Heart Disease and Cardiac Rehabilitation

Health on November 11th, 2016 No Comments

Heart disease is a serious affliction in America. According to the CDC (Centers for Disease Control) about 1 in 4 deaths in the United States is due to heart disease and roughly 735,000 Americans have a heart attack each year (210,000 of which occur in people who have already had one before). 1 Fortunately, there are many tactics to improve a person’s function, endurance and overall health after they have any sort of heart problems whether it be attack, failure, coronary artery disease or even procedures such as having a stent/balloon in place.  Generally, after an event and the patient is stable, their physician will recommend cardiac rehabilitation (rehab) to improve quality of life, decrease risk of another heart problem and help return a person as close to their prior level of function as possible.

                When it comes to cardiac rehab, physical therapy can help to improve a person’s endurance, strength and reduce the risk of death or re-hospitalization through a combination of exercise training, coping and compensation strategies while your body is healing and ensuring the patient knows the best route to recovery. Fortunately, the evidence supports the use of cardiac rehab for people who have coronary artery disease, heart failure, heart attacks or who have had coronary interventions such as stents or balloons implanted.  These demographics have been shown to decrease their chances of another cardiac event taking place, improve their quality of life, decrease the risk of going back to the hospital and improve their long-term mortality rate with proper adherence to a well-designed program. 2, 3, 4, & 5

      If you or someone you know has suffered one of these life changing events, take control of your health and inquire about cardiac rehabilitation to ensure you can get the most out of life and keep your heart as healthy as possible!



1.       Heart Disease Facts. Retrieved from the Centers for Disease Control and Prevention website on November 10, 2016 at http://www.cdc.gov/HeartDisease/facts.htm.

2.       Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, Ingle K, Miller P and Hinderliter A. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial.  Circulation. 2016 Apr 5; 133(14): 1341-50.

3.       Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees L, Martin N and Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2016 Jan 5;(1):CD001800.

4.       Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, and Singh S. Exercise-based rehabilitation for heart failure. Cochrane Database of Systematic Reviews. 2014 Apr 27;(4):CD003331.

5.       Goel K, Lennon RJ, Tilbury T, Squires RW. And Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation.  2016 Nov 8;(134):19.

Diabetes: How Physical Therapy Can Help

Health on November 10th, 2016 No Comments

Diabetes is a serious disease that can have debilitating consequences if left unchecked. Estimates show nearly 26 million Americans have Diabetes and unless new preventative measures are taken, roughly 48.3 million people are estimated to be diagnosed with type II Diabetes by the year 2050. 1 Fortunately, there has been ample research on the topic of Diabetes prevention, management and recovery in recent years and theories that were once thought to reduce onset and symptoms of Diabetes has been shown through objective data to help decrease the risk of developing this disease as well as either reduce, stagnate or even reverse the process of Diabetes in individuals of all ages, races and fitness levels.

In a study done by Turcotte and Fisher in 2008, it was shown that physical activity and skilled physical therapy can improve fat and glucose metabolism, improve insulin resistance and help control blood glucose concentrations through both aerobic and anaerobic exercise. 2 This means that through proper strength and aerobic training and exercise, the risk of Diabetes can be reduced, the need for medication with the disease is lessened and the chance of developing the disease is not as great.  In yet another study, exercising to burn 500 calories a week was shown to reduce the risk of Diabetes 6% (higher in patients with a high risk of Diabetes); exercising at least 40 minutes a week was shown to decrease the risk of Diabetes in middle-aged men, and modest weight loss through a combination of both diet and exercise was shown to decreased the risk among high risk patients for diabetes between 40-60%, and exercising for 150 minutes a week at a moderate intensity was shown to be twice as effective at reducing diabetes versus metformin (a diabetes medication) over a 3 year period. 3

                Essentially the evidence shows that whether you are at risk of developing Type II Diabetes or currently have the disease; there are more options than having to take powerful medications and suffer from the debilitating side effects associated with Diabetes.  Diet and exercise show clear and objective evidence that they are very effective at helping reduce problems and health risks that people can have with Diabetes and physical therapy can help people learn the proper techniques to safely and progressively take control of their own health.




1.       Deshpande, A. D., Harris-Hayes, M., & Schootman, M. (2008). Epidemiology of Diabetes and Diabetes-Related Complications. Physical Therapy, 88(11),1254-1264. Accessed October 12, 2016. http://dx.doi.org/10.2522/ptj.20080020.

2.       Turcotte, L. P., & Fisher, J. S. (2008). Skeletal Muscle Insulin Resistance: Roles of Fatty Acid Metabolism and Exercise. Physical Therapy, 88(11),1279-1296. Accessed October 13, 2016. http://dx.doi.org/10.2522/ptj.20080018.

3.       Warburton D.E.R, Nicol C.W and Bredin S.S.D. Health benefits of physical activity: the evidence. Canadian Medical Association Journal. Marh 14, 2006: 174 (6); 801-809. Accessed November 1, 2016. http://www.cmaj.ca/content/174/6/801.long.

Benefits of Exercise – Part 1

Health on August 19th, 2016 No Comments

The benefits of regular physical activity has been talked about for years, however the fitness levels of the average person in America are approaching alarming levels resulting in rising incidences of both preventable health diseases and early death.  According to the President’s Council on Fitness, Sports and Nutrition, only about one in three adults get the recommended weekly level of exercise and over 80% of adolescents are not getting enough physical activity. 1 With rising rates of cardiovascular disease, diabetes and other debilitating heath problems, it is more important than ever to ensure every person improves their activity level to not only improve their lifespan, but also their quality of life.

                In a longitudinal study looking at over one hundred-fifty scientific articles, it was shown that regular physical activity can reduce a person’s overall risk of death 20-35%, cut the risk of death from any cardiovascular disease (i.e. heart attack) in half, as little as one hour of walking per week can reduce the risk of death in women by 33% and in diabetics; two hours of walking each week can decrease the risk of premature death by up to 54%. 2 This evidence shows that increasing physical activity, even if it is only one to two hours a week can be beneficial for everyone regardless of health status or gender.  While it is important to exercise on a daily basis, any level of physical activity is better than none at all and it gives you a springboard opportunity to increase on the activity you are already doing.


1. President’s Council on Fitness, Sports & Nutrition. Facts & Statistics retrieved August 17, 2016 from http://www.fitness.gov/resource-center/facts-and-statistics/.

 2. Warburton DE, Nicol CW and Bredin SS. Health benefits of physical activity: the evidence. Canadian Medical Association Journal. 2006 March 14; 174 (6): 801-9.

Neck Pain and Physical Therapy

Health on June 10th, 2016 No Comments

Neck pain is one of the most common expensive problems in America. It is so common in fact that roughly two out of every three Americans experience some level of neck pain in their life and around five percent of the United States population at any one time has neck pain severe enough to be debilitating (over 30 million people). 1 If left unchecked, this pain may progress into something severe that can decrease quality of life and lower a person’s overall wellbeing.

While options such as medication, surgery and bracing may come to mind, unfortunately these methods rarely address the underlying cause and pain may reoccur as a result.  Multiple studies have shown both short and long term success for treating neck pain as well as headaches with physical therapy through a combination of spinal manipulation, strength training, and patient education. 2 & 3

Whether the problem is related to the muscles, joint or nerves; whether it stays in the neck or causes symptoms down the arms or back; physical therapy has been shown to improve symptoms, correct impairments and decrease pain while improving overall function. 4 This is done by not only addressing the painful symptoms, but also the underlying causes of pain (such as muscle imbalance, joint stiffness, improper posture, etc.) as well as providing you with information on what is causing the problem and how to prevent it from reoccurring once the symptoms have been addressed.


1. Alexander EP. History, physical examination and differential diagnosis of neck pain. Physical Medicine and Rehabilitation Clinics of North America. 2011 Aug; 22 (3): 383-93.

2. Brontfort et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012 Jan 3; 156:1-10.

3. Gross A et al. Exercises for mechanical neck disorders. Cochrane Database Systematic Reviews. 2015 Jan 28; 1.

4. Walker MJ et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine. 2008 Oct 15; 83 (22): 2371-78.

Knee Pain: How Physical Therapy Can Help

Health on May 24th, 2016 No Comments

Knee pain is the second most common type of chronic pain in America today and more than one in three people today are affected by long lasting knee problems such as arthritis. 1 & 2 If left unchecked, this knee pain can progress further and further until it become a major hindrance to everyday activities of life.  Eventually this can spiral down to the point where patients are in such discomfort and have lost so much function they have to take drastic measures to alleviate the pain such as prescription medication, assistive devices to walk (such as canes or walkers) or even invasive surgery such as a knee replacement.

Fortunately studies have shown there is a way to help slow down the progression and even help reduce or reverse pain, discomfort and impairments caused by this debilitating condition. With physical therapy intervention (the sooner the better as the longer a condition is left untreated, the more damage is done to the joints), patients can help stabilize and normalize muscles responsible for protecting the knee, ensure the joint is not being irritated and help improve balance, walking and pain. 3 & 4 Furthermore, recent research has shown that conservative treatment of knee problems such as meniscus injuries or osteoarthritis is just as effective as surgical procedures at a much lower cost to both the patient and their insurance, making for savings both in time as well as money as therapeutic treatment would be required post operation, meaning there is a low risk-high reward benefit to attempting physical therapy treatment prior to attempting surgery. 5



  1. American Osteopathic Association. Chronic Knee Pain.  Retrieved from http://www.osteopathic.org/osteopathic-health/about-your-health/health-conditions-library/pain/Pages/chronic-knee-pain.aspx.
  2. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58(1):26-35.
  3. Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, and Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee, a randomized, controlled trial.Annals of Internal Medicine. 2000 Feb 1; 132(3): 173-81.
  4. Crossley K, Bennell K, Green S, Cowan S, and McConnell J. Physicla therapy for patellofemoral pain: a randomized, double-blind placebo-controlled trial. American Journal of Sports Medicine. 2002 Nov-Dec; 30(6): 857-65.
  5. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. The New England Journal of Medicine. 2013; 368: 1675-84.

Dieting is a Life Sentence

Health on December 14th, 2012 No Comments

This is a tough pill to swallow, but it's true.  Regardless of whether you're thin or overweight, you need to be mindful of your diet.  This doesn't necessarily mean that you need to be cutting calories to lose weight but it does mean you always need to be aware of the amount of calories that are entering your body.  Excessive caloric intake, no matter who you are and what type of metabolism in have, will eventually take its toll on your body.

95% of all diets fail.  The reason for this is that most people consider diets to be a short-term solution to solve weight problems.  This is a mistake.  At the completion of your diet, the diet needs to continue.  You may increase your caloric intake but not excessively.  But suppose you're on a 1200 calorie diet in order to achieve weight loss.  Upon attainment of your goal, you abandon the 1200 calorie diet.  Now you go back to your old eating habits.  What do you think is going to happen? You're almost certainly going to return to gaining weight.  After all, it was your previous diet that was causing your weight problem in the first place.  There cannot be a final termination of any dieting strategy.  You must always have a caloric ceiling.  That means you must always watch your food intake.

It is critical when you're trying to lose weight or maintain weight, to always be conscious of your caloric intake.  Your body only burns so many calories per day.  Any amount of calories in excess of this number will result in weight gain.  Remember that weight loss/weight gain is only simple math.  It is simply calories in versus calories out.  Your body doesn't even care what type of food is received.  It is only measuring the amount of energy that it expends versus the amount of energy consumed.  When the balance tips in the favor of one side of the equation, that is when weight loss/weight gain occurs.

For those that are lucky enough to have a fast metabolism – be forewarned.  Eventually that magical metabolism will probably slow down at some point.  When this happens, you will join the masses of the overweight.  If, however, you adopt good nutritional habits and subscribe early to managing your caloric intake, you can avoid this problem.  Calorie issues aside, watching your diet simply makes good sense from a nutritional standpoint.  You need to be filling your body with good, nutritious foods instead of fast foods, processed foods, and junk foods.  Thin people are not immune to cardiac disease and other illnesses caused by poor nutritional habits.  A  fast metabolism does not entitle you to a free pass to fill your body with empty, non-nutritious foods.

Good News.  There is an easy solution to help you manage the calorie battle.  Simply stop eating processed foods, fast food and junk foods on a daily basis. Stop drinking high calorie, sugary drinks.  Instead stick to water. This is not to say that you need to give up all your indulgences forever.  It simply means that you need to sharply curtail their regular intake.  Limit your indulgences to one day per week.

The average male burns approximately 2400 calories per day, engaging in a moderately active lifestyle.  The average female burns approximately 2000 calories per day.  When you eat nutritious, naturally occurring foods you find that these numbers are fairly generous.  It is really not that hard to stay within the caloric limits when you consume healthy food.  If, however, you look at the caloric values of a typical fast food or restaurant meal, you'll be stunned.  It is easy to consume 1500 calories during a single meal.  This obviously does not leave many calories for the remainder of the day.  It is extremely hard to stay within your caloric limits with these types of foods.  This is exactly why were currently experiencing a weight problem in the United States.

Another good tip is to try avoiding the intake of any fluid, other than water, when thirsty.  Most everyone is aware that sugary drinks such as soda are laden with calories (soda has also been linked to type 2 diabetes).  But many people forget that  juices and milk are also sources for large amounts of calories.  While these drinks can be considered nutritious, they can also be considered high danger – from a calorie standpoint.  Play it safe and simply get used to consuming water as your first choice for fluids.

As with many things in life, quitting is not usually a good thing.  When you quit watching your calories, you're dooming yourself to failure.  You'll almost certainly gain unwanted weight.  When you first begin any lifestyle change/diet, you will find it hard to be compliant. But with some practice, you'll soon find that your new, healthier habits, can become as comfortable as your old, bad habits.

Don’t Stretch

Health on December 7th, 2012 No Comments

Many people incorporate stretching into their exercise routine.  They may perform stretching as a warm-up activity or as a way to improve flexibility.  In both these instances, stretching may be a big mistake.  In fact, stretching can actually predispose you to, or cause, an injury.

Stretching prior to activity: Stretching prior to activity is a recipe for disaster.  There are two reasons for this.  For one, most people have heard of the old adage "never stretch a cold muscle".  Despite most people being familiar with this statement, people regularly stretch muscles prior to activity-when the muscle is cold.  Stretching a cold muscle is akin to pulling on a piece of cold silly putty.  When the silly party is cold it will only tolerate a small amount of stretch before it rips.  Warm silly putty, on the other hand, can be stretched to extreme lengths without any trouble.  The soft tissues in your body respond in a similar manner.  Cold tissues tend to rupture more easily, whereas warmth tissues will be more extensible.

In addition to possibly causing an injury, stretching prior to an activity is also a bad idea because it stimulates your parasympathetic nervous system.  The parasympathetic nervous system is the part of your nervous system that causes blood to be diverted to the internal organs and away from the muscles.  Obviously the diversion of blood away from the muscles is counterproductive to exercise. For exercise, we need the blood to be going to the muscles in order to provide nutrition and oxygen for performance.  The parasympathetic nervous system also causes the entire body to relax.  This is the same system that is stimulated when you consume a heavy meal.  After a heavy meal, it is common to feel sluggish and lethargic.  Being sluggish and lethargic will decrease your athletic abilities and will also increase your likelihood of sustaining an injury.

So what should I do instead of stretching?  You need to get the muscles warm so that they are more extensible and less prone to injury.  You can do this with simple calisthenic exercises aimed directly at the muscles you tend to utilize.  You can also perform your specific activity at a 50% intensity for approximately 5 minutes.  This will allow the tissues to warm up and better prepare your body for exercise.

Stretching can predispose you to an injury.  Many people equate flexibility with good health.  This is true – but only to a point.  Excessive muscle flexibility can place you at increased risk for an injury.  This is because the muscles add support to the joints.  In addition to providing your body with the ability to move, muscles also help provide a protective response at the joints.  As a joint is moved, Slack is taken out of some of the muscles.  As the slack is removed, the muscles become more taunt, providing additional support to the joint.  If the muscle, however, is exceptionally loose or flexible, it will then be incapable of providing additional support to the joint.  Too much flexibility can be a bad thing.  The ideal amount of flexibility is that which allows you to perform the activities you normally engage in without any restrictions.  Remember, mobility and stability are at the opposite ends of the spectrum.  You cannot have it all.

Additional note: if you do not have enough flexibility in your body, you will place undue stress on the body, likely leading to an injury.  Restrictions in the body will result in the body compensating in some manner to allow for the completion of the movement.  When this occurs, stresses placed on the body oftentimes lead to repetitive strain type injuries.  So how can I tell if I need to improve my flexibility?  Unfortunately, the only way to truly ascertain whether you're in need of increased flexibility is to have a movement specialists such as a kinesiologist, or physical therapist perform a comprehensive examination and analyze your movement patterns.

Ladies: Exercise Smarter, Not Harder

Health on November 16th, 2012 No Comments

In the last blog I established that there is no fear of ladies becoming excessively muscular with weightlifting.  Now it is time to address the next problem with ladies lifting weights.  Ladies, traditionally, tend to lift weights that are incapable of causing positive benefits.  Ladies regularly perform exercises with weights that are far too light.  If the muscle is not given a stimulus that is beyond that which it normally encounters, then it has no stimulus for improvement/change.  It is also important to note that studies have shown that there is a direct relationship between the health benefits that you receive with weightlifting and the intensity with which the weightlifting is performed.  In other words, the more strenuous the exercise, the more benefits that you will receive.  A good rule of thumb for weightlifting is to choose a weight that causes you to become excessively fatigued by the 12th repetition.  Once you can perform 12 repetitions during a particular exercise, without difficulty, it is time to increase the weight.

Cardiovascular Exercise: many ladies utilize this is their entire exercise platform.  This can lead to trouble for two particular reasons.  For one reason, excessive cardiovascular exercise can lead to burn out and the cessation of an exercise program.  Spending an entire hour, or more, on a piece of cardiovascular exercise equipment can be painfully boring.  This lack of excitement will usually result in the participant stopping the exercise program.  Obviously, exercise is only beneficial as long as you perform it on a regular basis.  Exercising hard for one month and then quitting will do little to nothing to improve your health in the long term.

It is only necessary to perform a cardiovascular activity for 20 minutes, three days a week, keeping your heart rate and your target heart rate zone, in order to achieve a cardiovascular training effect.  In other words, for your heart to receive a healthy benefit from exercise this is the minimum that you must perform.  20 minutes is typically the amount of time that I recommend people spend performing cardiovascular activity.  The main reason for this recommendation is to help people to avoid burnout.  It is important to understand that the difference in the amount of calories burned between a 20 minute exercise session and a 60 minute exercise session (of moderate intensity exercise) is probably equal to that of 400 calories per exercise session.  While 400 calories may seem like a significant amount of calories, the significance quickly diminishes when you figure that it's going to cost you 40 minutes of extra time on a piece of cardiovascular training equipment.  The odds are that the burnout is going to outweigh the extra caloric expenditure.

In addition to burnout, excessive cardiovascular exercise can lead to muscular atrophy/shrinkage.  Although it seems counterintuitive, when you do excessive amounts of cardiovascular exercise your body will typically shed excess muscle.  The reason for this relates to the body being exceptionally efficient.  The body knows that it is highly inefficient to carry around extra weight when performing long-duration endurance activities.  Muscle is a very heavy, dense tissue that burns up to 35 calories, per day, at rest.  Why carry excess weight that utilizes extra energy?  Losing this extra muscle will slow your body's metabolism and reduce your overall strength.

Exercise is hard.  You certainly don't want to waste the time and the energy it takes to exercise by engaging in an inefficient program.  The key is to exercise smarter, but not necessarily, longer and harder.  Incorporate the above information into your exercise program and you can be assured that your body will be much happier.

Ladies: You Need to Lift Weights

Health on November 16th, 2012 No Comments

Ladies are the recipients of a considerable amount of false information regarding exercise.  This causes ladies to adopt exercise routines that are not only ineffective but oftentimes harmful to their health.  It is the goal of this blog to help ladies apply research-based science to help them achieve their weight-loss and fitness goals.

Weight Lifting: many ladies avoid weightlifting like the plague.  They feel that it is either unnecessary or will cause them to look like a man.  This is simply not true.  Ladies need to lift weights as part of their regular exercise routine.  Below are just a few of the reasons for engaging in weightlifting:

Perhaps the biggest reason the ladies fail to lift weights is their fear of looking like a man.  This is an unfounded fear.  The fact is that women lack the hormones necessary to develop excessive muscular growth.  The stereotypical lady bodybuilders are excessive drug abusers of steroids and growth hormone.  A lady may have a particular body part that tends to grow more than other body parts, but on the whole, the average woman will never become overly muscular.  As a worst-case scenario, if a muscle does grow beyond the desired size, reducing it's size is as simple as stopping the exercise that is stimulating the muscle.  The body is very efficient and it will not maintain muscle on the body unless it is continually utilized.  Muscle that goes unused is quickly reduced in size. 


  • Weightlifting has been shown by research to be more beneficial than cardiovascular exercise for many aspects of your health.  For example, weightlifting exercise has been shown to have a greater effect on blood pressure and cholesterol lowering than cardiovascular exercise (a combination of both is considered the best).
  • Weightlifting involves contraction of the muscles.  Muscular contraction is what stimulates bone growth (not weightbearing activity as was previously thought). Healthy production of bone mitigates your odds of developing osteoporosis.  Note: osteoporosis is a weakening of the bones that leads to potentially catastrophic fractures, typically in older individuals.  Reversal of osteoporosis is extremely difficult even with medication and exercise.  Prevention is the best treatment for osteoporosis.
  • Weightlifting improves muscular strength.  This translates to an improved ability to perform functional activities.  Improvements in strength will also help to improve a person's balance and reduce the risk of falls and injury.

You Need To Lift Weights

Health on March 30th, 2012 No Comments

Many people believe that cardiovascular exercise is sufficient to address all their exercise needs.  They engage in activities such as running, biking, or swimming thinking that they are receiving the maximum health benefit from thier exercise program.  They mistakenly think that weightlifting is either redundant or simply unnecessary.  People often look at weightlifting as an activity for muscle heads or narcissists. 

Surprisingly, the muscle heads and narcissists actually have an advantage on those simply doing cardiovascular exercise.  Studies over the last 10 years have shown that weightlifting exercise is more effective at reducing blood pressure and cholesterol than cardiovascular exercise.  The ultimate exercise plan, however, should involve both weightlifting and cardiovascular activity.  This will provide you with the optimum health benefits.

In addition to improving your general health, weight lifting will also provide numerous other benefits.  Weightlifting can improve your balance by adding strength to your lower extremities and core (stomach area).  You will experience an improved ability to perform functional activities such as stair climbing and squatting. You will notice daily activities such as lifting tasks will become easier.  Your posture will improve and you can expect a decreased risk for developing musculoskeletal injuries.

Weightlifting is also the primary stimulus for bone growth.  It was previously thought that weight-bearing activity provided the stimulus for strengthening bones.  This is not true.  It is actually the contraction of muscles that provides the bone with a stimulus to grow.  Regular weightlifting will lead to a decreased chance for the development of osteoporosis (weakening of the bones) which can lead to painful and debilitating fractures.

So, if you are currently avoiding weightlifting in your regular exercise routine, it is time to make a change.  And if you have not yet started to exercise, then this is a good time to make a decision to engage yourself in a comprehensive exercise program involving both weightlifting and cardiovascular activity.