Self health: Weight

Showing posts with label Weight. Show all posts

Thursday, August 31, 2017

Weight Bearing Exercise Can Be Dangerous For Neuropathy Patients

Today's post from huffingtonpost.com (see link below) looks at the problems that certain forms of exercise may bring the neuropathy patient who has lost most of the feeling in their feet. These problems are not to be underestimated but it's important to say here that the vast majority of neuropathy patients have some feeling in their feet, despite the numbness that can affect the toes and pads of the foot. These patients are unlikely to step on a nail and not feel something. That said, many people living with neuropathy feel very little and this can certainly lead to serious accidents. When this is the case, load-bearing exercises can be more dangerous than helpful. Nevertheless the article recommends exercise as being essential, as long as this is controlled and the feet are carefully and regularly monitored. The article is aimed at diabetic neuropathy patients but applies to all people living with neuropathy and foot problems.

Type 2 Diabetes and Peripheral Neuropathy: To Walk or Not to Walk?

Milt Bedingfield Posted: 05/11/2015

It is now well known that engaging in light to moderate physical activity on a regular basis is of significant value for most people that have either Type 1 or Type 2 diabetes. In fact the American Diabetes Association recommends that people with diabetes should get a minimum of 150 minutes of light to moderate exercise per week including aerobic and resistance training.

What the ADA says...

It has also been recommended that people with peripheral diabetic neuropathy that have reduced or absent feeling in their feet should not engage in any form of weight bearing exercise activity. The American Diabetes Association recommends that people with diabetes-related peripheral neuropathy should limit the amount of weight-bearing physical activity they perform due to their increased risk of foot ulcers and amputation (1, 2). This is based on the fact that with peripheral neuropathy there is either a decreased ability or total inability in the feet to feel pain or discomfort.

As an example, standing barefoot on hot asphalt maybe in a parking lot in the middle of the summer would be very uncomfortable for someone with normal sensation in their feet, however go unnoticed for someone with peripheral neuropathy. Similarly, the person with peripheral neuropathy may develop a painful nickel-sized blister after walking too far or when wearing new shoes and not even feel it. Without daily inspection of the ankles and feet (which a lot of people do not do) this blister could go unnoticed for days resulting in a potentially infected, slow to heal, or non-healing wound. In the worst case this could lead to an amputation. All of this is the result of losing what is called the protective sensation in the feet.

In the absence of peripheral neuropathy whenever there is insult to the foot or feet such as a blister, a cut or scrape or stepping on a small piece of glass or nail, there would be pain which would cause you to notice the injury and hopefully treat the wound accordingly.

There are also painful stages of neuropathy that can precede lack of sensation which are characterized by frequent but intermittent pain in the feet throughout the day, having pain only in the evening while in bed to constant pain. This stage of neuropathy can result in changing the way you walk, that is your stride length, which part of your feet you strike the ground with first and ultimately what part of your feet support your body weight.

Because of everything I have just mentioned above this leads to the unfortunately recommendation that discourages walking for a great many people with diabetes.

To Walk or Not to Walk?

So where does that leave us? Exercise is arguably the best treatment there is, particularly in controlling Type 2 diabetes, and preventing diabetes related complications, such as peripheral neuropathy, however once you have peripheral neuropathy in your feet you should avoid doing any weight bearing exercise.

I have wrestled with the dilemma for years about how to guide my patients that would benefit immensely from starting to exercise or increasing their exercise however have various stages of neuropathy.

According to the Centers for Disease Control and Prevention, from 2000-2002, approximately 60 percent of lower-extremity amputations in the United States were diabetes-related, with the majority of those amputations being preceded by a foot ulcer (3). Almost all diabetic foot ulcers occur in those people that have lost feeling in their feet due to diabetic peripheral neuropathy (4, 5).

On the other hand poorly controlled blood glucose control contributes greatly to peripheral neuropathy.

Eight-year cardiovascular mortality is 34 percent lower among people with diabetes who walk two hours per week compared with non-walkers (6).

Feet First Randomized Controlled Trial

The Feet First Randomized Controlled Trial was designed to look at the effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy. The study, conducted over a 12-month period by Lemaster and colleagues, showed that participants in the Feet First intervention group achieved a modest increase in activity, with no increase in foot lesions, compared with those in the control group. The group also recommended additional research be conducted in this area to investigate the current guidelines and close supervision for patients with diabetes and peripheral neuropathy (7).

Tuttle and colleagues found that people with Type 2 diabetes and peripheral neuropathy experienced no negative consequences when performing moderate-intensity, weight-bearing exercise in their study (2).

Dr. Sheri Colberg reports in her article "Exercising with Peripheral Neuropathy" that recent descriptive studies suggest that patients with a lack of feeling in their feet who participate in daily weight-bearing activity are at decreased risk of foot ulceration compared with those who are less active (8, 9), especially if their daily routine is very similar with little variation from day to day regarding their physical activity (9, 10).

As a result of the above information, I am going to continue evaluating each of my class participants on a case by case basis, however, for those patients with peripheral neuropathy that I believe will be prudent in checking their feet and following the recommended foot care guidelines and stand to gain significant benefit from performing some weight bearing exercise, I will be more likely to recommend it to them.

References:

1. Singh, N., D. G. Armstrong, and B. A. Lipsky: Preventing foot ulcers in patients with diabetes. JAMA 293 (2):217-228, 2005

2. Tuttle, L. J., M. K. Hastings, and M. J. Mueller: A moderate-intensity weight-bearing exercise program for a person with Type 2 diabetes and peripheral neuropathy. Phys Ther 92 (1):133-141, 2012

3. Centers for Disease Control and Prevention. History of foot ulcer among persons with diabetes -- United States, 2000-2002. MMWR. 2003;52:1098-1102. Medline

4. Pham H, Armstrong DG, Harvey C, et al. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000;23:606-611.

5. Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA. 2002;287:2552-2558. CrossRefMedline

6. Gregg EW, Gerzoff RB, Caspersen CJ, et al. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med. 2003;163:1440-1447. CrossRefMedline

7. Lemaster, J. W., M. J. Mueller, G. E. Reiber, D. R. Mehr, R. W. Madsen, and V. S. Conn: Effect of weight-bearing activity on foot ulcer incidence in people with diabetic peripheral neuropathy: feet first randomized controlled trial. Phys Ther 88 (11):1385-1398, 2008

8. Richerson, S., and K. Rosendale: Does tai chi improve plantar sensory ability? A pilot study. Diabetes Tech Ther 9(3):276-286, 2007

9. Ko, S. U., S. Stenholm, C. W. Chia, E. M. Simonsick, and L. Ferrucci: Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy--results from the Baltimore Longitudinal Study of Aging. Gait Posture 34 (4):548-552, 2011

10. Kanade, R. V., R. W. van Deursen, K. Harding, and P. Price: Walking performance in people with diabetic neuropathy: benefits and threats. Diabetologia 49 (8):1747-1754, 2006

http://www.huffingtonpost.com/milt-bedingfield/post_9394_b_7188266.html

Tuesday, August 1, 2017

Role of Physiotherapy In Weight Loss

Physiotherapy involves natural methods, for example exercise, massage, manipulation and adapted equipment, to help rehabilitate patients following a personal injury or suffering from movement disorders. You typically perform physiotherapy exercises at low intensities, his or her purpose is to reduce and stop stiffness -- not promote weight loss. However, whenever you perform them correctly, and combine all of them with other activities, as well as a healthy diet, it's fairly easy to lose weight with physiotherapy exercises.

Putting on weight and obesity can happen for many different reasons. Regardless if you are genetically predisposed to 'storing' your nutrition and also have simply given-up, whether you will find the 'post-pregnancy pot belly', or if you've been gaining weight due to a chronic problem for example pain from a physical trauma or depression, you enjoying a new start at health and also to see the absolute difference in vitality that regular visits to some physiotherapist can bring you.

Physiotherapy will help your commitment to loose weight by giving you with an educated, healthy and personally-tailored program that supports and acknowledges YOU being an individual who has a unique physical constitution and acts and reacts to some physiotherapy program in unique ways.

Our top-of-the-line Vancouver physiotherapists are trained experts who thoroughly understand what the body, mind and spirit need to be able to function optimally to ensure that successful weight-loss can occur. Our physiotherapists can help you with safe and proper exercise with nutritional advice.

It's normal for mental or physical challenges, or little hurdles, to appear as we start to make healthy changes towards weight-loss. Unfortunately, often these may throw us to square one and keep us residing in a vicious cycle. But this time around, our physiotherapists can help alleviate these challenges and help you receive on a weight-loss program for real, for good, and forever.

A physiotherapist is the 'wing-man', along for the ride while you begin one of the most honourable endeavors you can personally take on for the sake of bettering your health, and ultimately for a much better YOU. Alone? Never. Your physiotherapist understands. Have confidence in them, they have literally seen everything. And no challenge or excuse that you simply give them is too big for these to fully understand as they help you and also guide you towards your individual best in a positive and motivating manner.

Statistics reveal that obesity and putting on weight are on the rise and are generally contributing factors to larger issues for example chronic pain, diabetes, depression and cardiovascular problems. With modern workloads, financial pressures and time limitations growing larger, a lot of women and men in downtown Vancouver find their waist sizes increasing together. And with this their about feeling balanced within their lives fade.

Feelings of inadequacy often accompany high-performing individuals. Sometimes probably the most successful people could be stuck in a rut that they can't get out of as their fear of failure in this region is so strong that it's literally immobilizing. It can be immensely useful to team up with somebody that works with you towards your goals and wants you to definitely succeed as much as you need to do. This is the role a physiotherapist is able to fill.

To achieve weight-loss, an organised approach needs to be combined with healthy eating, exercise along with a low-toxin lifestyle. But personal support as well as an individually tailored program are crucial. There are so many small factors that interact to result in weight gain, and bring about an inability to keep the body at healthy, balanced levels.

Step 1

Perform all of the exercises your physiotherapist prescribes with perfect technique, so that as often as he advises. There's a vast range of physiotherapy exercises, all made to improve certain conditions. To rehabilitate, you need to follow your physiotherapist's advice exactly. As the exercises may not be overly demanding, they'll still burn calories, and improve your heart rate, which can help with fat loss.

Step 2

Include other exercises inside your workout program that don't have negative effects on your injury. For example, in case your therapy involves your knee, the correct answer is possible that you can still carry out some upper body training using machines. Likewise, for those who have a back, shoulder or neck injury, then doing a bit of light sets around the leg curls, leg extensions and leg presses can increase your exercise program without affecting your problem.

Step 3

Walk, swim or cycle if you are able. The Center for Disease Control and Prevention recommends that adults should take part in at least 2 1/2 hours of low-intensity cardio exercise every week. This is the minimum for maintaining your health and weight. To shed weight, you may need to increase this amount or consume fewer calories. For those who have an upper body injury, walking, jogging and cycling are great cardio exercises you can still perform. For those who have a lower body injury, swimming is a great option. Fully discuss your complete workout program with your physiotherapist to make sure you are not putting stress on your injury.

Step 4

Consume a calorie-controlled balanced diet. Diet is just as essential as exercise in slimming down. The USDA recommends that many men and women consume between 2000 and 3000, and 1800 to 2400 calories daily, respectively, to maintain weight, based on age, weight and activity levels. Begin in the middle of these guidelines, and adjust your intake based on your weight loss progress. Base your diet around lean proteins like meat, fish and low-fat milk products, carbohydrates from whole grain products, fruits and vegetables, and fats from nuts, seeds and healthy oils like olive oil.