Move. Tag. Support. Share.

These four simple words comprise the essence of #IMovedToday, a social media movement that aims to support and encourage people in their efforts to integrate more activity in their lives.

Many people are starting the new year with new goals that involve movement and health. In fact, according to a YouGov poll, the most popular New Year’s Resolution for 2019 was to get more exercise…a great goal! Unfortunately, according to U.S. News, approximately 80% of resolutions fail by the second week of February. The reasons that happens are numerous and often complex, and are usually accompanied by sinking feelings of guilt and failure, as people slip back into their old, less healthful habits. But what about those 20% of people who stick with their resolutions? What factors are associated with making positive long term changes in their lives?

A study from 2016, led by Drs Kaitlin Woolley (@Kaitlin_Woolley) and Ayelet Fishbach, and published in Personality and Social Psychology Bulletin, suggested that both enjoyment and importance are significant factors in whether people stick to their resolutions. In fact, the researchers found that enjoyment was the factor that mattered the most. In other words, if the participants were getting immediate, positive rewards from their new habits, they would be more likely to make positive long term changes.

This is where #IMovedToday comes in! #IMovedToday is both a hashtag and a supportive, non-judgemental online community that will support your efforts to incorporate more movement in your life. The “rules” for participating are simple and welcoming:

  • 1) MOVE. Anyway you want to. Walk, run, bike, shovel, lift, yardwork. Literally anything you want!
  • 2) Post about your movement on Twitter or Facebook. Use the #IMovedToday hashtag, and tag others you think would want to join.
  • 3) Support other #IMovedToday people. Search #IMovedToday on Twitter, and like, encourage, and engage!
  • 4) Have FUN! Enjoy your bodies abilities and reach your goals to MOVE!

#IMovedToday is the brainchild of Mark Milligan (@markmilligandpt), a practicing physical therapist in Austin, TX, who specializes in orthopaedics and pain science. Mark is also the founder of Anywhere Healthcare (@Anywhere_Health) – “A telehealth platform solving the problem of healthcare access by allowing any provider of any discipline remote access to their patients.”

I recently spoke to Mark, and asked him how he came up with this simple, yet highly motivating, concept. Here’s what he had to say:

“Life is changing in America. In America, people are dying faster and earlier every year and for the first time in century, the life expectancy in the U.S. is getting shorter. Diseases such as heart disease, respiratory disease, cancer, and diabetes are changing the landscapes of our lives as we all know someone who has or who has died from one of these conditions.

Movement is necessary for life. The information and evidence on movement and it’s protective qualities at this point in time are undeniable. Here’s the catch. Most people think that exercise has to be hard, long, exhausting, and unpleasant. That’s a myth. The research supports that just 150 minutes per week (about 21 minutes per day) of intentional movement can provide great health benefits for body and brain! However, if you have not been moving, or have pain with moving, or are having a hard time seeing the benefits of movement, you are not alone!!

Change is hard, especially changes that take daily sacrifices and different choices even when our surroundings don’t change. Most have experienced this in some way throughout their lives. The most common experiences include trying to lose weight, start exercising, stop drinking, to be honest, changing any behavior that is different from the one you already do!!

On the path of change there are several different stages and each stage needs support in different ways. During all stages, information and support are needed. #IMovedToday was born out of a desire to provide information and support people making the choice to change their life, and move when that choice is HARD! So please join us. We will support you in your choice to move and make a difference in your life, and the more people you bring along with you, the better!”

And there you have it! How did you MOVE today?

Thanks for reading,

Cheryl

Advertisements

Reassuring the Persistent Pain Patient

This post first appeared in The Physical Therapy Tribune on February 6, 2018.

When I was struggling with persistent pain, I saw many providers who confidently reassured me that I’d be fine, that I’d get better. The problem, however, was that even after completing their recommended treatment or exercise program, I was not fine. I did not get better. And not only did I not improve, but sometimes my symptoms got worse, often accompanied by an increasing sense of despair and hopelessness, which would further feed into the pain cycle.

Unfortunately, this experience is all too common among those who suffer from persistent pain. These individuals have often seen numerous clinicians, each of whom may have provided different, and often incomplete, explanations of their pain. The reasons for this are vast and multifactorial, and include our broken health care system, lack of understanding of modern pain science, confirmation bias, inadequate or inappropriate treatment, and the use of quackery, among others. But what I want to discuss in this post is the concept of reassurance. It is quite common, and often expected, for clinicians to reassure patients that they will improve over time with (and sometimes without) treatment. And no doubt, especially in acute care situations, a little reassurance can go a long way toward healing, especially for patients exhibiting fear and avoidance behaviors. Further, sometimes persistent pain patients also just need some reassurance that that pain doesn’t equal damage, and that it’s okay to move.

But is reassurance always helpful to those experiencing persistent pain? I’d argue that there can often be a fine line between helpful reassurance and overpromising. Given the complexities of pain and pain-related behaviors, it is not uncommon for pain to be/become persistent, even in the presence of a strong therapeutic alliance in which patients receive high-quality care from a skilled provider and take an active role in their own recovery. And if pain can persist/be persistent despite these desirable circumstances, what happens in the majority of persistent pain cases in which many factors complicate potential recovery? More pain.

But wait? Wasn’t the patient reassured that they’d “be fine”?

Oh, they weren’t fine? They didn’t “get better”?

What do you think goes through the mind of a patient with persistent pain when they are told they’d improve, but then don’t? I know what went through my mind, but also spoke to a few people I know who are currently experiencing persistent pain, and asked them whether they had been reassured about their pain and prognosis, and if they found that reassurance to be helpful. Several people responded, all with a consistent theme. In particular, the general consensus was that early on, the reassurance was welcome and gave them hope, but as time when on and treatment failures accumulated, they began to lose confidence in the ability of the medical community to help them.

This comment pretty much sums it up:

“At first, I did. It seemed to offer hope, and the first orthopedist I saw as well as a physical therapist said they were determined to find answers and find the source of the pain/issue. At about the 8 month mark, after many tests, x-rays, MRI’s and many, many PT visits, the reassurance seemed hollow.” – Vanessa M.

Although it’s not scientifically based, I think this comment illustrates how important it is to beware of how, as a clinician, your words influence those in your care. Reassurance is an important aspect of care, and sometimes that may be all someone needs to improve their outlook and condition. But it’s also prudent to keep in mind that, depending on the situation at hand, the type of reassurance you offer can also be viewed as false hope or even insincerity by patients struggling with persistent pain.

So, what should you do? I suggest offering gentle reassurance, without overpromising. Recovery from persistent pain is never a guarantee. But is it possible…and there is most likely a path forward for almost everyone. Your job as a clinician is to:

  1. Use your knowledge and expertise to help them learn to find their own way
  2. Help them set realistic goals and expectations.
  3. Offer them support and encouragement.

During my own recovery, the physical therapist who helped me the most spoke this powerful phrase:

“I don’t see anything that would preclude a full recovery”

Let’s break that down. He did not say that I’d “be fine”. He did not say that I’d be better in 6-8 weeks. He did not say that recovery would be easy. Rather, he told me that it was going to take hard work. He told me that it was going to take time and patience. He told me that I’d continue to have some bad days, but over time we’d expect to see more good days than bad days. He told me we would work through it together. He was optimistic. He gave me hope. But he never overpromised. And during some of those dark days that are inevitable while experiencing persistent pain, I would think of that statement. It helped drive me forward. It was, well…..reassuring.

Thanks for reading,

Cheryl

 

Do you feel the need, the need for fatigue?

If you’ve never seen the classic ’80s movie, ‘Top Gun’, go watch it. For those of you have seen it, you may recognize that the title of this post is based on an oft-quoted line: “I feel the need, the need for speed.” The movie is about a group of advanced fighter pilots in an elite US Navy flying school. These guys are in the prime of their life, physically speaking, and they go hard and fast. All. The. Time.

Okay, now that we have today’s ’80s education out of the way….

I was talking to a friend the other day, and she was telling me about a recent workout she did at a local gym. She had taken a high intensity interval training (HIIT) class, which involves alternating short periods of intense anaerobic exercise with less-intense recovery periods.

“It was great, “she said with a big smile on her face, “My legs were toast. I could barely walk afterwards!”

Let that sink in for a moment. She could “barely walk” at the end of her workout, and she was happy about it!

Now, I’m sure she was exaggerating to some extent, but her sentiment is not uncommon. In fact, I regularly see posts on social media from people who brag about feeling completely spent from spin class, kickboxing, running, or a workout involving scores of burpees, push ups, lunges or whatever. Regardless of the nature of the exercise, these individuals regularly push themselves close to their breaking point. Not only do they believe that exhaustion is the hallmark of a good workout, but they seem to have a need for fatigue. They crave that physical, psychological, and emotional rush that often accompanies a really hard effort. It can feel satisfying in more ways than one, and serves as an immediate confirmation (and sometimes as a lasting reminder) that you “worked out”….an invisible badge of honor, so to speak. And I get it. I used to seek it too. In fact, prior to my long bout with injuries and chronic pain, I often viewed deep fatigue as an integral, even desirable, aspect of exercise. If there was no fatigue, I didn’t work hard enough. But I was wrong.

Complete exhaustion does not equal great workout.

Before I go any further, allow me to explain. There is nothing wrong with hard work that challenges you. And I’m not picking on a specific form of exercise. Crossfit, powerlifting, running, HIIT, just to name a few, all have value and provide exercise benefits. Getting your heart rate up to promote cardiovascular fitness is, indeed, a valuable component of a healthy exercise program. There is also a time and place for pushing your limits and going for PRs. However, these times should be saved for competition and/or lightly sprinkled on top of a large volume of quality training that is designed to help you improve, not stress your body to the point at which you have difficulty moving your body.

Wait…doesn’t exercise reduce stress? Yes! Many studies have demonstrated that regular exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem.

So, why would exercise cause stress? Well, exercise itself is a form of physiological stress. The body actually needs stress to grow stronger, faster, more agile, etc. and, in fact, the stress must be above a minimum threshold intensity in order to produce these adaptations. But here’s the rub: Too much stress, in the form of intensity and/or frequency, can result in chronically elevated stress hormones such as cortisol, which can interfere with learning and memory, lower immune function and bone density and has been linked to weight gain, high blood pressure, and heart disease, among other things. Further, pushing your body to the point of excessive fatigue also places a tremendous amount of stress on your nervous system. The reason you may have “trouble walking” after a hard workout is because you’ve taxed your nervous system to the point where the brain starts shutting down your ability to move before you’re able to inflict serious or permanent damage to yourself.

Does this sound like a good path to better health and fitness?

I don’t think so either. The goal of any health and fitness program should be to improve, not take a step backwards. Yet, day after day…especially in January….people flock to the gym and push themselves beyond their limits. Quite frankly, it’s counterproductive and not helping them reach their goals. The hard part for most people, however, is finding that sweet spot. How do you know if you are getting enough exercise, but not too much? How do you know if you are putting in enough effort, but not too much?

screen-shot-2017-01-10-at-12-22-18-pmAsk yourself…

Are you making steady progress toward your health and fitness goals? Are you moving well, seeing improvements in body composition and strength? Are you less “out of breath” after you run up a flights of stairs?

Are you practicing quality over quantity? More is not always better. Better is better. Strive for high quality training. If quality starts to fall off and your form or technique starts to fall apart, then you’re done. Better yet, stop before your form begins to break down. (An exception to this rule is hypertrophy training, or bodybuilding, which requires working to failure.)

Can you see yourself exercising this way a few times per week for the next 10-20 years? A good exercise program should be sustainable over the long haul.

How do you feel after your workout? A quality workout should leave you feeling invigorated and ready to tackle your next task of the day.

Do you feel completely recovered before beginning your next workout? If not, you are very likely are overtraining which depletes your body’s resources and inhibits your ability to recover, putting yourself at increased risk for illness or injury.

“Suppress your desire to keep pushing and learn to do the minimum amount in order to progress.” – Neil Meekings, Trainer and Therapist at Kinect Health

One also should keep in mind that, in addition to recovery, proper nutrition and adequate sleep are critical to good health and fitness. You can be on an ideal exercise program, but if you are eating and sleeping poorly, your performance will suffer and progress will stall.

Listen, it would be great if we were forever in our physical prime like Maverick and Goose. (Well, maybe not so much like Goose. And if you don’t know what I’m talking about, go back and reread the first sentence of my post!) But the reality is that most of us are not in our twenties, and if you are in your twenties, you won’t be there forever. Going hard all the time is just not sustainable, and it won’t improve your health and fitness in the long run.

Finally, always remember to put health before fitness. If you are having any pain or discomfort, make time to seek help from a physical therapist who can help you address it before it becomes a bigger problem. They can help facilitate your return to a pain-free, active lifestyle.

Happy New Year!

Thanks for reading,

Dr. Cheryl Keller Capone

What’s the harm?

veggies.jpg

One day last week, I found myself talking to a small group of friends about this blog and why I felt it was important to explore some of science and pseudoscience in the health and fitness industry. The conversation took an interesting turn when someone asked me if there was any real potential for harm in allowing unsupported claims about health and fitness to persist….

To illustrate some of the misinformation prevalent today, I used the example of the “alkaline diet”. For those who may be unfamiliar with this concept, proponents claim that certain foods can affect your body pH (acidity level), and can thus be used to treat or prevent disease, including cancer. To be very clear, these claims are NOT supported by scientific evidence, and they make grossly inaccurate assumptions that are in complete disagreement with the modern understanding of human physiology.

Rather, basic biology tells us that while the pH of the stomach is highly acidic with a pH value between 2 and 3.5 (which is necessary to break down food), human blood is always slightly alkaline with a pH between 7.35 and 7.45. This narrow pH range of the blood is critical for human health, and is very tightly controlled by normal processes in the lungs and kidneys. In the absence of any pathology or disease, it is virtually impossible to significantly change your blood pH through consumption of food. In fact, nothing you eat or drink can significantly change the acidity of your body, with the exception of urine. That’s because any extra acid or base that you eat is simply removed by the kidneys and excreted in urine, while the pH of the blood and most other tissues in the body remain essentially unchanged.

Consider this fact: Any significant deviation outside of the normal pH range of the blood can lead to death. So, if it were that easy to manipulate our body pH through the inclusion or exclusion of certain foods, we would either not have survived as a species or we would have drastically different body chemistry!

No doubt there are some people who do feel better on an alkaline diet. Any improvements in health, however, are likely due to an increase in consumption of healthy foods such as fruits and vegetables and a decrease in consumption of processed foods and sugar, both of which could help normalize blood sugar and insulin levels and help improve hormone regulation. One thing is certain, though–these benefits are not from a change in body pH.

Back to the conversation with some friends…

After mentioning the alkaline diet myth, someone asked, “What’s the harm? So what, if someone wants to drink a lot of alkaline water and it makes them feel good about themselves?”

I paused and thought about her question for a moment…what IS the harm? Am I just bothered by the pseudoscience aspect, or is there a real potential for negative consequences from following an alkaline diet? Good question, right?! It is true that I’m very fact-driven, and pseudoscience is a pet peeve of mine. But is there an actual potential for harm? I would argue, yes, for several reasons.

  1. Believing that alkaline diets can be used to treat disease could delay individuals from seeking proper medical treatment.
  2. An alkaline diet promotes excluding certain families of foods, and thus, could result in a less-balanced diet and nutritional deficiencies.
  3. Finally, the belief that body pH is so easily changed by eating or avoiding specific foods could lead to unnecessary and excessive fear and anxiety about one’s health.

None of these possible effects are desirable and certainly do not improve one’s health, physical or mental. Unfortunately, I regularly read about individuals promoting the need to “alkalize” your body….not only by celebrities, bloggers, and fitness professionals with no scientific or medical training, but even from some registered dietitians and respected clinicians!

People are constantly being swamped with misinformation and half truths about health and fitness, and led to believe that they must be increasingly concerned about the “fragility” of their body.

“Our health becomes something we have to protect with a never failing, always higher reaching diligence.” – Mark Sisson

In reality, this is simply not true! The human body is remarkably resilient. No doubt that most of us would be better served by making a greater effort to make better choices with regard to our health. But the human body is not so frail as you are sometimes led to believe. You deserve better. You deserve accurate information that will aid you in your journey to better health and fitness, not hinder it.

Thanks for reading,

Dr. Cheryl Keller Capone

What does your path to better health and fitness look like?

cropped-img_251312.jpg

If you are human, you may perceive that it looks something vaguely like the path in the above photo…rocky, with obstacles, and you’re not entirely sure if it’s going to lead you to where you want to go. And truth be told, this analogy is not too far from reality. Very often, the path is not clear, the footing is uneven, and sometimes we run into barriers (eg. injury, illness) that require us to backtrack and find an alternate route to move forward. This approach can often be frustrating to the point where many people just give up.

Why is it so easy for some people to lose weight, gain strength, improve their body composition or increase athletic performance, while many others struggle their entire lives with seemingly little to no progress, and instead plateau? Or worse yet, experience declining health and the onset of chronic disease like obesity, metabolic syndrome, heart disease, etc.?

One of the reasons that everyone’s path looks a little different is due to normal biological differences, or genetic variation, between humans. (More on this in a future post.)

However, another reason many people struggle is due to the vast amount of seemingly conflicting information available at the touch of a button. After an hour of searching the internet, you wind up with a few snippets of quality information buried beneath unsupported claims, pseudoscience, and myths that are factually inaccurate, at best, if not potentially dangerous.

“I fear we are witnessing the “death of expertise”: a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers – in other words, between those of achievement in an area and those with none at all.” – Tom Nichols, The Death of Expertise

That’s right! You don’t need to be an expert in anything to have website and offer advice about various topics such as how to lose weight, gain strength, improve your nutrition, enhance your athletic performance or on some other controversial health topic. Further, much of the information that’s available at your fingertips is not backed by science, but rather is based on someone’s personal experience of what’s worked for them. (Remember, everyone’s path is a little different!) In other situations, the limited science that IS available on a particular topic may be adulterated to the point that it is now meaningless or just plain wrong. And typically, the biggest explanation for this problem is that someone is trying to make money by taking advantage of those who are desperate to see change in their lives.

I do not proclaim to be an expert in all things health and fitness. I am, however, a full-time scientist with a Ph.D. in Biochemistry and Molecular Biology from Penn State University, and have over 22 years of research experience in muscle development, neuroscience and gene regulation. Further, I am also a former collegiate level runner and a current certified personal trainer through the National Academy of Sports Medicine. Through this blog, I aim to explore some of the science and psuedoscience in the health and fitness industry, with the goal of helping people to think more critically about these claims and making the science more relatable to those seeking a healthy lifestyle.

Thanks for reading,

Dr. Cheryl Keller Capone

Follow me on Twitter @KellerCaponePhD