Posts tagged exercise
Impact Of Walking On Chronic Low Back Pain
walking-exercise-chronic-pain-low back pain

Low back pain remains the most common musculoskeletal diagnosis seen by primary care providers including Physical Therapists. While the majority of cases of low back pain are not serious in nature symptoms tend to be recurrent and can become chronic (> 3 months) if left untreated. As low back pain progresses from acute to chronic in nature changes in the both the peripheral and central nervous systems can occur leading to increased symptoms and loss of function. Patients with signs and symptoms consistent with nervous system changes are often prescribed pain science education and graded exercise to improve their symptoms and most importantly participation in life, work, and recreational activities. A recent review of the research examines the impact of walking vs. general exercise on patients with chronic low back pain.

Vanti and colleagues reviewed the available research on the effects of walking alone compared to exercise, as well as, the impact of the addition of walking to other forms of exercise (Disabil Rehabil. 2019). They reviewed 5 randomized controlled trials on the topic and make recommendations based off this evidence. In general, most forms of exercise including walking, showed a positive effect on a patient’s low back pain, fear of activity, and disability. Authors noted walking was not superior to other forms of exercise, but may be more easily implemented because of its’ ease of implementation compared to other forms of exercise. This study confirms prior research advocating for increasing the activity levels of patients with chronic back pain.

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Physical Therapy Exercises Are Cost and Clinically Effective Compared To Primary Care Alone For Knee Arthritis

Physical Therapy interventions including manual therapy and exercise remain the primary intervention for patients with knee arthritis. These treatments have been shown to delay or prevent the need for costly, more invasive treatments including total knee replacement. Prescribed Physical Therapy exercises are designed to reduce pain, improve mobility, and increase a patient’s leg strength. Stronger muscles attenuate forces across the painful knee joint allowing a patient to achieve a higher level of physical function and participation their prior levels of activity. Additional treatment options available to patients include primary care or orthopedic management involving diagnostic imaging, medication, injections, and education. A recent study compared the cost and clinical effectiveness of usual care versus Physical Therapy management for patients with knee arthritis.

A randomized controlled trial in the journal Osteoarthritis and Cartilage was conducted to compare the effectiveness of different conservative interventions among patients with hip or knee arthritis (Abbott et al. 2019). Authors randomized 206 patients with either hip or knee arthritis to one of four groups: usual medical care, supervised Physical Therapy Exercises, manual Physical Therapy, or combined manual and exercise Physical Therapy. Physical Therapy participants were provided with 10, 50 minute sessions including follow up “booster” sessions at 4 and 13 months. Authors found the greatest cost and clinical effectiveness in the patients who received supervised Physical Therapy exercises in addition to usual care.

Can push ups help determine future heart disease events?

Heart disease remains the number one killer of both women and men in our country. Although the causes of heart disease are multifactorial in nature a significant percentage of known risk factors are modifiable. Abstaining from smoking, weight loss, nutrition, and exercise remain some of the most powerful ways to reduce your individual risk for heart disease including heart attack and stroke. Unfortunately, only a small percentage of Americans reach minimum national standards for weekly exercise. As our country becomes more sedentary and obese heart disease will continue to be a major health problem. Consistent with any disease, emphasis is often placed on prevention of heart disease as a more effective and less costly option for tackling heart disease. A recent study identified a functional test that can be used to help identify those at risk of future heart disease.

Researchers in the Journal of the American Medical Association reported on a retrospective analysis of heart disease events and push up ability (Yang et al. JAMA Network Open. 2019). Authors reviewed the cardiac history, anthrometric measurements, and functional testing of over 1100 participants. During the 10 year follow up 37 cardiovascular disease outcomes were reported. Authors reported a lower push up capacity was associated with an increased risk of cardiovascular disease events. Participants who could perform > 40 push ups were at a significantly lower risk of cardiovascular risk compared to those who were unable to perform 10 reps. Further studies are needed to confirm these findings and determine if this relationship is present in other patient populations.

If I Am Active At Work Do I Still Need to Exercise?

Studies reported the United States lost 1/3 of all manufacturing positions between 1999 and 2010. Many of these individuals have not returned to their prior manufacturing jobs and may have started more sedentary occupations. While prior U.S. generations relied upon their work to provide daily activity, more recent generations must actively pursue aerobic and strength training exercise to receive the incredible health benefits associated with consistent exercise. Individuals who continue to work in active jobs such as construction, shipping, or manufacturing often believe their jobs provide all the activity they need, but new research questions the ability for these occupational activity to meet each individual’s exercise requirements.

A review article in the British Journal of Sports Medicine discussed the available research on occupational activity and health benefits, as well as, made arguments as to why workers with more active occupations should exercise (Holtermann et al. 2018). Previous research in this area has shown occupational activity does not improve an individual’s health. Further, many studies have shown these individuals have poor health and an increased risk of cardiovascular disease and early death.

Individuals in jobs with higher occupational activity often perform repetitive, low load movements with periods of heavy lifting and/or abnormal postures. This is in contrast to the shorter duration, higher intensity body movements associated with physical activity and exercise. Specifically, authors report aerobic capacity utlization of 30-35% and 60-80% between occupational activity and exercise, respectively, These lower aerobic intensities do not meet the minimal aerobic levels required for cardiovascular health benefits.

Aerobically trained individuals demonstrate decreased resting heart rate and blood pressure measurements compared to their sedentary peers. Conversely, research shows individuals involved in occupational active jobs demonstrate increased inflammation, heart rate, and blood pressure in the 24 hours following their shifts. If sustained, elevations in heart rate and blood pressure have been shown to be independent risk factors for the development of cardiovascular disease. These increases may be explained in part due to the lack of adequate recovery following occupational activities. Resistance training participants take 1-2 days off between sessions while this category of workers often perform job duties longer hours over consecutive days within the work week. Based on these aforementioned factors, workers in these jobs are encouraged to meet the same weekly exercise goals as the general population.

How Does Exercise Compare With Medications In The Treatment Of High Blood Pressure?

The ability of aerobic exercise to reduce systolic (top number) blood pressure has long been established. Reductions in blood pressure have been shown to reduce an individual’s risk for chronic diseases including heart disease and ischemic events such as stroke and heart attack. Reducing an adult’s high blood pressure is an aim of many primary care physicians. Commonly utilized medication classes including beta blockers, calcium channel blockers, diuretics, and ace inhibitors are commonly prescribed to effectively reduce high blood pressure. Exercise, although shown to be an effective treatment for 26 chronic diseases, remains underutilized by both patients and physicians prompting many medical groups to adopt “exercise is medicine” platforms to raise awareness. A recent review of the evidence compared the effectiveness of medications and exercise on blood pressure.

The British Journal of Sports Medicine published a review of the medical literature including 391 randomized controlled trials (Naci et al. 2018). These trials included both exercise (10,491 participants) and blood pressure medications (29,281 participants, but unfortunately no trials compared the two interventions against one another. Interestingly, only 56 of the available trials (3508 participants) on the benefits of aerobic exercise on blood pressure were performed in patients with high blood pressure (systolic > 140 mmHg). When authors combined the data of all participants (high blood pressure or normals) they found blood pressure medication was more effective than exercise for lowering blood pressure. Conversely, and importantly, when authors pooled the data of only patients with high blood pressure they found exercise was equally effective to most blood pressure medications (beta blockers, ACE inhibitors, and diuretics). The authors of the review called on researchers to produce more head to head randomized trials between exercise and medications, as well as, stronger methodology to reduce the risk of bias and validity errors. Patients are advised to speak with their physician before making any changes to their medications or beginning an exercise program.

Aerobic Exercise Shown To Make The Body's Cells Younger

Aerobic exercise has been shown to improve our current mental, emotional, and physical health. In addition, aerobically trained individuals experience significant health benefits including decreased risk of chronic disease and premature death compared to their sedentary peers. In addition to these health benefits, scientists are also researching the impact of exercise on the aging process. New research is discovering exercise impacts aging at the cellular level. Scientists often measure a cell’s age by the length of the tip, telomere, of its’ chromosomes. Shorter chromosome length is associated with cellular dysfunction and cell death, but this length is modifiable through environment factors including exercise. A recent study examined the impact of exercise on chromosome and telomere length.

Werner and colleagues enrolled 124 inactive participants and randomized them into one of four groups including control, aerobic training, interval aerobic training, or resistance training (Eur Heart J. 2018). Both exercise groups attended 3 45 minute training sessions per week over the 6 month training period. Authors reported aerobic capacity, VO2 max, increased in the exercise groups but only the aerobic training group impacted the individual’s chromosomes. Aerobic training was shown to lengthen telomeres on the ends of chromosomes after the training period. Authors reported the length changes were important for a cell’s regenerative ability and healthy aging.