Physical activity helps those with Parkinson’s disease

Parkinson's disease is a progressive neurodegenerative disorder affecting motor function. Recent information indicates that physical activity may slow the progression and improve the quality of life for those affected.

Movement disorders are a broad category of illnesses that include Parkinson's disease and related disorders. They are generally the result of a neurochemical imbalance. In the case of Parkinson's, it is due to a lack of dopamine in the area of the brain controlling the fluidity of movements.

Typical symptoms include a tremor along with very slow, stiff movements. Treatment involves supplementing the dopamine in the brain while increasing the sensitivity of dopamine receptors.

Standard physical therapy regimens consist of range of motion exercises to avoid tightening of joints. More recent programs emphasize balance and stretching by utilizing yoga and tai chi.

Dance has now become an accepted complementary modality in the treatment of Parkinson's disease. Dance programs are generally held in group sessions for patients and caregivers. A study performed at Washington University compared patients enrolled in Argentine tango classes to those receiving non-dance therapies. The tango group fared better regarding slowed progression and improved function. The Argentine tango was especially appropriate for this study since it requires dynamic balance, frequent turns, variable speeds and walking backward.

Locally, a weekly dance class for patients with Parkinson's disease and their caregivers has been ongoing at Connecticut College. These classes, led by instructor Rachel Balaban, are designed to improve the strength, stamina and balance of participants. "The dance program addresses the physical and emotional needs of patients by providing an outlet for both patients and caregivers," said Balaban.

While dance therapy may be an unconventional treatment for Parkinson's, it has certainly proven to be effective.

Football safety debate could benefit from local examples

The topic of safety in football has recently risen to become a priority at all levels. There is a high level of concern that changing the rules, equipment or strategy will detract from the entertainment value of one of America's most popular sports.

Specifically, this initiative is the result of the rising number of concussions and spinal injuries, as well as the potential long-term effects of cumulative trauma.

Football is among what are best described as violent collision sports. Others include hockey and rugby. Concussion is a group of symptoms that results from a blow to the brain. It may be from a direct blow or a sudden jerking of the head causing the brain to strike the inner skull.

Proposed changes in football include changing the rules to penalize players for what is felt to be excessive violence as well as using their helmets as weapons. Another proposed change is modifying the execution of plays to minimize vulnerability to injury. Some absurd proposals include eliminating the use of helmets entirely.

One change that would make a difference is creating a "culture of safety" in football.

Arguably, from the standpoint of neurological injury, the most violent sports are combat sports like boxing, mixed martial arts and kick boxing. In boxing, the only way points are scored is by inflicting neurological injury on the opponent.

In Connecticut, the Mohegan Tribe Department of Athletic Regulation, the Mashantucket Pequot Athletic Commission and the Connecticut State Boxing Commission have developed this approach over recent years. Interestingly, the changes put in place have not taken away from the "entertainment factor" in any of these events.

Maybe there is something to be learned.

A culture of safety means that the safety of athletes is the highest priority. Safety takes precedence over money and winning. It is also not limited by time and is an ongoing process.

Boxing has shortened the number of rounds involved in a bout. A typical championship match used to be 15 rounds and is now 12.

Locally, many bouts are four or six rounds and there are more bouts on a card for the night. MMA uses three, five-minute rounds. This provides an opportunity for more athletes and removes them from exposure to injury.

The NFL is currently considering lengthening the season to 18 games from the current 16- game schedule. This will increase the exposure of professional football players to neurological injury.

Combat sports utilize independent physicians to evaluate participants. These physicians are not employed by the venue, promoter or fighter. Professional football relies on a system where physicians are direct employees of the team.

Rules have evolved in combat sports to allow for safety. Football is trying to implement similar rules. These are in place to make the contest safe and officials will gradually become more comfortable with enforcement, while athletes will become more comfortable with following the rules. In boxing, the loss of points or disqualification have been effective penalties. Hefty fines as proposed by the NFL have little impact.

Creating a culture of safety is not an overnight process but a gradual evolution. Football does not need to "reinvent the wheel" to promote safety at all levels.

Swimmer’s death a reminder that we all have limits

Among the goals of all athletes is to establish higher standards of performance. This applies to any level whether on a treadmill in a basement or breaking an Olympic record. There are also physical limits that must be respected or a workout can potentially end in disaster.

The recent death of Fran Crippen, a champion swimmer who died at the age of 26 in a 10-kilometer open-water race, serves as a sobering reminder of the inherent danger of sports.

Intense competition puts tremendous energy demands on the human body. The cardiovascular system must provide adequate blood supply to vital organs including the brain, heart, lungs and kidneys while meeting the increasing vascular needs of large muscles.

There is also a thermoregulatory component to be considered. Exercising in extreme environments of heat or cold puts added stress on human organ systems. The physiological mechanisms involved in human function work best at a stable temperature. Any variance requires added energy to provide adequate cooling or warming.

Safety considerations often include making certain the venue is safe for competition. Medical support, adequate nutrition, hydration and properly functioning equipment must be available and supervised by officials.

Athletes typically envision themselves as indestructible. While that belief may serve as a driving force, it may also lead to trouble.

In the case of Crippen, there is evidence that he recognized this event and others may be unsafe. Inadequate medical support and dangerous conditions were reported but not changed.

Crippen suffered extreme physical exhaustion and eventual cardiopulmonary failure. The most likely cause was exertional heat stroke given that the water temperature was in the high 80s.

This incident provides a reminder that all athletes, spectators and officials have an obligation to safety.

Take precautions when exercising on trails

An off-road experience can be both exhilarating and a welcome change of venue for a good workout. This especially applies to athletes who exercise in areas where fall color changes are beautiful and the climate is moderate.

Safety measures such as wearing bright, visible colors, trail knowledge and adequate nourishment can be applied to almost all trail sports, but some precautions are specific to trail running and hiking:

• Stretching and warm-up: Even if this is done as part of a normal pre-run routine, special attention should be made before moving to rough terrain. Specifically, the feet and ankles become more vulnerable to injury on an irregular surface. Suddenly inverting the ankle can result in torn ligaments. Small muscles of the feet will be more prone to strain. The best way to loosen these muscles is by rocking forward and backward from heel to toe.

• Footwear: As opposed to typical running shoes, trail shoes have higher ridges for more traction. This helps when climbing and descending steep inclines.

• Adjust speed-running: Off-road requires a slower, more careful pace than road running. Hidden, wet surfaces, along with varying terrain, demand more attention.

• Avoid distractions: Many runners like to listen to music while on the road. While this may be safe in a controlled environment like a running track, it can be a dangerous distraction on a trail. Sound provides important information when running off-road and typically these natural sounds provide part of the enjoyment.

The fall season in New England provides an outstanding opportunity for workout variation. It is also a perfect setting to begin a new outdoor activity along with friends. Planning an outdoor adventure with safety in mind goes a long way.

When the leaves change, so can workouts

When fall arrives, athletes may be tempted to change the setting of outdoor workouts to more colorful and challenging terrain. Although this will add a new and more exciting element to any fitness regimen, it deserves caution.

Typically, biking, running and hiking are most suitable for an off-road experience.

Trail Biking Safety

• Equipment: Road bikes are not well-suited for trail cycling. Mountain bikes are equipped with wide, densely treaded tires that are able to grip rugged terrain. The gearing of a mountain bike is also unique and allows for steep climbs and descents. The braking systems and handlebar grips are also safely positioned.

• Protective clothing: Helmets are always imperative when cycling to avoid catastrophic injury — even the most experienced mountain bikers wear helmets. Other protective clothing includes gloves, elbow and knee pads. The rule in off-road cycling is that falling should be expected as part of the experience. Brightly colored clothing is also advisable when riding in areas that may be shared by hunters.

• Knowledge: Try to use trails that you are familiar with or study the area on a posted map before entering a wooded area. A compass or GPS device is a wise investment. A cell phone or other communication device is helpful.

• Group ride: It is best to travel with others when going off-road, and stay together as a group. This is important from the standpoint of safety as well as adding an aspect of socialization.

• Nourishment: Water and energy bars are worth bringing along. Fatigue can be very dangerous and a rider shouldn’t hesitate to take a break for rest and nourishment.

Safety should always be the highest priority in any sport, even when they border on the extreme. Next week we’ll discuss trail running and hiking.

Barefoot running takes adjusting to get in stride

Consumers are constantly updated on the latest innovations in running shoes. Arch supports, gel insoles and weather-resistant fabrics are now standard components. Recently, a growing group of runners have gone against the “more is better” trend by beginning to run barefoot.

In his recent best-selling book, “Born to Run,” Christopher McDougall investigates the running habits of the Tarahumara Indians of Mexico. Members of this tribe are able to run hundreds of miles without rest. These tribal runners accomplish these amazing feats by running barefoot or by wearing a leather sandal to protect their soles in rugged terrain.

The human foot is made up of 26 bones held together by small ligaments. These joints are activated by a network of muscles and nerves. There are three anatomic regions to the foot: the forefoot in front, the midfoot and the hindfoot.

Barefoot runners use a different stride that keeps the hip and knee flexed while landing on the forefoot instead of the heel. Running experts believe that this style of running can diminish injuries to hips, knees and low back. Flexing a joint on impact will absorb more shock and avoid trauma to the cartilage, tendons and ligaments.

“The key to beginning a barefoot running program is to start slow on a level, natural surface,” said Dr. Jeffrey Kierstein, a podiatrist in Norwich. “Many runners don’t realize that when using the barefoot technique, they are beginning to use different muscles. Starting out too hard and too fast will injure those muscles and cause stress fractures to the small bones of the foot.”

Barefoot running is not for everyone, but runners who have been able to adapt are enthusiastic about their new sense of freedom.

Yoga benefits a wide range of people

The mind-body connection has intrigued scientists for centuries. The ability to meditate and visualize various physical activities is believed to be instrumental in healing as well as athletic performance.

This mental and physical collaboration is essential to yoga. Yoga has been practiced for more than 5,000 years. The meditative aspects were the principal emphasis, with the physical component added later.

Poses vary based on each person’s abilities and the yoga style. Many older participants with health limitations are able to benefit from the mental relaxation and stretching along with the camaraderie of class participation.

Among the benefits of yoga are improved:

• Flexibility: Stretching ligaments and tendons protects against sprains and muscle strains.

• Strength: The resistive component of some poses will improve strength especially in core muscles.

• Concentration: Yoga encourages focusing on a specific task without distraction.

Medical studies have demonstrated that patients suffering from cardiac disease, respiratory conditions and neurologic illnesses have all been helped by adding yoga to their therapeutic regimen.

The image of a yoga participant as a thinly built individual able to contort themselves into a variety of “double-jointed” poses immediately comes to mind when thinking about a yoga class. Recently, Lee Elci, a local talk show host, and I challenged that image by attending a yoga class at the Centerspace Wellness Studio in Bozrah. We were both impressed by the intensity of the workout and the benefits.

“The popularity of yoga has steadily grown in Eastern Connecticut,” said Lyndsay Meiklem, a certified yoga teacher and owner of Centerspace. “Many young athletes participate to enhance performance in their primary sport and patients recovering from orthopedic injuries use yoga for rehabilitation.”

Utilizing yoga to treat and prevent illness may provide an effective tool in controlling future healthcare expenses. If interested, contact Centerspace Wellness at 860-886-8562.

‘Stroller strides’ help new moms lose weight

Pregnancy and childbirth are among the greatest events in life. The physiologic changes potentially impact every aspect of a woman’s body.

The most disheartening change for most women is weight gain. Ideally a woman should gain 25 to 30 pounds during pregnancy. This number can increase drastically with inactivity and overeating.

One of the most difficult challenges is returning to pre-pregnancy weight and physical activity. Among the obstacles to achieving this goal include erratic sleep schedules, demands of returning to work and caring for a new baby.

An outstanding solution to this problem is a program called “Stroller Strides.” Stroller Strides is a national, total fitness program for new mothers. It consists of a combination of aerobic and resistive exercise performed along with a child six weeks after giving birth.

The configuration of a stroller has changed over time. The large, inflated tires along with lightweight construction are perfect for running and power walking. The resistance component is introduced with the use of resistive bands and body-weight exercises.

April Holtmeyer is a certified instructor and local franchise owner who lost 145 pounds after giving birth to her first child.

“I always struggled with weight gain and found myself obese and a new mother. My obstetrician confronted me with the likelihood that I would die young and have to leave this beautiful child behind,” said Holtmeyer.

After moving to Eastern Connecticut, she purchased a local franchise and leads classes consisting of 15 to 20 mothers and children.

One hour sessions are offered six days-per-week; most participants attend four sessions per week. An added benefit is the social interaction among the mothers and children. The playgroup aspect helps combat post-partum depression.

Stroller Strides is a program worth considering for young mothers. If interested, visit www.strollerstrides.com

Family histories are tools to avoid sports injuries

Alarming numbers of children are the victims of sports-related injuries each year. Unfortunately, some of those are fatal.

Sports medicine specialists throughout the world persistently look for ways to avoid these tragedies. Perhaps one way is already within grasp.

One of the most important parts of a medical examination is recording a family history. Information regarding illnesses that have affected a patient’s ancestors is noted.

Diagnostic tests are growing in cost and the expense related to screening every athlete for potentially deadly conditions is prohibitive for many athletic programs.

Often the family medical history will indicate what tests will have the most value, based on specific conditions.

• Neurologic. Athletes in whom there is a family history of brain aneurysms should have radiologic studies to screen for any vascular abnormality. Epileptic seizures in close relatives or in the athlete’s childhood can be further investigated with an EEG. A family history of dementia at an early age suggests caution when participating in contact sports where concussions are common.

• Cardiac. Screening tests to avoid sudden cardiac death are increasingly common. These examinations are imperative for athletes with a family history of abnormal cardiac rhythms, coronary artery disease at a young age or sudden cardiac death. An EKG or echocardiogram is a useful screening test.

• Hematologic. Sickle cell trait and a variety of inherited forms of anemia can lead to abnormal clotting and decreased oxygenation of vital organs.

The success of this strategy is based on full disclosure by parents regarding the family medical history. Some families have refused to submit their children for testing despite the potential danger.

Careful attention to physical risk based on family medical history can make sports participation safer.

Exercise helps those with Multiple Sclerosis

Multiple Sclerosis (MS) is a neurologic illness that results in abnormal function of the central nervous system. Despite the seriousness of the diagnosis, exercise can be therapeutic and should be encouraged.

MS typically affects men and women between the ages of 20 and 40. There are two types of MS. The relapsing and remitting form consists of episodes of visual loss, numbness or weakness that improve. A more serious, chronic, progressive form follows a slowly deteriorating pattern.

Magnetic Resonance Imaging (MRI) scans are particularly sensitive to changes in nerve cells resulting in the formation of MS plaques. This has permitted earlier diagnosis and initiation of treatment.

Immunosuppressive medications have successfully reduced the number of MS relapses and slowed progression. Recent studies have shown that patients who suffer from MS and exercise regularly perform better on objective tests.

Any exercise regimen should only be performed after physician approval. The goals should be as follows:

• An adequate period of warm-up and stretching

• A minimum of 30 minutes of aerobic exercise three days per week

• Resistance exercise on alternating days

• Activities that improve balance

One area of concern for patients is the potential for making symptoms worse when exposed to extreme heat. MS patients must be especially careful not to exercise on hot days and to remain hydrated. Cooling vests are sometimes recommended to provide a more tolerable environment.

Among the best fitness activities for patients with MS are swimming, cycling, running and martial arts. Participation in group activities also provides a social outlet.

Inactivity can lead to joint spasticity and muscle atrophy. It can also lead to diminished coordination and potentially deadly falls.

Any treatment plan for MS should include a combination of medication and an appropriate fitness regimen.