Saturday, 16 February 2019

Tips for using this versatile piece of exercise equipment

Seasonal allergies can be frustrating. When spring crawls in, many people begin to experience all-too-familiar itchy and watery eyes, runny nose, and congestion. Symptoms of seasonal allergies are the result of an immune system in overdrive in response to pollen and other allergens. Those bothersome symptoms are intended to protect you from unwanted foreign particles, but in this situation they end up causing misery. There are quite a few options when it comes to controlling allergy symptoms, but we want to watch out for a few that can be quite dangerous when used incorrectly.
Nasal steroids

The first-line treatment for seasonal allergies is an intranasal corticosteroid such as fluticasone propionate (Flonase). These sprays are available without a prescription and you can use them as-needed. Nasal steroid sprays have been shown to help with both nasal symptoms of runny nose and congestion, as well as eye symptoms. When using these sprays, it is important to direct the spray away from the nasal septum, as there have been some cases of nosebleeds from using these sprays. If this happens, stop using the medication and let your doctor know.

To date, most studies looking at the effect of intermittent use of nasal steroids on growth in children have been inconclusive. However, a large study reported a slight reduction in the rate of growth when nasal steroids were used daily over 52 weeks by children before puberty. Therefore, it’s a good idea to discuss steroid nasal sprays with your doctor if you find your child needs it on a more regular basis.
Oral antihistamines

Antihistamines such as diphenhydramine (Benadryl), loratidine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) can also be quite helpful. The key is to take the medicine before symptoms develop, such as early in the morning. Another important thing to remember is that some of these medications can cause drowsiness and should be used cautiously during the day, especially if you are driving.
Decongestants

Nasal decongestant sprays such as phenylephrine and oxymetazoline (Afrin) should be used cautiously. Although they may work well in the short term when used occasionally, if used regularly for more than a few days (approximately five days), you may find your nose more congested than usual. This is called rebound congestion or rhinitis medicamentosa. I usually recommend patients not use these products for more than three days. Using these sprays too often causes a biochemical change in certain receptors on your cells, resulting in a vicious cycle of dependence — the more you use it, the worse your symptoms, and the more you need to use it. If this happens, stop using the medication, and talk to your doctor about switching to another type of nasal spray (intranasal glucocorticoid spray) which has been shown to help with this condition.

Oral decongestants such as pseudoephedrine or phenylephrine may help reduce symptoms as well. You should also use these medications cautiously. They mainly work by constricting blood vessels, and may cause side effects such as increased blood pressure, palpitations, headaches, nervousness, and irritability. These medications should not be used by patients with a history of uncontrolled high blood pressure, heart rhythm problems, strokes, glaucoma, or other conditions.
Alternative therapies

Other therapies that have been shown to be beneficial include nasal saline irrigation. Irrigating the nasal passages with prepared solutions, such as with neti pots, has been shown to improve symptoms of runny nose, congestion, and itchy throat, and to improve quality of sleep in children with acute sinusitis and allergic rhinitis. When using these products, however, make sure you are using distilled, sterilized, purified, or previously boiled water, as there have been rare cases of fatal infections by amoeba when using tap water that was contaminated. Although the evidence for menthol rubs such as Vicks is limited, some patients find that rubbing a little menthol ointment under the nose can sometimes also offer congestion relief. Sometime back in 2010, a good friend of mine from college who had since become a pediatrician posted a complaint on Facebook about “made up” health conditions. “Fibromyalgia, I’m looking at you,” she wrote. At this time, pain was more of an occasional visitor in my body rather than the permanent tenant it has since become. Still, I was offended on behalf of those patients with the disease.

Fast forward to today and my life is all about pacing. This is because everything I do — cook, sleep, work, walk — takes time. This gradual approach to every aspect of my life is not about enlightenment or mindfulness. It is about pain. Or more specifically, trying to evade or minimize it. To minimize is key because I’ve learned it can’t be avoided, at least not entirely, no matter my effort. For me, fibromyalgia became a default diagnosis — a catch-all phrase the doctors slapped on me to encompass all the aches and health complaints that had begun to persistently plague me. I received this diagnosis even as imaging showed degenerative changes and other damage in my spine and hips, even as endometriosis was confirmed to be spreading like strands of spider web inside my abdomen, wrapping its tendrils around my organs with the insidiousness of an invasive plant. When the pain reached the point of making it impossible to work more than on a very part-time basis most weeks, I began to inquire about disability. But my doctors — the same ones who diagnosed me, treated me, and viewed my MRI results — all shook their heads and refused to sign off on any paperwork.
“You don’t seem sick,” they said

This was the same line I was offered in college after extreme intestinal distress caused me to lose more than 20 pounds in a single semester. But the school nutritionist thought I just wasn’t eating enough bananas. “You have such shiny, healthy-looking hair,” she explained, pinching a lock of it between her fingers as though I were a doll on display. “People who are really sick don’t have hair like yours.” A colonoscopy showed nothing visibly wrong, so the doctor diagnosed me with irritable bowel syndrome and treated me as though I was a hopeless neurotic. “Stop being so stressed and eat your greens,” he scolded. Two years later, a laparoscopic surgery would show widespread endometriosis, a large portion of it choking my colon. Its removal eased my GI complications considerably. But by then I learned the hard lesson that doctors often erred on the side of disbelief when they couldn’t see something plainly… or even when they could.

I have heard an extensive list of reasons why I can’t be in as much pain as I say despite my test results… and besides my shiny hair, like: I am too young; I have good teeth; I’m too thin to have back problems. Yet, these haven’t granted me immunity from illness, and they have not prevented pain.

Only recently has medical research started to catch on to what patients suffering from chronic pain have long known. As reported in a New York Times Well column written by Tara Parker-Pope in 2011, a study by the Institute of Medicine discovered that pain can endure long after the illness or injury that caused its initial onset has been treated or healed, until it eventually evolves, or devolves, into its own disease. That is, pain is no longer indicative of another prognosis — it is the prognosis, and a disabling one at that.

Specifically, under the strain of prolonged pain, nerves not only become super-sensitized to pain signals, but begin amplifying them. Once these changes occur, they can be extremely difficult to undo. Meanwhile, most medical students are woefully lacking in training in chronic pain, usually receiving only a few hours’ worth in their entire education. In fact, veterinarians receive more training on how to treat animals in pain than medical doctors do for their human patients. Unfortunately, without an adequate understanding of pain and its mechanisms, many medical practitioners are quick to downplay the experience of their patients as faking or exaggerating. What this translates into is denying a disability because it is invisible to the naked eye.
Wiser doctors needed

What would help me at this point would be to have practitioners who are not only more well-versed in chronic pain, but are willing to acknowledge its disabling impacts on their patients. In other words, doctors should start believing their patients when they say they are hurting. Validation is the first step toward a solution, or at the least, toward offering alternative adjustments and treatments that can accommodate a pain patient and bring them a better quality of life in the absence of a long-term cure. I used to think of treadmills as the walk (or run) of shame. They were only used on rainy or cold days when I was desperate to get in my workout.

But I have since wised up. Approached the right way, they can offer in-depth, all-around workouts beyond the usual push-the-button-and-go.

“The machines can target all the key muscle groups needed to improve lower body strength and endurance, such as quadriceps, calves, glutes, and hamstrings,” says Dr. Adam Tenforde with the Department of Physical Medicine and Rehabilitation at Harvard-affiliated Spaulding Rehabilitation Hospital. “Plus they offer various programmed workouts that vary the speed and incline, so you can focus on specific goals and needs, like cardiovascular health.”

Treadmills are also ideal for people returning to exercise after an injury or surgery, since you can control the pace and intensity, and they are equipped with handrails for added support.
Using treadmills safely and effectively

Most treadmills monitor intensity with hand sensors that measure your heart rate, but that’s not always the most accurate approach, says Dr. Tenforde. A better way to gauge your effort is with the rate of perceived exertion. This involves ranking your sense of how hard you’re working on a 1-to-10 scale, with 1 being low and 10 being high. For example, 5 to 7 is a moderate-intensity level where you work hard, but can maintain a conversation and not overexert yourself.

Finally, always do a five- to 10-minute warm-up and cool-down by walking at a slow pace. This helps reduce your risk of injury and improves post-workout recovery. (As always, talk to your doctor first before beginning any exercise program.)
Speed, endurance, and muscle building

Here are three treadmill routines from Dr. Tenforde you can add to your exercise program that address three areas of fitness: speed, endurance, and muscle building. Begin with a 10-minute workout and then gradually build up to 20 to 30 minutes as you progress.

Routine 1: Incline (endurance and muscle building). An incline setting generates more muscle activity than walking or running on a flat surface, since you work against gravity. A small 2014 study in the journal Gait & Posture found that incline treadmill walking also could benefit people with knee osteoarthritis and knee replacements.

The workout: Begin walking or running at a zero-grade incline at an exertion rate of 3 or 4 for up to two minutes, then increase to level 1 incline for another minute or two. Repeat the routine until you reach an incline level where you work at 5 to 7 exertion and try to maintain it for a minute or longer. Then reverse the routine until you reach the zero-grade incline again. It is fine to stay at an incline longer, or to exercise at a lower exertion rate, until you are more comfortable.

Routine 2: High-intensity interval training (speed, endurance, and muscle building). HIIT involves alternating between set periods of high-intensity work and rest. The high intensity is at an exertion rate of around 5 to 7, while you rest at a rate of 2 or 3. “HIIT is based on your individual exertion, so adjust the treadmill to match this desired effort,” says Dr. Tenforde. “The point with HIIT is to mix up the intensity to make yourself work harder for shorter periods. It can be fun and breaks up the monotony of exercise.” HIIT is also ideal for people who have trouble finding time to exercise. A study published online by PLOS One found that HIIT produces health benefits similar to longer, traditional endurance training.

The workout: Begin with a moderately high intensity-to-rest ratio of 1:3, in which you power walk or run for one minute and rest for three minutes. As you improve, you can vary the ratio to 1:2 or 1:1 or even work for longer high-intensity periods with shorter rest breaks.

Routine 3: Speed variations (speed, endurance). Most treadmills have pre-programmed workouts that vary the speed and incline with labels, such as “fat burning” or “hill climbing.” “These can help increase your cardiovascular health by varying the effort and can be another way to add variety,” says Dr. Tenforde.

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