May 27, 2013
In a prior post, I reveal that I have managed to eke my way into the "over-fatness" category of body composition. I have decided it is time to become serious about reforming some of my less healthy consumption and activity habits. By being more conscious about my food choices and breaking out those free weights, I'm hoping to increase my lean muscle mass.
All of this started back at Christmas when my husband gave me a FitBit activity tracker. He later acquired one for himself, along with the companion Aria scale. We've begun a friendly competition, comparing walking distance and stair climbing every evening. I average approximately 5 miles of walking a day, but unfortunately, this is not enough to actually burn the excess adipose tissue which the Aria reveals has taken over my body.
What the Fitbit has encouraged is for me to take more stairs while I'm at work. At home, I'll bring the garbage and recycling down from our 3rd floor walk-up apartment to curb separately. David will take the dog on longer walks, partly to up his mileage count, but also to help rehabilitate her from a recent knee surgery.
I also began performing squats and lunges at home, and some yoga. Unfortunately, using the carpet sweeper on the living room rug to clear away the animal hair does not burn as many calories as I would hope. The free weights remain in the box under the bedroom chair and soup cans suffice for now for upper body exercise. While my 2lb weight loss remains steady, my body fat percentage has not budged one tenth of a percent; not one. This is going to be harder than I expected.
I'm uniquely positioned at work to exercise. I'm a physical therapist. I've recently been transferred to work in our rehab gym. Unfortunately most of our exercise equipment is designed for very low functioning patients. There is not treadmill or exercise bicycle; our gym weights go up to only 10 pounds and we use them as counter weights to prevent equipment from shifting during use.
Then I was assigned a patient who had sustained a stroke. He was fairly young, fit, and "high-functioning." His problems dealt primarily with balance and his ability to talk and problem-solve rather than strength. I worked with him for full week, racking my brain to increase the physical challenge for him. Every day we walked and increased the number of stairs we climbed by a flight a day until we hit the ground floor of the hospital: 8 flights, 18 steps per flight (typical is 13 steps).
Finally, I saw the body fat percentage on the Aria shift three tenths of point.
April 30, 2013
In my prior post, I reveal that I have managed to eke my way into the "over-fatness" category of body composition, despite having an average BMI. I have decided it is time to become serious about reforming some of my less healthy consumption and activity habits. By being more conscious about my food choices and breaking out those free weights, I'm hoping to increase my lean muscle mass.
I've been calorie counting and trimming back on the number of indulgences for about two weeks, and I've lost 2 pounds - my body fat composition has not budged a bit. Here's what I have learned (and already known for years):
1) alcohol: nothing but empty calories: 130-180 calories per 12 oz bottle - no need to eliminate a treat from my diet, just cut back to one or two a week. Craft beers, which are my preference, dark beers, and high alcohol beers pack more calories.
2) sweets: choose wisely - go for quality not quantity. Be critical about what choose to indulge in. You want this treat to really count, so be picky about what you choose. For me, two dark chocolate Dove Bites really do the trick: 42 calories each.
3) starches: convert white processed breads and rice to brown. I like the nutty taste of brown basmati rice which is actually found to have better nutritional content than white basmati rice.
4) portion control: this is a basic tenet of Weight Watchers. Surprise, surprise - if left to my own devices, I tend to put a cup of that basmati rice on my plate. This is technically not an incorrect amount of rice in a meal, but if your tracking your food by serving, that's 2 servings of grain which should increase the percentage of "forgiveness" foods (vegetables) you should be putting on your plate.
5) breakfast: I need protein for breakfast or I won't last the morning without a metabolic meltdown by 10:00 am. The worst thing I could consume in the morning would be a plate full of pancakes or waffles - I'd be better off without breakfast at all. A peanut butter sandwich only lasts until 11:00 am. So, I switched to an egg sandwich, about 340 calories, when made with olive oil. Cutting back to one egg instead of two, saves an additional 70 calories, and I can still last until lunchtime.
6) water: if possible, swap out as many portions of fluid out for water. Hate water? Squeeze some lemon juice or a jigger of fruit juice to make it more palatable. Need to get off of soda? Try seltzer water with a jigger of juice. Better yet, let a regular soda go flat, then try to drink it - that stuff is disgusting. Also, a new study shows that consumption of just one soda per day ups your risk for acquiring type 2 diabetes by 20%. Often, our body will send a signal of hunger when, in fact, we're thirsty. Try drinking fluid first, especially if you feel tired or have a mid-afternoon craving, to see if the signal is truly hunger or really thirst.
7) dairy: for me, there is something unique about dairy products that helps me feel healthier. Go low fat (1% milk); vitamin D, essential for bone metabolism, is a fat soluble vitamin that requires some of the fat present in dairy products for absorption into the gut. Lactose intolerant? Go for fermented dairy: yogurt or kefir - I'm on a Kefir kick right now because of the probiotics it provides for healthy gut flora.
Ultimately, when talking about weight loss, the rule still remains: less calories in, more calories out.
April 25, 2013
It's been creeping up for years - middle-age spread has finally struck. The scale may not have moved, but clothes my clothes do not fit right. My clothing binds, once fitting pants have gotten too short, size "long" fits better than size "regular". An occasional indulgence became a daily habit, and the slippery slide into middle age spread has caught me in free fall.
Since the beginning of the year, I've been tracking my activity, mostly walking, since I got the Fitbit for Christmas. I average about 5 miles of walking every days. My husband saw how much I was enjoying my Fitbit, so he decided to get one for himself, and got the Aria scale that you can order along with it. The Aria uses bioelectrical impedance to calculate body fat percentage when combine with weight, height, and age data.
Since its arrival, I've been plunged into a world of body composition calculations, base metabolic rate analysis, calorie counting, and classic transference. A "quick and dirty" measure of body fat percentage can be calculated with BMI and waist circumference to determine the following categories: underweight, ideal, average, and obese. BMI calculators, the traditional method for calculating ideal weight, only factors in height and weight to give a gross estimate of where we are compared to a large population of people. Where this scale breaks down is at the level of the individual. It does not factor in bone density, lean body mass, percentage of body fat, nor fitness.
For example, a shorter than average man or one who body builds may show up as "over weight," even obese, according to the BMI scale. I, having occupied the underweight region most of my adult life, now fall within the average section of the BMI scale. I hate that "blankety-blank" scale. My husband finds the transference hilarious. What the Aria has revealed is what I have known for some time.
I have "over-fatness," a term I learned in PT school, to describe body composition that is beyond the norm in adipose tissue. Our food odyssey through NYC in search of the best doughnut/gelato/bakery along with my advancing age, has changed my body composition. Unfortunately, the 5 miles of walking I accomplish every day is not the sustained activity I need to burn fat. It's time to get serious about diet and exercise before I reach an age where accomplishing fitness becomes difficult. In subsequent posts I will share what I have learned, what is working, what is not.
April 20, 2013
I discovered a website designed to help people change their thought processes. It's called Purpose Fairy.
Mindfulness is a means toward living in the moment. Staying in the moment helps prevent regretful thoughts about our past and worrying about the future. These may sound like inspirational jargon, but reading this blog, I could actually feel my mind relaxing.
April 4, 2013
It was the picture with this article that caught my attention and cracked me up. Not only is it the angle, where these people are all legs, but it's the fact that they look exhausted - I feel this way at the end of my work day.
I spend the majority of my work day coaxing older people to exercise. It's not easy. Often, we are working with people who are ill, in pain, unmotivated, or pushing against cultural biases about physical activity. Many people believe that if they feel weak and tired that if you exercise before you walk, you will not have the energy or stamina for walking - this is actually not true. Many people believe that exercise means exercising to exhaustion.
With those beliefs, no wonder so many avoid it. They associate it with pain, exhaustion, inconvenience, sweat, and a host of other things to be avoided. In reality, exercise is anything you do to keep your body moving, and this is the point I try to get across to my patients.
Once we have blasted through the belief system that exercise is difficult to accomplish, it is necessary to establish activity as a habit. That requires a cue, followed by an action, which should result in some sort of reward. When I say reward, I do not mean a pint of Ben and Jerry's ice cream, I mean a sense of accomplishment, and X on a calendar, or the body's natural endorphins. The cue can be a pair of tennis shoes by the door, or exercise pants on the dresser, or that calendar with Xs marking the days you worked out. The action, of course, is the exercise.
Next is working that new habit into a lifestyle change that is sustainable. When I talk to my mother about exercise, she considers a walk around the supermarket with a grocery cart a work out. *sigh* Okay, she is right, that is activity; it's not sustained activity that builds endurance, but it is something. She been talking about moving her computer downstairs into a spare bedroom - but I've continued to discourage that, because the stairs are a great form of exercise, so long as she is safe on them. Housework - that counts. And when you begin to add up all the little things that can be done in a day, it get easier to add in more to increase activity levels.
The good news is that the body is amazing resilient and malleable even into old age. For the elderly, especially, stillness=weakness, decreased quality of life, and ultimately decreased longevity. A body well used will pay back its occupant by remaining strong enough to be active. Staying active reduces social isolation and depression thereby sustains quality of life for the aged.
February 11, 2013
Recent finding published in the Journal of the American Medical Association (JAMA) determined that use of steroid injection with physical therapy to treat tennis elbow or lateral epiconylitis show no benefit after one year. However, the study did find that physical therapy help in the short-term or acute phase of the disorder. Steroid shots at any time during treatment were be linked with less positive outcomes overall.
Other good news, those receiving physical therapy used less analgesic medications at one-year. The study authors also state:
"I believe strongly in physical therapy for tennis elbow, both to help the patient through the acute phase of the injury and to provide the patient with exercises/knowledge to prevent reinjury down the line," Dr. Cooper told Medscape Medical News. "In many cases, patients will benefit considerably just from knowledge gained in physical therapy. "If they apply this knowledge consistently, they may achieve better long-term outcomes."
Here's why steroid shots may not work for tennis elbow: steroid shots work on inflammatory conditions. Tennis elbow is an over-use condition and by the time most sufferers go to their doctor, the inflammatory phase of the condition is ancient history. Instead, what people have is a degenerative condition, or epicondylosis where the tendon fibers have become separated and the collagen becomes disorganized. Treatment for epicondylosis consists of stretching, eccentric or loaded muscle lengthening with gravity, rest, and ice for pain. Cross fiber friction massage has also been found to be part effective treatment.
February 4, 2013
An acquaintance of mine, upon finding out I was a physical therapist, told me about his PT experience this past year. He suffered from back pain so bad he could not perform basic lifting in order to get household chores done. Standing up straight was difficult, as well. His diagnosis: lumbar spondylolisthesis.
Spondylolisthesis, the kind most commonly encountered in the adult population, is an degenerative joint disease caused by instability in lumbar spine resulting in forward slipping of the vertebral body in relation to the it sits on top of. Outwardly, the individual may present with a "sway back" or an increased in lumbar lordosis. Often, people who have this disorder may not have symptoms as all. Onset may be insidious aching pain which progresses to radiating pain in the buttocks and back of the thighs. Comfort can be attained with spinal extension. Symptoms are likely aggravated by spinal loading, such as my acquaintance who had discomfort with lifting.
So, I asked him what the physical therapist did, after all, it has been 3 years since I had my out-patient rotation in physical therapy. The answer: core stabilization. Increasing hamstring flexibility is also indicated since a common finding among this population is shortened semimembranosus and semitendonosus muscles of the posterior thigh. This is logical since one of the ways to relieve spondylolisthesis is to sit and sitting shorten hamstrings.
The good new is that the therapy worked. He's feeling much better and even lost a little bit of weight with the new workout. Keep up the good work. If you have back pain, please consult a professional before performing a new exercise program in order to perform the exercises correctly and prevent further injury.
January 3, 2013
I walk a lot in my life here in New York City. I walk to work and I am on my feet all day for my job. On the weekends, we get out and discover the greatest city in the world - we may log in 2 to 4 miles a day of walking (see my prior post about the FitBit) on the weekends in our quest for lunch and adventure. As a result, I have developed hip pain. Specifically, the pain I have developed corresponds with greater trochanteric bursitis.
I feel it after we have walked in the city all day, or, more often, when I first stand up from sitting for a while. My solution is to stretch, targeting my iliotibial band and tensor fascia lata muscle. Unfortunately, I'm relatively flexible and I am having a hard time getting enough of a stretch through these areas. So, I've invested in a foam roller, which I've been meaning to do for years, but PT school got in the way. And the day I tried it out I almost cried. It is some kind of painful! But the results are amazing.
First I rolled slowly, from knee toward hip, supporting much of my body weight through my arms and opposite foot. Then I stayed on my tensor facia lata (TFL) muscle, surprised to discover how full of trigger points it was. As TLF and the IT band released, I could roll over these tissues with decreasing discomfort (though, honestly, the pain never really went away completely). I used the same technique to roll over my hamstrings on the back of my legs and on the quadruceps muscle at the front of my legs. All were painful, especially the quadruceps in my right leg. What was interesting was how the points of most intense pain were inconsistent from one side to the other, indicating muscle imbalances.
The benefit: no pain in my hips the next day and for an additional 2 days following that. I had more energy and elevated mood. Interestingly, I exhibited an increase in power and endurance for walking up hills (we have a lot of hills in our neighborhood - which protected us from the ravages of hurricane Sandy). When the discomfort returned I rolled around on my foam roller again.
December 30, 2012
My husband got me the perfect fitness gadget for Christmas: a FitBit. Interestingly, I had just read a New York Times article that compare 5 different tracking devices for daily activity and the FitBit came in near the top next to an Omron pedometer for ease of use.
What's neat about the FitBit is that it tracks my sleeping patterns. After using it for several days, I'm not sure it's accurately monitoring when I'm actually asleep, but it does monitor how often I'm active during the night, which usually corresponds to whenever I'm woken up.
The computer interface is full of graphs, though directions for its use are limited. My criticism for the device is that it has no explanations about how this device is actually monitoring my sleep (inquiring minds want to know). There are ways to log in heart rate, blood pressure, daily caloric intake and weight. There are also devices for sale that you can buy that will sync to the device.
However, according to the New York Times article, the best websites for tracking caloric intake is My Fitness Pal, which makes monitoring intake easy due to their enormous database. With little effort, you can input what you've eaten, and for foods that are eaten frequently, there is a one-click option to take the effort out of calorie counting. Studies show that one of the most important aspects of successful weight management is a food journal to track everything that you put into your mouth. From a physical therapy perspective, it reminds me of constraint induced therapy, where journaling daily activity has been found to be just as important as wearing a mitt - awareness of what you're doing is key to changing behavior.
I got birthday money in October and finally decided what to get with it. I got Light on Yoga by BKS Iyengar. I've mentioned this book on my blog before, when, after 25 years, I rediscovered this book that was lent to me when I was 17. In this seminal text, I found pictures with clear explanations for the asanas, breathing techniques, and philosophy that has shaped many aspects of my life since, most importantly, my attitude toward exercise and self care.
I was always the smallest, youngest child among my peers at school. Add to that a genetic predisposition to late development, it was a no-brainer that I was almost always the kid to get picked last for group sporting events on the playground. I hated PE. However, through yoga, I was able to find an exercises routine where I could control my own rate of progression without letting anybody down. And so, I have gravitated toward solitary sporting activities such as running, cycling, weight lifting (swimming seems like too much trouble).
Which leads me to my other birthday acquisition: tennis shoes. Around NYC I'm seeing lots of bright neon colored running shoes, so I decided to procure my own pair of obnoxious shoes: black Asics' with electric pink and yellow accents! This brings a little grin to my face - gone are the days in my massage practice where I exclusively wore white New Balance Cross Trainers as part of my work uniform. The one day I slipped up and wore my grey running shoes, a full 2/3 of my clients actually noticed and commented on them. What would my former clients say to these?!
The reason it takes me so long to settle on shoes has to do with how they fit. I have narrow feet so the best shoes for my feet are Asics' and Saucony's. Nike's are totally out for and New Balance require a trip to the shoe store to try on several pair for a proper fit. Manufacturers would make my life a lot easier if they would just make a style and stick with it instead of discontinuing or changing it every year.
December 13, 2012
Massage Magazine posted his passing, allowing many who have studied his technique or learned from him personally to express their gratitude for this gentle, hands-on therapy.
I, myself, met Dr. Upledger briefly during a class I attended in West Palm Beach. He wasn't what I expected in person. Not much taller than myself, with a shock of white hair, he was quiet and unassuming. I likely overwhelmed him with the enthusiasm of my introduction, as he stepped back reflexively - maybe he sensed the Augmentin that I was taking to treat strep throat, so that I would not miss my education seminar.
I asked him how he was able to perform certain, more difficulty handholds on the cranium. He turned his palm up and opened his hand, exhibiting one of the widest palmar spans I have ever seen. I laughed and told him he should have played piano, at which he gestured toward a table with a CD of his piano music. And that was it, my brief encountered with a person who likely had one of the most sensitive palpation skills on the planet.
My condolences go out to his family, friends, colleagues and to all us whose life he touched through Craniosacral therapy.
December 10, 2012
My sister e-mailed me last week and asked:
What is the type of massage oil that is used in spas and by therapists? My skin always feels so smooth, and I want to buy some for my use, especially in the winter.
Generally, my answer would be to ask your massage therapist what they use and do they sell that oil, either in sample sizes or 8oz bottles. In my practice, I used sweet almond oil by PurePro. Alas, they no longer manufacture that oil, which is a shame, because I didn't have any problems with that oil, neither with laundering my sheets nor with allergic reactions (except for one person who knew she was allergic). My understanding is that allergic reactions are a result of an antigen activation to proteins which are not present in pure oils.
One way to get around potential allergic reactions when selecting an oil is to choose a seed-based oil over a nut-based oil because people generally have less allergic reactions to seeds. Therefore, I recommend PurePro's apricot kernal oil or their grape seed oil. (Please note - I do not get a kickback from the company for mentioning their products).
My sister and I have a similar skin type, so this reminded me to pursue my own solution to winter dryness. I was reluctant to continue using an oil-based moisturizer following last summer's Jojoba Oil disaster which resulted in my having a systemic allergic reaction for 5 weeks that required 2 rounds of steroids before it finally cleared up. However, I feel comfortable using an oil that I used daily without incident for 8 years from a company whose products I trust for purity.
A word of caution with the use of oils: if you use massage oil when soaking in bathwater, please be careful entering and exiting the tub, as this will make wet surfaces even more slippery which will increase risk for falls. Be aware, the bathroom is the most dangerous room in the house because of generally small cramped quarters and hard surfaces. Add water, soap and/or oil to the mix and the bathroom, especially an empty tub with oil residue, is downright treacherous.
I use my oil in the shower. I shake off excess water, apply a small amount of oil to wet skin, rub it in, and pat dry with a towel. The massage oil has a creamy texture and gives my skin an almost silky feel to it. I can feel my hands tingling after I've applied the oil, likely due to the sensory stimulation that also occurs to a lesser degree to the rest of the body when rubbed.
One final note, grape seed oil is ideal for people with sensitive skin and is rated safe to use with infants.