activity do you need? Centers for Disease Control and Prevention website. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html. Updated June 4, 2016. Accessed July 21, 2016.

Promoting physical activity with a public health approach. American College of Sports Medicine website. Available at: http://www.acsm.org/about-acsm/media-room/acsm-in-the-news/2011/08/01/promoting-physical-activity-with-a-public-health-approach. Accessed July 21, 2016.

2008 physical activity guidelines for Americans. United States Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx. Accessed July 21, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated:10/22/2014

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.