Category Archives: Exercise

Put on your running glasses!

The 2009 Boston Marathon

Monday was Patriot’s Day in Massachusetts and the annual running of the Boston Marathon. The above photo, from 2009, was my first time watching in person and was amazing and thrilling. Having cheered on the runners again in 2010 and 2011, I can say it is no less inspiring and something I will think about as I struggle through my “couch to 5K” running plan. Next year I think I’ll hold up a sign that says “Watching you is making me really tired!”

As I watched the race, one thing I wanted to pay attention to was whether any marathoners were wearing glasses. Not special funky reflective, speed-demon exercise sunglasses, but “I need these or I’ll run into the Bay” spectacles. Like mine. Because I HATE exercising in my glasses, but I also hate to waste a pair of disposable contacts on an hour of exercise when I’m wearing my glasses the rest of the day. I went out on a 5K training run the other day in my glasses. It wasn’t so bad. And while watching the marathon I did see more than a handful of runners cruising by in good old regular glasses. I also saw a guy dressed as a gorilla, several Easter bunnies and a guy playing a guitar while running.

Maybe one of my blog friends, like Roni, who have a much bigger readership with lots of runners will see this and pose the question for me: Do you run in glasses? Anyway, just something I’ve been thinking about as I try not to give myself an excuse to avoid a run. I’ll also think about all the amazing wheelchair athletes and runners with other challenges participating with guides, running on artificial limbs, etc. If they can do it, I really can’t complain about my glasses bouncing and slipping around on my face.

2009 Boston Marathon

Now I’m just angry!

High on the list of things making me angry is the weather. A foot of snow each week? Really, Mother Nature? Really? Global warming or not, it’s wearing on us. I’ve tried making idle threats against the earth, which go something like this – “Make the snow stop or I swear I’ll never recycle anything ever again! Look at me holding this peanut butter jar! It’s going in the TRASH. That not enough for ya? OK, I can do better. Here’s a laundry detergent bottle! OOOOH all that plastic, bobbing around in your oceans. Gonna stop the snow now???” Yeah, well, I think all the snow is making me loopy. Not to mention that we’ve had so many snow days causing patient cancellations that it’s really fouling up everyone’s schedules.

What else makes me angry? An article with the headline “Docs Don’t Follow OA Guidelines.” Why so accusatory? In my mind that headline assumes there’s a bunch of guys smoking cigars sitting around a table saying, “To hell with guidelines! We don’t care about guidelines! We’re doing what we want!” (I don’t know why it’s like a 1920’s mobster scene, but that’s my vision here).

Here’s the first paragraph:

Physicians are apparently disregarding standard guidelines to manage osteoarthritis — relying on painkillers and surgery rather than on steps like exercise and weight loss that could help reduce morbidity — adding to the soaring costs of treating OA, researchers argued.

Let’s think about that for a minute. A patient comes in with osteoarthritic knee pain. Usually it hurts when getting up after sitting for a while, hurts going up and down stairs. Maybe they’re already active and it hurts when exercising. Maybe it used to respond to an OTC analgesic but isn’t anymore.

I am fairly certain that most doctors almost always if not always counsel patients with OA about diet and exercise. I’ve given the “even a little bit of weight loss would help take some pressure off your knees” talk so many times I wouldn’t be surprised if I say it in my sleep. But here’s the clincher – diet and exercise are the PATIENT’S responsibility. I can’t go home with you and cook your food (though I can help you find some great internet resources for healthy eating) and I can’t take you to the gym. I have enough trouble getting myself out to exercise and to avoid the lure of the office candy bowl! But when patients come to the doctor they expect us to DO something. Dieting and exercise are slow. They’re hard to do. Your knee still hurts when you’re exercising. Painkillers, injections and even surgery can help you feel better as youre working on healthier lifestyle modifications. So please don’t tell me that I’m “disregarding guidelines” by recommending other treatment options. I’m just trying to help.

The Lazy Blogger Award

Is there a Lazy Blogger Award? Well, if not, I am officially giving it to myself. Congratulations, Doctors’ Rheum, you’ve been a really lazy blogger!!

However, I have been reading blogs and trying to comment here and there and really appreciating some new commenters on my older blog entries. Let’s just say we in New England aren’t used to long stretches of hot, humid air and I think my brain is melting like the dark chocolate in my cabinet. However, I can’t put my brain in the fridge to firm it up, so let’s hope the neurons fire better after this cold front, or with the approach of fall.

Anyway, did you see these articles? If not, these are some points of interest I’ve been collecting to share:

The New York Times’ Well blog featured Voices of Scleroderma. Most people I’ve diagnosed with this condition have never heard of it. Fortunately it is rare, but unfortunately the treatment options are limited. I did my fellowship at The University of Pittsburgh, with several outstanding faculty members doing both clinical and basic science research on scleroderma.

Cheers! Could you actually help prevent Rheumatoid Arthritis by drinking alcohol? The very day I saw this article come across my daily email briefing, a patient brought it in and said, “Hey, does this mean I can drink?” Well, if you’re on Methotrexate that answer is still going to be no, no and are you crazy? The article was an observational study that found arthritis was less severe in drinkers compared with nondrinkers. However, the article also notes,

“We would wish to point out that, at the moment, that our findings are preliminary, and would not recommend that patients drink alcohol with the specific purpose of treating their arthritis,” said Dr. James Maxwell, lead author of the study and a consultant rheumatologist at The Rotherham NHS Foundation Trust in England.

Finally, did you see that all those “toning shoes” may not be all that great for you after all? One of my co-workers, a DIE-HARD fan of the shoes, was very disappointed when I mentioned this article to her. If you’re out of shape, strapping on a new pair of shoes won’t magically get you in shape, just as a treadmill that serves mainly as a clothes rack isn’t doing much for your fitness. However, if the promise of extra toning inspires you to walk more, be my guest. I just think they look a little funny, but, then again, I’m not winning any fashion awards.

If you love a cyclist . . .

[picapp align=”left” wrap=”false” link=”term=bicycle&iid=7306812″ src=”1/8/3/7/2008_CSC_Invitational_5cff.jpg?adImageId=13033416&imageId=7306812″ width=”380″ height=”253″ /]. . . please read this post. And share the road!

http://drjohnm.blogspot.com/2010/05/cycling-wednesdays-3.html

Didn’t the bionic man run?

[picapp align=”left” wrap=”false” link=”term=hang+glide&iid=184215″ src=”0180/28acefb5-5b41-4526-be46-4810a69a9645.jpg?adImageId=11353302&imageId=184215″ width=”380″ height=”253″ /]A story about playing sports after knee replacement came this week in one of my daily medical news emails. You can read the MedPage Today article here.  I send a lot of patients to the Orthopaedic surgeons for joint replacements. Unless there is something else I see them for, sometimes they don’t need a Rheumatologist anymore and don’t come back, so I don’t know how they’re doing. A fair amount do come back, though, for their RA or OA of other joints, and we talk about life after knee replacement. According to the article, here are the accepted and discouraged post-replacement activities:

Encouraged activities include bowling, croquet, golf, doubles tennis, table tennis, ballroom dancing, square dancing, stationary biking, swimming, low-resistance rowing, walking, hiking, and low-resistant weight lifting.

Discouraged activities include baseball, basketball, football, hockey, soccer, high-impact aerobics, gymnastics, jogging, power lifting, rock climbing, hang gliding, and parachuting.

I think we have to first decide if we’re talking about an elite athlete or just an every day person trying to remain fit and active. Not many of my patients wanted to rock climb or hang glide BEFORE their surgery, let alone after. I have a hard enough time trying to convince people with arthritis that they CAN and SHOULD exercise (check out my prior post on exercise resolutions). Sports medicine doctors are probably seeing a different patient population than I am. I also found this interesting:

The revision rate for mechanical failure of the implant was lower in the patients who participated in high-impact sports (8.5% versus 11%), although the difference was not statistically significant.

How can I use this information in my practice? Well, if it seems to be OK for super athletic patients to get out there and occasionally do high-impact exercise after joint replacement, then us average Joes and Janes can certainly keep up a healthy low to moderate intensity workout post surgery. Good news!

TV for good, not evil!

[picapp align=”center” wrap=”false” link=”term=television&iid=5063757″ src=”9/c/a/0/Man_in_swimming_2439.jpg?adImageId=9456306&imageId=5063757″ width=”380″ height=”254″ /]True confession time: I love TV. Reality, drama, sitcom, home and garden, cooking, sports. Truth be told I’m not a fan of the celebrity talk show, though. Imagine my personal dismay at this article, which cites the following:

Aussies who reported watching four or more hours of TV a day were 46% more likely to die during a 6.6-year period than those who watched less than two hours a day, according to David Dunstan, PhD, of Monash University in Melbourne, and colleagues. . . The associations were independent of leisure-time exercise and traditional risk factors such as smoking, poor diet, high blood pressure, and abdominal obesity.

“Even if you exercise, if you have a lot of sedentary living with the things that go along with it — the bad diet and everything else — you still have a net degree of physical inactivity, which is a coronary artery disease risk factor,” Fletcher told MedPage Today.

Is the typical scenario someone who gets home from work and plops down in front of the TV, dinner break, maybe in front of the TV as well, then crawls into bed to watch TV and fall asleep to Conan Jay? Wait, that might sound a little too familiar. What if we substitute other sedentary activities: blogging or working online, doing puzzles, playing cards, reading? I suppose those activities are not as mesmerizing as the flickering glow of the flat screen.

Many people have spent time and money on their entertainment setups, media rooms and the like. How can we use them for good instead of evil? Here are some ideas:

  • Wii Fit
  • On-demand or Fit TV programming (check with your cable company)
  • Fitness DVDs
  • Cooking shows with focus on healthy eating
  • Use your DVR so if there’s a show you really love you can fast forward through commercials and watch it in less time or you can save it up for a Friday night.
  • If you don’t have a DVR, do exercises or stretches during commercial breaks.
  • Ask yourself, as you sit down to watch another rerun, “Is this enriching my life?” If the answer is no, maybe you can find something that does and may help you be healthier in the long run.

Exercise Resolution?

Although I said in my last post that I do not tend to make New Year’s resolutions, I know almost everyone else does. One of the most frequent is to lose weight, which often involves exercising more. As a doctor and specifically a musculoskeletal specialist, I ask all my patients about exercise. Not just “Do you exercise?” I try to ask everyone “What do you do for exercise?” The most frequent answers are “Nothing” or “I try to walk.” Here in New England during the winter, I know that “I try to walk” really means “I’ll exercise when the snow melts.”  However, the American Heart Association recommends that all healthy adults aged 18-65 need moderate intensity aerobic activity at least 30 minutes 5 days a week or vigorous activity at least 20 minutes 3 days a week. These guidelines, plus those for older adults, are found here. Yes, I know this says healthy adults, and I often hear “I can’t exercise, I have arthritis!” The Arthritis Foundation would disagree with you. The Arthritis Foundation Exercise Program was formerly known as PACE, or People with Arthritis Can Exercise. I liked that name, because it speaks the truth. People with arthritis CAN and SHOULD exercise. “Use it or lose it,” we sometimes say. More information about exercise for folks with arthritis are found under the fitness tab on the Arthritis Foundation website. I’ve written before about what it’s like to learn new athletic skills as an adult.

Here are some other ideas:

  • Check out this article in The New York Times about cost savings on gym memberships.
  • Water exercise is one of the best forms of physical activity for people with arthritis or other musculoskeletal conditions. If you don’t have access to a gym with a pool, check out local community colleges and high schools which may have hours for public use.
  • Colleges and high schools may also allow the public to use their workout rooms. I know of one local high school that opens its gym to the public on evenings and weekends. If your town does not do this, why not ask?
  • Community colleges and city departments of parks and recreation often have classes. I have taken a yoga class and a pilates class and while both were not fancy (held in a school gym) they were cheaper than at a yoga studio!
  • Schedule walks outside or at a mall with a friend. If your neighborhood doesn’t have safe sidewalks or streets, drive to a different area or to a park. Many malls open early for walkers. I didn’t know this, not being a frequent 8am mall visitor. One Sunday morning we had a special work event at one of the mall stores and I was amazed that the place was full of people exercising! Ask the customer service desk what time they open for walkers.
  • Some gyms, especially independent gyms or yoga studios, will give free or discounted classes if you volunteer to clean or work the check-in desk.
  • I was introduced to the Leslie Sansone videos through Weight Watchers. A lot of people just getting started on their exercise journey seem to like these videos, which involve walking in place and doing some upper body movements.
  • While on the subject of exercise videos, most libraries will have these you can check out, Netflix has a whole category of workout DVDs if you belong to that service. Both of these will allow you to try something before purchasing it. In addition, many cable TV services with “on demand” have fitness channels with different workouts.
  • A site like www.yogadownload.com has free 20 minute yoga sessions, and longer ones are quite affordable. I recommend that if you are new to yoga, you take some classes first if possible. Even though there are PDFs of the poses, nothing beats an instructor making sure that your positioning is correct.
  • Do you have a friend or family member with home gym equipment? Will they let you come over and use it?
  • I’m afraid I can’t comment on the whole Wii fit phenomenon as I’ve never used it, but so many of my patients are now saying that is how they are exercising. Do you have one? Does a friend who will let you try it out?

Good luck with your exercise resolutions!