Now that restrictions are being lifted, is it still worth maintaining that walking habit? Dr. Peter Broadhurst, a physical medicine and rehabilitation physician at Sunnybrook, and Kaleigh Starritt, an occupational therapist at Sunnybrook, share some of the physical and mental health benefits you can expect from walking regularly, and it might be enough to convince you to keep it up.

Physical benefits

Your body can experience significant physical benefits from a consistent walking routine.

“We know that people who do a regular walking program … have been shown to have reductions in their resting blood pressure, resting heart rates, their total cholesterol levels,” says Dr. Broadhurst. “And then we see increases in their ability to distribute oxygen successfully to the different tissues in the body.”

Of course, walking is not an option for everyone and there are physical limitations that can prevent a person from taking up a regular walking routine, says Dr. Broadhurst.

“When we think of various types of mobility impairments, some people can’t walk, but it doesn’t mean they shouldn’t locomote—another term we sometimes use—which is how you get from point A to point B,” he says. “Walking is obviously the most conventional way of doing that, but it’s not always applicable to every person out there.”

Get that heart rate up

Dr. Broadhurst says anyone over 18 can follow Canada’s exercise guidelines and aim for 150 minutes of moderate to vigorous activity per week, in increments of 10 minutes or more.

He says the benchmark of 150 minutes a week, whether it’s 30 minutes a day most days of the week, or longer walks fewer days of the week, will help with “hitting that threshold that we like to see, that we know from studies will have that proven benefit.”

Dr. Broadhurst says moderate activity will elevate your heart rate to 60-70 per cent of your maximum heart rate. Your maximum heart is 220-your age (e.g. 220-45=175). Wearable technology such as a Fitbit or Apple Watch can measure your heart rate, but you can also gauge it yourself.

“For moderate activity, you’d be breathing heavily in between words,” says Dr. Broadhurst. “For more vigorous activity, you probably aren’t carrying on any real conversation because you’re focusing more on breathing.”

Mental health benefits

Kaleigh Starritt works in Sunnybrook’s in-patient mental health unit where once a day, Monday to Friday, patients participate in “wellness walks,” 45-minute walks on the hospital’s grounds (or indoors if it’s raining) that have become one of the unit’s most popular programs.

“Without fail, it’s the favourite group, always, on the unit,” says Kaleigh.

In addition to the physical health benefits of walking, Kaleigh says the mental health benefits are equally as important.

“If you think about anxiety and you think about stress, often we want to move our bodies anyway, even if it’s just pacing in the hallways,” she says. “But actually getting outside, getting your ‘vitamin green’ from nature, perhaps having the opportunity to connect with someone you are walking with — all of this provides psychological benefits as well.”

“Moving your body is so critical,” Kaleigh says, and a regular walking habit can become a “really great, healthy coping mechanism.”

“It just slows things down a little bit. It clears your mind, it gives you that space in your mind that we need so desperately because we’re generally so plugged in all the time.”

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“Before the pandemic, I was in the gym almost every day,” says the 21-year-old. “It became the best part of my day.”

When Richard’s local gym closed due to the COVID-19 pandemic, he started working out at home using a resistance band, a large band made of synthetic rubber that can be used for strength training or rehabilitation. The bands provide resistance so muscles are working against its force to help build strength.

The band that Richard used was weighted to 50 pounds, almost 23 kilograms, which means using it was like working out with a 50-pound hand weight.

“After a couple of pulls, the band snapped out of nowhere,” says Richard. “One end hit my left eye and I couldn’t see anything for about 10 minutes. After awhile, my vision started coming back, but was a little blurry. At first, I thought it was just a little injury and wasn’t a big deal.”

Richard says the initial force on his eye caused some pain, but it eventually subsided.

“My eye just looked really bloodshot and red,” he says.

Later in the day, he noticed some changes to his vision.

“I would look left to right and started noticing darker spots, and that’s when I started thinking it might be more serious.”

Impact of retinal detachment

After seeing his optometrist who suspected Richard had suffered a detached retina, he was referred to Sunnybrook where it was determined there was more damage than first thought.

“Richard had an unusual retinal detachment. His retina was damaged in three separate areas,” explains Dr. Kenneth Eng, chief of ophthalmology and vision sciences in the Hurvitz Brain Science Program at Sunnybrook. “There was a large tear in his retina as well as extensive bleeding and bruising. The retina had detached in two places, and there was also a hole in his macula, which is the central part of the retina. He lost a lot of vision. Enough to be considered legally blind in that eye.”

The operation was extensive. Dr. Eng and his team used special surgical tools to do precision work on the fine membrane inside the eye, measuring only one micron thick (or 1/1000^th of a millimetre). The surgery also involved laser treatment to help repair the retinal tears. The team also applied a special silicone solution to help the holes in Richard’s eye heal.

After a few weeks, the bleeding and bruising subsided. After another surgery to remove the silicone, the holes eventually closed and his retina remained attached with improvement in his vision.

Unique case study

The case was so unusual that a photo essay case study was recently published in The Canadian Journal of Ophthalmology.

Dr. Eng says within a couple of weeks of Richard’s eye injury, another patient experienced a similar injury after working out with a resistance band at home during COVID. Dr. Eng says while these exercise band injuries seem to be rare, there is the possibility for more cases as more people are exercising at home over the course of the pandemic. Dr. Eng says safety during physical activity is imperative.

“It’s important to exercise with caution and not be cavalier with any workout equipment that is used,” recommends Dr. Eng. “Accidents can happen that could impact vision or lead to serious complications.”

Recovering after retinal detachment

“The first time I had surgery I thought, ‘I won’t be able to see anymore,’” says Richard. “But Dr. Eng had put his whole effort to helping me and the best I could do was move forward and just recover one day at a time with the help of people around me. Throughout my recovery, my family has been there to support me.”

Dr. Eng says about 80 per cent of Richard’s vision has returned over a couple of months.

“Richard has come a long way,” adds Dr. Eng. “Time will tell how much of his vision will return, but he has made some positive progress after his ocular trauma.”

“Before this injury, I had 20/20 vision and I saw everything crystal clear,” says Richard. “But now, if I read with my left eye, I am not able to read small-font books, so I rely on my right eye. I might not get all my vision back, but I just have to get used to it and I am adapting.”

“While exercise is important to maintaining mental health and physical conditioning during the pandemic, care and attention is needed whenever new activities or equipment are being used. Individuals should familiarize themselves with the use and warnings of all equipment being used. Some equipment, like exercise bands, can store significant amounts of energy,” emphasizes Dr. Eng, “so ensuring that they are installed properly and securely is of the utmost importance to help avoid serious accidents.”

In the meantime, Richard says he is remaining positive and when using the bands in the future, he plans to wear protective glasses. “It may look strange to be wearing safety glasses, but I’m not taking any chances. This injury won’t prevent me from going to the gym in the future. I’m going to be more careful and am looking forward to going back when it is safe to do so.”

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Along with these dietary changes, many also wonder if they should choose lower fat milk, avoid fried foods or opt for margarine over butter. While choosing foods containing lower levels of fats won’t directly improve blood sugar levels, this can help protect and improve heart health. That’s important because people living with diabetes may be at risk of developing heart disease up to 15 years earlier compared to people who don’t have this condition. Here are some of the reasons why:

Gender
In Canada, women with diabetes are 4 times more likely to develop heart disease due to its connection with hormonal levels during menopause, as diabetes cancels out the protective effect that estrogen provided.

Insulin resistance
Insulin resistance plays a role in the development of diabetes and prediabetes. Insulin is the hormone in our bodies that regulates energy or glucose, and resistance happens when the cells in your muscles, fat and liver don’t respond properly. Over time, your blood sugar levels go up because your body isn’t able to use glucose from your body for energy. Insulin resistance plays a role in the development of plaque in the arteries. If plaque builds up too much, it can lead to blocking the blood vessel, significantly increasing the risk of heart attack or stroke.

Unhealthy cholesterol levels
Diabetes can increase the risk of “bad” cholesterol in the body, and lower the “good” cholesterol, which in turn can increase the risk of stroke and heart disease.

High blood pressure
Many people with type 2 diabetes also have high blood pressure, also known as hypertension. There are likely many factors contributing to both conditions including obesity, a diet rich in fat and salt as well as inactivity.

Inactivity
Physical activity is important for overall general health, and may be especially important if you have diabetes. It can help maintain a healthy weight, keep the heart strong and reduce insulin resistance.

Increased body weight
Insulin therapy can lead to weight gain, as insulin promotes fat storage in the body. In turn, being overweight or obese means your heart has to work harder to do its job, increasing the risk of heart disease and other cardiac complications.

Ways to protect your heart

When it comes to diabetes there are many ways to protect your heart, such as having regular check ups with your doctor or endocrinologist to monitor your blood pressure, cholesterol and blood sugar A1C to get these levels into health ranges. The target ranges for blood pressure and cholesterol are much lower for people with diabetes, and similar to targets for someone who has already has had a heart attack or stroke. It’s also important to not smoke, and to take any medications as directed.

Coming back to diet, it plays a critical role. Worldwide, diets low in fruits and vegetable are major contributors to the risk of developing diabetes and heart disease, and nutrition therapy is an integral part of managing both conditions together. Generally, avoid processed foods as they are normally high in salt, sugar and saturated fat. Opt for fresh fruits, vegetables, legumes, beans, lentils, nuts, whole grains and lean proteins, while limiting alcohol intake. Be sure to reach out to your diabetes care team for more information and direction.

View the full Speaker Series event here:

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Here at Sunnybrook, we piloted a program a few years ago that combined 15 weeks of CBT treatment with 12 weeks of aerobic activity, which included things like biking, running and using an elliptical machine. We found there were symptomatic improvements for all the participants, and they found exercise to be a “doable” component of their treatment.

While we know exercise appears to provide benefits, more research is needed to understand why that happens. Exercise could be likened to a form of exposure therapy, in that it exposes the person to uncomfortable feelings that they get through and feel better afterwards. Exercise may also improve cellular function and blood flow in the brain, as imaging scans have actually shown that exercise changes brain activity and structure.

Combined with a few earlier studies looking at aerobic exercise in OCD, we can say that exercise does appear to provide benefits. Exercise also seems to have a synergistic effect when combined with CBT. In short, the more people do, the better they feel. This is great news, as exercise is generally low cost and accessible in some form to most people.

OCD is not the only mental health condition that can benefit from exercise. There is a larger body of research around exercise (mainly aerobic) and its beneficial effects for major depression. Regular physical activity has also been associated with a decreased prevalence of panic disorder, agoraphobia (a type of anxiety disorder), social phobia and general anxiety. Increased physical activity in childhood has also been associated with a reduced risk of depression in adulthood.

So how much exercise is enough? For general health, Canadian physical activity guidelines recommend adults aged 18-64 get 150 minutes of moderate-to-vigorous physical activity (meaning activity that makes you sweat) every week. That equals about five proper workouts lasting 30 minutes, five times per week. Despite this recommendation, research has found only 15 per cent of Canadian adults currently meet this standard.

For depression specifically, current guidelines recommend about three exercise sessions per week, each lasting about 45 minutes to one hour. While aerobic activity has been studied the most, there is no indication that other types of exercise won’t be also beneficial.

The bottom line is that exercise is important for your physical and mental health. If you’re not sure where to start, talk to your doctor about setting up a program that is the best and safest for you.

View the whole Speaker Series event here:

The post The role of exercise in managing obsessive compulsive disorder appeared first on Your Health Matters.

Heart problems are often to blame.

Dr. Robert Myers, a cardiologist at Sunnybrook Health Sciences Centre, says sudden death in young people is rare, but there are several causes that may contribute: “an arrhythmia (irregular heartbeat) disorder; a viral illness that weakens the heart; Marphan syndrome – a connective tissue disorder that can cause the aorta to rupture; to name a few. But the most common cause is hypertrophic cardiomyopathy.”

Hypertrophic cardiomyopathy is a genetic condition where the heart muscle becomes thickened and enlarged. Myers says it is responsible for more than one-third of all sudden deaths in young people.

“A thickened heart muscle can block the flow of blood and, in rare cases, can cause a fatal arrhythmia during vigorous physical activity,” says Myers, who is also the cardiologist for all Toronto sports teams, including the Raptors, Maple Leafs, Marlies, Toronto FC, and Argonauts.

One in 500 people has hypertrophic cardiomyopathy, the majority of which go undiagnosed. Symptoms of the condition can include sudden fatigue, rapid heartbeat, dizziness, chest pain, and fainting. Although symptoms can be managed, there is no cure.

“Unexpected breathlessness, rapid heartbeat, dizziness, losing consciousness – these symptoms are red flags that need to be investigated,” says Myers. “And exercise should be restricted.”

Mandated athlete health screening varies around the world, but in Ontario, official sports league athletes are screened for the condition through family history, physicals, electrocardiograms, and sometimes ultrasounds and stress tests, explains Myers. If any abnormalities of the heart are found, the athlete is benched until their health is cleared for play. If, however, they are diagnosed with hypertrophic cardiomyopathy, they will need to manage the illness with restricted activity.

“Athletes who have this condition would not be allowed to participate in their sport,” says Myers. “Because of that, people may not come forward with their symptoms.”

Myers says anybody who wants to partake in vigorous sporting activities should look out for the symptoms, speak up if symptoms appear, and talk to their doctor about being screened.

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According to Statistics Canada, Canadians spend about 10 hours of each day being sedentary. That is, not moving. That doesn’t even include the hours when we are sleeping. A recent study by researchers at the Institute of Clinical Evaluative Studies found that standing still too much isn’t good either. In short, whether sitting or standing, we don’t move very much.

And that’s a problem, says Joanne Dorion, a physiotherapist at Sunnybrook Health Sciences Centre.

“The body wants to move. It was made to move,” she says. Daily activity can help reduce the risk of illness, help us maintain a healthy body weight, and improve our overall mood. Physical activity is also very important for bone and joint health.

In the summer, we are all typically a bit more active, Joanne says. But as summer turns to fall, and a hot afternoon swimming at the cottage becomes a cool evening bingeing on Netflix, it’s time to really think about how much time you spend sitting, laying, or standing still.

“We sit at our desks, or in the car on the way to and from work, or on the couch when we get home,” she says. “A good first step is to become aware of just how much time you spend not moving.”

Next step is becoming aware of how you sit.

“Most often, we aren’t sitting well, in terms of our posture,” Joanne says. “We all spend a lot of time hunched over our laptop or our phone or a book.”

At work, choose an office chair that you can raise or lower the height and has good lumbar support. Be sure to take it for a “test drive” before you buy it. (Here’s more tips for setting up your desk)

If you do sit for your job or are in still in school, be sure to switch your sitting position throughout the day. Stand up and stretch when you can. Stretch your neck by bringing your ear to your shoulder (left and right). Roll your shoulders forwards and backwards. Reach your arms out with your elbows straight, palm down. Bend your wrist down. Repeat with your palm up.

“Set a reminder in your phone or on your computer to get up and move every 30 minutes,” Joanne suggests.

There are a few other small things your family could do to be a little less sedentary, Joanne says.

“Get off the bus one stop early. Don’t go for the closest parking spot to the door. Park a little farther and walk,” she says.

For parents driving their little ones to school, park a block away and walk over to the school together.

At work, make a point of going to the farther washroom or the cafeteria that’s on the next block instead of in the building.

“Sometimes when we get home from work, we are just tired and want to sit down,” Joanne says. “Try a walk in the neighbourhood or a short bike ride before or after dinner. Even though you feel tired, doing something active will actually energize you.”

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Do you move enough?

Here are some simple ways to add a little movement into your day.

Park farther away.

Stretch at your desk.

Walk and talk after dinner.

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But, evidence-based research shows that people living with cancer can and should keep exercising or add some physical activity into their lives. Sunnybrook has introduced new exercise guidelines for people with cancer based on recommendations from Cancer Care Ontario.

“Exercise can give you more energy, help you sleep better, make your muscles stronger and improve your mood,” said Leslie Gibson, occupational therapist at Sunnybrook’s Odette Cancer Centre.

Cancer treatments like chemotherapy and radiation decrease strength and endurance, sometimes making it hard to complete day-to-day tasks. Participating in physical activity before surgery, or during and after chemotherapy or radiation can help. Being physically active helps keep your muscles strong and can maintain or improve your fitness level. And, it releases endorphins, brain chemicals that are known to improve mood and lift energy levels.

“I feel that endorphin release every time I drag myself to the gym, and then feel better and more energetic after I exercise,” said Joanna Mascarenhas, physiotherapist at Odette.

“Cancer is now a chronic disease for many people,” she added. “We now know that following the Canadian Physical Activity Guidelines of 30 minutes of physical activity a day can improve quality of life for people living with cancer, and for those without cancer, too.”

Leslie and Joanna even prescribe exercise to some patients before their cancer surgery.

“We are finding patients who comply have shorter hospital stays. They are stronger going in, so they are stronger going out,” Leslie said.

For cancer-related fatigue, exercise is the #1 prescription.

“We want patients to balance rest and activity. Expending some energy actually makes your rest-time more restful,” Joanna said. “So, while it seems backwards, being more active actually helps with the fatigue.”

So if you are newly diagnosed with cancer, undergoing treatment or post-treatment, here are Leslie and Joanna’s tips for adding physical activity into your life.

Talk to your health-care provider before starting any new exercise routine.

Start slow.

Set a realistic goal and build from there. Try shorter bouts of exercise, like 10 minutes three times a day. You should be able to talk throughout the activity – that’s called “moderate intensity.” If you are working so hard you can’t carry on a conversation, that’s too hard. Slow it down.

Listen to your body.

“If you are in pain or out of breath, that’s your body’s way of telling you to take a break,” Joanna said. Don’t forget to warm up (with a slow, short walk) and cool down (another slow walk).

Anything is better than nothing.

“Look at your day,” Leslie said. “Where are the opportunities for you to add in a bit of physical activity?” This doesn’t necessarily mean full-blown, hit-the-gym-for-hours exercise. Park a little farther away. Take the stairs instead of the elevator if you are going up one flight. Walk to Starbucks instead of taking the car. This is called “lifestyle-based physical activity.”

It’s never too late.

“No matter your age or the stage of your diagnosis, adding some physical activity into your day can help you,” Joanna said. Improved strength, lower pain levels, better balance: these are all positive outcomes of exercise. Here are more.

Do what you love.

Choose an activity that’s enjoyable for you. If you don’t like running, don’t make running your goal! If you love being out in your garden, do that instead.

Find a buddy or a group.

For many people, exercising with a friend can help you stay motivated and make your new routine more sustainable. In many cities, there are free, supervised exercise groups for people living with cancer.

“These groups can help you stay motivated and help support you as there are other people on the cancer journey too,” Joanna said. “Plus, the classes are supervised by cancer exercise experts, so if you have questions or are nervous to get started, there’s support.” Check out this list for more info.

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That sounds reasonable, don’t you think? Carving out a dedicated half hour might be tricky, but 10 minutes a few times a day seems way more doable! So, if you aren’t a gym person (like me!) then this type of physical activity might be right for you.

Physical activity has lots of known benefits, like reducing the risk of numerous chronic conditions, including coronary artery disease, stroke and Type 2 diabetes. The physical activity should be moderate intensity (so, you won’t be panting like a bulldog at the park in July, but your heart rate should be elevated. If 10 is the hardest you can move, moderate is about a 6 out of 10)

So, got 10 minutes? Here are some ideas for getting active:

(If you have health concerns or have been inactive, please consult your health-care provider before starting any new activity.)

Get off the bus a stop or two early (or park farther away):

I’ve been doing this lately, and I’ve come to enjoy arriving at my desk with my heart pumping! Snowy where you are? Be sure to wear proper footwear and keep your hands out of your pockets for balance if you are doing this one! And, keep your head up – don’t text and walk.

Have an active walking meeting:

Instead of meeting a coworker for a coffee or in an office, ask for a walking meeting instead. Some studies suggest exercise boosts creativity, so your ideas will flow along with your blood!

Living room dance party:

Before hitting “play” on your latest Netflix binge of choice, pick three songs and have a 10-minute living room dance party. Clear a safe dancing space (watch out for the coffee table!) and shake your body! Dancing has also been found to improve mood, so this is a fun one! Get the whole family dancing!

Set up an in-house 5-station circuit:

This idea comes from Mark G. Anunciacion, physiotherapist at the Holland Centre. Set up a five-station circuit in your home and spend two minutes at each station. No gym and little to no equipment required! If you aren’t sure what’s right for you, consult a local health care professional. They can give you further details about correct body mechanics and what exercises might be best for you.

Here’s some ideas for circuit stations you can do inside your home.

• Quarter wall squats (Stand with your back against a wall and then push down into a squat position. Knees must not pass ahead of toes) with forward reach of arms as you squat.
• Marching with arm swing.
• Countertop push-ups (wear your running shoes to avoid slipping)
• Chair rise (sit-to-stand motion. knees must not pass ahead of toes)
• Seated rowing with a theraband (resistance band)

The post Got 10 minutes? You can get active! appeared first on Your Health Matters.

These elbow injuries can occur following an increase in activity or start of a new activity that involves repetitive gripping and use of the wrist. So, if you’ve been inspired to pick up a racket or club, learn more about how to avoid these elbow ailments.

Tennis versus golf

Tennis elbow typically an overuse injury from excessive, quick or repetitive movement of the wrist (especially bending/extending the wrist back or turning the hand). Golfer’s elbow also occurs with wrist movement but in the opposite direction (curling or flexing the wrist). This leads to inflammation from micro trauma of the tendons that attach to the elbow. While named for sport-related injuries, these conditions may result from work-related activities, including gardening.

Symptoms are typically gradual, but can occur suddenly with an acute injury.

What to look for?

• Tenderness over the outside of the elbow (tennis elbow) or the inside of the elbow (golfer’s elbow) that may radiate into the forearm.
• Pain may be: achy, sharp, or stabbing
• Weakness and decreased endurance of wrist movement and gripping. This can lead to difficulty with activities involving carrying, lifting, using keys, opening jars.

What can help?

Try to rest and avoid activities that aggravate the injury. But it’s important to stay active in other ways. Complete rest should be avoided as it may lead to decreases in muscle strength and endurance as well as decreasing blood supply to injured tissues, which can slow healing.

Pain will determine what activities are appropriate: if it hurts don’t do it!

Allow for healing time before resuming any aggravating activities to ensure the muscles and tendons are healthy and able to withstand stress. So, if your last 18 holes upset your elbow, be sure to give it some time before hitting the tee blocks.

Through a gradual return to activities, your muscles will build strength and endurance required for daily activities. A specific stretching and strengthening program for forearm muscles can prepare for return to sport/leisure. Talk to your health-care provider or physiotherapist.

Final Tip:

A proper warm-up before activity will prepare your muscles for use and decrease the risk of future injury.

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You’ve got arthritis. Painful joints, stiffness and inflammation.

But don’t let that be an excuse to be sedentary. Being active may actually help ease some of the symptoms.

Arthritis is inflammation of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. Joints may become damaged over time and can lead to increased pain and decreased function.

It’s a common misconception that a diagnosis of arthritis means hanging up your running shoes and packing away your tennis racquet. But there are many ways you can modify your activities, find new activities and stay active with arthritis.

“Physical activity does not worsen arthritis. Physical activity can help manage arthritis!” says physiotherapist Suzanne Denis. “It can make everyday day activity easier as well as provide many other health benefits.”

Suzanne has some tips for living active with arthritis:

Stand up! Research is pointing toward the importance of being active, whether or not you have arthritis. Sitting too much isn’t good for your arthritis. And it’s not good for your overall health either.

Find middle ground. If you have lower extremity arthritis, some load bearing is good for bone density, but too high impact might be painful. Try something in the middle: activities in water, cycling, Tai Chi, some light running. Doubles tennis. Golf. Curling with an extender.

Avoid activity that’s too intense.  Also avoid activities that have twisting, high speed uncontrolled movements (like singles tennis) forcing end range of movement, or kneeling (though not everyone has difficulty with that). Avoid only if painful or modify (with a kneeling pad or towel rolled under shin)

Hot or cold? “You can use heat before your activity to warm up your joints,” she says. “If your joint is red or swollen, don’t use heat.” After activity, if you have some swelling or your joint feels warm, use ice for 10 minutes, Suzanne says. There’s no hard and fast rule. “You have to find out what works for you.”

Talk to your doc about anti-inflammatory medicines. Check with a doctor before using any oral anti-inflammatory medications. There are many topical anti-inflammatories that can also be considered.

If you have been inactive, talk to your health care provider or seek the help of a physiotherapist before adding activity into your life.

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