When should I consider Physical Therapy?

         Physical therapy provides rehabilitative practices to help people recover from impairments to their optimal movement functions or to alleviate recurrent pain in movement. Commonly people are referred to physical therapists post-injury. Physical therapists also are sought out by the patient themselves in seeking treatment for an ailment. Physical therapists understand the function of the body and are thus able to treat and help improve quality of life from simple concerns like posture to major treatment like post-hip replacement.
            Physical therapy is often recommended by your doctor when treatment of a problem with your functionality or pain is necessary and out of the range of practice of your physician. It is beneficial to see a specialist when you have a body issue that needs fine-tuning.
            Awareness of what problems frequently recive physical therapy referrals can help you evaluate whether you might be a candidate for physical therapy. Janet Freburger looked at the discharge data from acute care hospitals in North Carolina to determine which diagnoses received the most referrals to physical therapists. She was then able to examine the characteristics of the patients utilizing the services of physical therapists. Both stroke and joint replacement patients were the two most common diagnoses with physical therapy recommendations at these hospitals. Out of more than 2 million patients being treated, 22.5% were sent to physical therapists with an average age of the patient being 66 years old and 58% being female patients. Patients with joint replacement had physical therapy that didn’t vary much between the 128 hospitals studied. Stroke physical therapy programs were different across the hospitals. While this study looked only at hospitalized patient discharge instructions, it is useful for understanding that referrals can vary. I recommend that patients and their primary caregivers should become self-aware of treatment options instead of relying on discharge instructions alone.
            The first step in determining if you need or would benefit from seeing a physical therapist is to evaluate yourself. Have you had an injury, surgery, soreness, stiffness, or trouble doing an activity of daily living? Do you have pain when you do specific movements? A physical therapist can work with you to improve your body movements, whether it’s your daily functioning, your range of motion, your flexibility, or your persistent pain. Make sure you find a credentialed physical therapist who has proper training and experience in your condition to make the most of your time.
            Expect to be given homework by the therapist that you may do several times a week for a certain length of time until improvements are made and you finish working with the therapist. Ideally, the therapist will help you get better and improve. You do not need to become a regular to a therapist’s office for the same treatment that you can do on your own, although you may benefit from a tune-up visit if you sense your problem recurring.

Freburger, J. K., Shank, K. H., Knauer, S. R., & Montmeny, R. M. Delivery of Physical Therapy in the Acute Care Setting: A Population-Based Study (February 2012 ed., Vol. 92, pp. 251-265). Physical Therapy: American Physical Therapy Association.

Are there any diets that meet national health guidelines for reducing CVD risk?

Diet: A Means for Reducing Cardiovascular Disease

            Cardiovascular disease (CVD) is one of the major causes of death worldwide. Risk factors include age, family history, smoker status, lifestyle (sedentary), obesity, hypertension and blood profiles. Diet is an important element for moderating risk status. A diet that is high in fruit and vegetables and low in trans fat is typically thought of as “healthy” and therefore the best protection against CVD. Eating a diet that will help with CVD risk reduction is vital for living a healthy life.
            Before you begin any diet it is important to consider how diet can affect your macronutrients. It should be a priority to maintain the national guidelines for appropriate nutrition when you think about the food that you eat. Since there are so many diets being promoted now, looking at a comparison of the diets and making an informed decision on which diet to try should be part of your plan to reduce your CVD risk.
De Souza looked at the macronutrients in 9 different diet plans to compare them to the national health guidelines and assess their ability to prevent CVD. The Optimal Macronutrient Intake Trial to Prevent Heart Disease (OmniHeart) was divided into 3 trial diets: Omni-Carb, Omni-Protein and Omni-Unsat and then compared to 6 other popular diets (DASH, Atkins, Ornish, South Beach, Mediterranean and Zone). Each diet had a 7 day menu plan created. The diets were evaluated on how they fell into the guidelines of the Acceptable Macronutrient Distribution Ranges (AMDRs), Adequate Intake (AI), American Heart Association (AHA), American Diabetes Association (ADA) and American Cancer Society (ACS). All 3 of the OmniHeart diets were found to fulfill the major AMDRs along with the popular Zone diet. Overall, the OmniHeart diets were found to be dependable with fulfilling the national guidelines for cancer, diabetes and heart disease prevention. While the popular diets may meet some guidelines they had serious limitations for meeting all the requirements. The Omni-Protein and Omni-Unsat were found to improve CVD risk over the Omni-Carb; all 3 diets would be helpful for enhancing disease prevention. While popular diets may be beneficial they may not have all the health benefits that they claim.
This article was beneficial because it included tables that outlined what foods were eaten for examples for each of the diets, which allows you to compare across all the diets the variations and differences. This could be your starting point for developing your meal plan if you decide you want to begin a diet. There are online resources for heart-healthy eating based on the Omni Heart plan. Check out the 3 Omni Heart diets in the Appendix of the Harvard Healthy Eating for a Healthy Heart guide available at  http://www.health.harvard.edu/special_health_reports/healthy-heart-diet. Or review the chart at http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2010/October/information-about-the-omniheart-diets
          You can modify your diet to an OmniHeart by eating 3.8 servings of fruit, 4.5 servings of vegetables, 5 oz whole grains, 2.5 servings of milk or dairy, 3 oz vegetable protein, 5 oz animal protein, 3.5 tbsp fats, 2.5 tsp of sugar with 1.1 egg. Now go get your heart pumping and with this diet plan to keep your heart healthy for a long time!

de Souza, R. J., Swain, J. F., Appel, L. J., & Sacks, F. M. (2008). Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations. [Article]. American Journal of Clinical Nutrition, 88(1), 1-11.

The Power of Pilates: Perfecting your Powerhouse

I’ve heard that Pilates can cause injury. How can I begin to fit Pilates into my workout routines safely?

            Pilates was founded by Joseph Pilates as a method for strengthening muscles using the mind, body and spirit. He combined elements of yoga, dance, gymnastics and martial arts into a routine that would help one lead a healthy life and improve ability for activities of daily living.
            Incorporating Pilates into your physical activity routine is important because it brings a variation of working different muscle groups in a different way than you can through dancing, running, swimming, biking or even yoga. Pilates builds strength and helps with muscle function.
            The Pilates method of exercise was shown to produce significant results by Cruz-Ferreira. Review of studies provided evidence that established improved flexibility and endurance from training. It has been linked to improving reaction time, life satisfaction, and perception of health status. Cakmakci showed that an 8 week Pilates program is effective in helping body “weight, body mass index (BMI), lean body mass, waist-hip ratio, biceps, triceps, fat percentage, basal metabolic rate, and flexibility.”
            Pilates is a powerful workout that will help you lengthen and tone. While there are plenty of DVDs and books available on Pilates, I would strongly encourage you to attend a Pilates class in person for your first attempt. This class should be taught by a certified instructor who has, at a minimum, been trained and tested through a written and practical exam on at least basic knowledge of anatomy and modifications.
            To begin, be aware that Pilates can be modified so the movements are suited to your particular body capabilities – so if you go into a class and they go into a full teaser (start laying down and raise up into a ‘V’ shape with your arms and legs forming the arches) and you are just beginning and have no abdominal strength you can have the pose modified so that you will begin strengthening your core. Pilates could be done every day as long as you worked different muscle groups on consecutive days. As a beginner, I would recommend starting with just 1 class a week to ease into it. Doing pilates 2-3 days a week is what you can work towards as your goal. You can even fit some pilates moves into your other exercises like stretching. To avoid injury make sure that you are properly warmed up and not attempting to do movements until you are literally warm. For example, perhaps do some jumping jacks and stretches before getting onto the mat.
            I really enjoy the progression that is possible with Pilates. I began with modified movements and have worked up to even adding some weights and accessories to my routine. I think the flexibility of Pilates as a form of exercise is fresh because there can be so much variety of what moves you can do to work the same muscle groups. Go grab a mat, take a class and begin quivering as you try to hold your pose!

Cakmakci, O. (2011). The Effect of 8 Week Plates Exercise on Body Composition in Obese Women. [Article]. Collegium Antropologicum, 35(4), 1045-1050.
Cruz-Ferreira, A., Fernandes, J., Laranjo, L., Bernardo, L. M., & Silva, A. (2011). A Systematic Review of the Effects of Pilates Method of Exercise in Healthy People. [Review]. Archives of Physical Medicine and Rehabilitation, 92(12), 2071-2081. doi: 10.1016/j.apmr.2011.06.018

Why and how should I start meditating?

           The ancient practice of mindfulness and understanding the mind/body connection has interested various practitioners from yogis to gurus to philosophers to healthcare professionals. Meditation is the art of training one’s consciousness to open in a way that transforms the person positively by achieving a higher state of awareness. Meditation has been linked to spiritual connectivity, lowering resting metabolic variables such as heart rate, blood pressure and respiration, and an increased understanding how our bodies and minds relate. You should try mediation to help reduce stress.
            Geoffrey Melville studied the effect of yoga and meditation in an office environment on preventing stress using physiological and psychological markers. Both were shown to reduce perceived stress in the subjects and had the ability of maintaining the reduction post intervention. Both yoga and meditation  lowered the subjects’ heart rates compared to the control group. Meditation reduced the systolic and diastolic blood pressure measurements in the subjects. Melville found that both yoga and meditation offered in a workplace were successful at controlling and lowering stressors.
            Meditation can seem daunting at first. It can be overwhelming to begin, as the act of sitting still and silencing the mind is contrary to our normal behavior being stimulated by technology and media. I’ve been slowly experimenting with meditation for about a month. I have found that by acknowledging my insecurity of doing it “right” and continuing to practice that I am becoming more comfortable. Start meditation by sitting on the floor with some back support (yogis sit in lotus or half lotus position where you are cross-legged but your feet are tucked up over your thighs). Rest your hands palm up on your thighs with your thumb and pointer finger touching. Sit up straight and close your eyes. Begin by focusing on your breath. Breathe in through your nose and out through your nose. Feel your breath as it fills your chest and it rises and falls with each contraction. There are so many styles of meditation that if you start one and feel uncomfortable or that you are doing it incorrectly don’t give up – seek another style. In Hatha meditation the breathing is guided by breathing in through one nostril, breathing out through the nostril and then taking in a breath on that nostril before breathing out the other nostril and continuing the sequence. There is also spinal breathing where you focus on your breath coming up your spine all the way to your third eye before you focus on it going back down. There is also no exact “correct” way to meditate. I’ve been learning that it is not wrong if you cannot silence your mind completely; it is normal to have your mind wander during meditation if you are inexperienced. The key is to be able to acknowledge your mind wandering but bring it back to focus on your mantra. Some prefer using the mantra “I AM” as a sound, not analyzing any meaning. I find that meditation allows me to begin to unwind and relax. Afterwards I feel refreshed and slightly less stressed. I know it is a process that you have to work on continuously and at the moment I find 5 minutes is hard enough to complete. But I know people who recommend 5 minutes of spinal breathing followed by 15 minutes of meditation followed by Savasana (corpse pose in yoga: lay on your back, legs and arms out, eyes closed). Meditation is personal and can be tailored to suit your comfort level so you will still be able to achieve its benefits.

Melville, G. W., Chang, D., Colagiuri, B., Marshall, P. W., & Cheema, B. S. (2012). Fifteen Minutes of Chair-Based Yoga Postures or Guided Meditation Performed in the Office Can Elicit a Relaxation Response. [Article]. Evidence-Based Complementary and Alternative Medicine, 9. doi: 501986

Embodily Defined

Express your spirit to embody wellness!

em·bod·ily Adverb

1. Express or give a tangible or visible form to (an idea, quality, or feeling).

2. Provide (a spirit) with a physical form.