Monthly Archives: June 2011

Measuring Exercise Intensity

The American Heart Association recommends 30 to 60 minutes of exercise daily.  A number of different activities such as walking, cycling, swimming, or jogging will improve the health of your cardiovascular system.  A common question asked from people starting an exercise program is “how intense must the exercise be to produce the desired benefits for the heart and lungs?”  The answer is in measuring your heart rate and respiration.

An easy and specific method for measuring the intensity of exercise is by wearing a heart rate monitor.  These can be purchased at most sporting goods stores for under $100 and are easy to use.  An elastic strap is worn around the chest that transmits your heart rate to a wrist watch that displays your pulse.  As the intensity of exercise increases, so will your heart rate, allowing you to constantly monitor your intensity level just by checking your watch.  The recommended “zone” for cardiovascular exercise is in between 60% to 80% of your maximum heart rate.  This zone can be calculated by using the following formula:

220 – (your age)   x  .6

220 – (your age)   x  .8

An example for a 60 year old would be as follows:  220 – 60 = 160 (max heart rate)

160 x .6 = 96 beats per minute

160 x .8 = 128 beats per minute

The cardiovascular zone would be from 96 to 128 beats per minute.

A less specific method for determining the proper exercise intensity is by monitoring your breathing pattern.  At the lower end of the zone you should be able to sing or hold a conversation with minor difficulty.  At the upper end of the zone, speaking 3 to 4 words will be difficult before needing to breathe.  If you can not speak more than one word before needing to breathe, the intensity is probably too high.

Monitoring the intensity of your daily exercise will allow you to maximize the benefits of your efforts.  Be sure to consult with your physician before starting any exercise program.

By Steve Bernstein, PT,OMT

What’s up with Glucosamine and Chondroitin?

There is a lot to that question, and we’ll cover some details below if you care to read more, but the basic answer is: it probably can’t hurt, and it might help.

We have recently noticed a surge in advertisements for these two products, with claims to offer major benefit for stiff and painful joints. So, we felt it would be helpful to pass along our assessment of the value of these supplements and our opinion of what is sensible vs. what is nonsense.

First, what are we talking about?

Glucosamine and chondroitin sulfate are natural substances found in and around the cells of cartilage. Glucosamine is an amino sugar that the body produces and distributes in cartilage and other connective tissue, and chondroitin sulfate is a complex carbohydrate that helps cartilage retain water.1 In the United States, glucosamine and chondroitin sulfate are sold as dietary supplements, which are regulated as foods rather than drugs1. The interest in using these elements became popular as a result of the reports of successful use in the veterinary arena and in the 1997 book “The Arthritis Cure”2.

Most of the reports on the use of these supplements have come from non-scientific reports. Many sources advocate the inclusion of other substances with the daily dose of glucosamine and chondroitin, thus it makes it difficult to know if in fact any effect or benefit noted is a result of the glucosamine, the chodroitin, both, or from one or more combinations of the other ingredients in the product being marketed.

An ingredient that many preparations include is MSM (Methylsulfonylmethane). The reported advantage of this chemical, that is found in small quantities in many foods, is that it provides sulfur to the body in a very useable form. Sulfur is reported as being beneficial because it helps in forming connective tissue cross-linkages.3 Glucosamine and chondroitin are the building blocks of joint cartilage and, thus, are bound together by sulfur bonds.3 So, combining MSM and glucosamine and chondroitin would seem to be sensible.

There is one recent study that points to the potential benefit of MSM. The paper was published in 2006 and reported on the results of a study done in 2004 by Southwest College Research Institute, Southwest College of Naturopathic Medicine & Health Sciences, Tempe, AZ. It was published in Osteoarthritis and Cartilage and reported statistically significant reductions in pain and in difficulty performing activities of daily living compared to a placebo control group.

The scientific basis for use of glucosamine and chondroitin has been primarily grounded on the results of the 2006 study by the National Institutes of Health, “Glucosamine/chondroitin Arthritis Intervention Trial” (GAIT).5 Proponents as well as skeptics are able to find elements of this study to support their position, but the bottom line seems to be that for some patients there was relief of symptoms though no improvement of the overall degenerative changes within the knee. Thus, it may not help but it doesn’t seem to harm. Interestingly, of the almost 1,600 patients in the study, the small group in the moderate-to-severe pain group (22%) had significantly reduced pain while the larger “mild” pain group (78%) found no significant relief. Because of the small size of the subgroup the findings had to be classified as preliminary and thus need to be confirmed through larger studies to prove statistical significance.

So, what do we recommend based upon our reading and experience?

First, if you are going to try this dietary supplement then you should get a form of it that is of high quality so as to assure purity, potency, quality, and consistency among batches. Second, make sure the quantity of glucosamine and chondroitin is at a level at least that of the strength in the GAIT study – 1,500 mg glucosamine and 1,200 mg chondroitin. It is possible that MSM can help and so it makes sense to have a formula that includes that. Sources suggest between 1,500 and 6,000 mg. per day. We think the lower end of that scale makes sense. Lastly, since absorption in the intestine is important, the use of a liquid formula may allow for more complete uptake of the ingredients since pills have binding agents that may affect their breakdown within the stomach.

By Rett W. Talbot, PT, MS, SCS, ATC, CSCS

1National Institutes of Health National Center for Comlementary and Alternative Medicine “Questions and Answers: NIH Glucosamine/chondroitin Athritis Intervention Trial Primary Study” http://nccam.nih.gov/research/results/gait/qa.htm

2 “Glucosamine: Everything You wanted to Know” http://www.jointhealing.com/pages/productpages/glucosamine.html

3 “How MSM Works to Improve Joint Health”, http://www.msmguide.com/

4 “MSM Research Papers”, http://www.msmguide.com/

5 “Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT)” http://nccam.nih.gov/research/results/gait/

Risk of Falls

Anyone is at risk of falling. Did you know that most falls occur in the home?

Take a look at your surroundings. How well lit is your home? Make sure that your bedroom, bathroom, hallways, and stairs are well lit to avoid tripping over an object you don’t see at night. Hand rails are good to put in your shower, bath, and toilet area. Area rugs should not be able to move, make sure they are tacked down or have a non skid backing. Electric cords should not be lying around walking areas. There should be rails on both sides of stairs for extra support. It is important to wear non skid shoes and avoid wearing loose slippers that could cause you to fall.In your kitchen store things where they are not too difficult to reach, not too low or too high. This would prevent you from having to use a step stool or step ladder and if it’s too low from bending down.

Now that you have taken care of your indoor surroundings it is important that you take care of yourself. Getting regular exercise helps keep your muscles and bones strong. If your doctor suggest that you use a cane or a walker, use it. It will help with stability and help to avoid falls. It is important to wear non skid shoes and avoid wearing loose slippers that could cause you to fall.

When you get out for bed in the morning or at night to use the bathroom, sit to the side of the bed for a few minutes before standing. Your blood pressure takes some time to adjust when you sit up. If your pressure is too low you may get dizzy and fall. Talk to your doctor if you have dizzy spells. Four or more medications is a risk factor for falls. Medication can cause effects such as dizziness, drowsiness, or low blood pressure. Prescription medicines and regularly taken over the counter medication should be checked by physician or pharmacist. Vision acuteness decreases with age. Periodic eye exams are recommended. Be aware that with a change of prescription your field of vision may change and you could be at risk to fall. Remember to keep your glasses clean.

When you are outdoors you should be aware of any potential hazards. Some of the things you should be aware of are terrain, uneven sidewalks, curbs in need of repair, rails installed improperly. Pets can get under your feet, lie in your pathway, or jump on you causing you to fall. It is important you clean up any spillage properly.

For more information on fall prevention visit the Home Safety Council .

By Rita Zimmerman, LPTA/CLT