Mayo Clinic
Exercise and Cancer: Strategies for Prevention and Therapy
Regular exercise is a valuable tool for the prevention of cancer and provides many benefits for people living with cancer. Join Adam Shultz, MS, ASCM-CEP, CET, a Clinical Exercise Physiologist at Mayo Clinic, as he educates about the benefits of exercise and the strategies to apply to have success. Adam also shares about the Mayo Clinic Cardio-Oncology program that can help develop a personalized program to assist you in achieving your fitness goals.
Chapters:
0:00 Introduction
0:50 Objectives and Outline
1:24 Background
6:15 Safety and Effectiveness
7:22 Benefits of Exercise
8:50 Important Considerations
13:19 Cardiorespiratory Training Guidelines
20:14 Resistance Training Guidelines
24:25 Flexibility Training Guidelines
25:57 Mayo Clinic Cardio-Oncology Exercise Program
29:54 Summary
31:07 Questions and Discussion
At the Mayo Clinic Stephen and Barbara Slaggie Family Cancer Education Center, we believe in putting the needs of the patient first. Our holistic approach focuses on removing nonclinical barriers to care and providing comprehensive education and support. Our videos explore various aspects of cancer care, including prevention, risks, screening, diagnosis, treatment, survivorship, and end-of-life care. Join us as we delve into these crucial topics, offering guidance and encouragement. Whether you're a patient, caregiver, or loved one, our videos are designed to inform and support you throughout your cancer journey.
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[Music] Center for all of your hard work in putting this great webinar series together and for everyone listening in and watching of course as well I appreciate your time and the opportunity briefly I'm can I I'm sorry I'm interrupting you I forgot to say this before but we are recording this session so I just wanted people to know um that we're making a recording of this so that we can post it um afterward for people who weren't able to join us here um in live time and the recording is just showing the screen that you're seeing in our faces just for just for your reference so sorry to interject as you were getting going but I wanted to say that part thank you yeah great I just wanted to mention that I'm employed by the mayil clinic but I don't have any other Financial disclosures or any conflicts interests and so upon completion of this presentation attendees should be able to list benefits to be expected from regular exercise as they relate to cancer prevention and therapy to describe the key parts of a comprehensive exercise program and to even develop a basic personal exercise prescription here's a brief outline of our discussion here and I just want to start with some background information cancer is actually a group of nearly 200 diseases characterized by the uncontrolled growth of abnormal cells and it may be caused by inherited uh or even environmental factors environmental factors being exposures to things like tobacco smoke radiation ultraviolet rays from the Sun and other potentially cancer causing agents that result from damage or result in damage to DNA which is really responsible for helping with the development and function of organisms and also important for our conversation today is the term Survivor we're going to be referencing it a lot so I wanted to just review it briefly and according to the National Cancer Institute the Survivor is one who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease so in cancer then a person is considered to be a Survivor from the time of diagnosis until the end of life so how common is cancer well if we look back at data from 2015 to 2017 about 40% of men and women will develop cancer at some point in their lifetimes in 2019 there were just under 17 million cancer survivors in the US with over 22 million expected by 2030 and cancer affects people of all ages of course but it is most common in those who are 55 years or older the vast majority of which in fact about 75% in that age group and the benefits of exercise really have been known for centuries uh and structured exercise is actually considered to be a foundation of primary and secondary disease prevention primary disease prevention meaning preventing something from occurring to begin with with secondary disease prevention referring to preventing it from happening again and if we look back historically within the US of individuals who unfortunately die of cancer cancer about a third of those can be attributed to things like diet and exercise another third could even be contributed to Tobacco exposure so genetics can certainly influence the risk profile for developing cancer but what we know thus far is that most of the variation comes from factors that we may have control over or not inherited and unfortunately physical function in cancer survivors is generally less than normal because of losses in aerobic fitness muscle tissue and range of motion and this can have longterm consequences for example even after five years post treatment about half of cancer survivors will still note limitations in things such as standing for prolonged periods of time about two hours lifting and carrying 10 pounds walking uh relatively short distances about a quarter of a mile and also kneeling and crouching so some things that do have some functional limitations or functional impairments to day-to-day living and unfortunately individuals with cancer are also more likely to have other or develop other diseases such as cardiopulmonary disease osteoporosis diabetes and others but fortunately exercise can be helpful with those things as well which we'll talk about a little bit later now if we look back in time cancer survivors similar to other groups such as those with heart disease were essentially told to rest and to take it easy which nowadays is almost the exact opposite of things that we'd want to tell cancer survivors in most instances in fact only recently has exercise gained acceptance as a possible additional supplemental therapy for cancer in fact the American College of sports medicine and a Dutch Source cancer Rehabilitation concluded the exercise should be recommended to all cancer survivors so a big change in stance seen there throughout the years but importantly what does the research say about the safety and effectiveness of exercise for cancer survivors well exercise has been found to be safe and well tolerated therapy significant improvements have been noted in fatigue levels Exercise capacity which is the ability to perform exercise depression and quality of life and exercise is actually associated with decreased risk of developing cancer in the first place about 10 to 42% less risk in fact for 13 different types of cancer and even improv survival after being diagnosed When comparing survivors that are most to least active actually the risk of dying from cancer is decreased by 26 to 69% according to recent literature again this is comparing those who are most active to those who are least active and the risk of dying of any cause actually is decreased by to 45% so what are some of the benefits that participants might expect to realize with a regimented exercise program well as I just mentioned decreased risk of death from any costs improved or decreased anxiety and depression decreased risk of Falls and injuries particularly in older individuals improve fatigue levels which sometimes might seem counterintuitive that exercise would improve fatigue but it certainly can and a number of different improvements in body composition such as decreased fat tissue improved bone health and increased lean tissue which is important for day-to-day functional tasks cancer survivors who exercise regularly will also help to improve their cardiorespiratory health which is a really important marker of outcomes in survival even improve cognitive function improve lymphadema control or swelling also improve strength flexibility and improve quality of life overall so just a snapshot of some of the things that can be achieved this is a look at our exercise Center here in Rochester on our fourth floor it houses our cardiac rehab center and our cardio oncology exercise program this picture was taken prior to the covid pandemic you can tell without all the masks and not much distancing I'll show you a picture later on of what our Center currently looks like next I'd like to review just some important considerations for those looking to start or maybe further their exercise programming again I think it's important to acknowledge that cancer survivors should avoid physical inactivity even during and after treatment what we know is that only about 10% of individuals going through treatment are actually physically active unfortunately only about 20 to 50% afterwards despite the known benefits and also exercise guidelines for cancer survivors are very similar to those for the general population meaning there aren't any limitations per se beyond what we would take into account for different treatments that people underwent how they're feeling and what their goals are and of course patients may experience some treatment related side effects that limit their ability to exercise so sometimes working with a professional can help you to identify these things and adjust a program accordingly also different cancer populations may require special precautions so for example someone who under went surgery for breast cancer is going to have different considerations to keep in mind than perhaps someone who underwent therapy for prostate cancer and a large number of other examples exist so it's all on an individual basis no two experiences will be the exact same and so with this in mind it is important to keep in touch with your Healthcare team as move forward with starting and and maybe starting new exercise regiments I'd also like to identify several principles that that I like to keep in mind and I like to share with people when they're thinking about how to go about exercise and the first is being specific so what I like people to do is to take note of the physical qualities maybe they're hoping to improve or some of the specific things that they're wanting to accomplish for example if someone is wanting to just be overall more fit able to do things like aerobic activity strength requiring activities or being flexible then a well-rounded program will certainly suffice targeting all of those things if someone for however is looking to specifically improve their strength they're already doing a really good job of aerobic exercise it's not going to be of much benefit to do more aerobic exercise we need to incorporate the things that are going to help us match those specific goals so again training specifically also have to keep in mind that changes are reversible the body does an outstanding job of adapting to Greater stresses that we put on it through exercise that's what accounts for improvements in Fitness but it's equally as good as adapting to less stress or deconditioning is another way to put it so when we do adopt these new changes and we're doing a good job of exercise we have to be sure to keep up those efforts to maintain those benefits we also want to make sure that we're progressing reasonably so otherwise we might find that we're reaching a plateau or we're not quite reaching the potential that we can so there are a number of things that we can do practically to gradually progress you without overdoing it or underdoing it I also encourage people to incorporate a lot of variety into their exercise regimen otherwise you might hear of people getting a little bit bored with their routine maybe they're doing the same thing time after time and they end up getting some sore muscles or joints so for example if someone is on a really nice walking program they're walking nearly every day of the week I would encourage that individual to really focus on flexibility incorporate a couple days of cross training perhaps in a pool or on a bike so that they're not only giving themselves some mental variety or a mental break but also using their body in ways so that they're not going to expose themselves to repetitive injury types of situations so those are just some things to keep in mind again as you're looking to take your program to the next level or start one in general and so with that I'd like to review some specific recommendations for different categories of fitness meaning a or cardiorespiratory training strengthening and flexibility and I'm going to break them down into four different parts four different letters it's called the fit principle fi t t where frequency is the f i is for intensity the first T is for time and the last is for type so for aerobic exercise we encourage patients to do this at least three to five days per week preferably even most to all days of the week certainly giving the opportunity to take a day or two off especially when just starting frequency is a really important part of the big picture for intensity we recommend that people would exercise at moderate to vigorous levels moderate exercise is simply an intensity be it when walking swimming biking whatever it is you're doing it results in your breathing being elevated you're noticing some petin but you could still carry on a conversation in other words you could talk but not sing if you could sing you're probably underdoing it vigorous intensity on the other hand would be exercising at an intensity that is noticeably causing maybe even some shortness of breath there are places for both of these but in general that's what intensity would look like and we'll talk more about this shortly time again in general would be 20 to 60 Minutes we'd recommend some people start with 3 to five 5 minutes a day maybe they're getting started maybe they're very deconditioned or have other limitations 3 to five minutes might be a reasonable starting point just doing that a few times per day other individuals might be very well versed in exercise and could start out doing an hour or more right away again it'll be individualized but in general 20 to 60 Minutes is very reasonable kind of the gold standard for aerobic exercise is to work towards doing at least 150 minutes per week of that moderate intensity vigorous intensity can also be incorporated but I like to say that it should first be approved by your healthc care team the vast majority of individuals cancer survivors included can take part in vigorous exercise such as interval training but there are just a few things that we like to sort out first before instructing people to do this now the type of exercise for again aerobic training mainly focuses on rhythmic movement involving large muscle groups which might be examples that I've already mentioned but also things like the elliptical trainer rowing machine anything really that you enjoy there isn't one that's necessarily better than the other the most important thing is that you enjoy it and that it's well tolerated as far as progressing again a very important part if someone's starting out with say 20 minutes a day I'd encourage them to try adding one to five minutes per session or weak as tolerated so let's say for example I'm doing 20 minutes today it feels like a good challenge I would maybe try anywhere from 21 to 26 minutes the next time building up gradually that again has been a a proven way to implement progression without overdoing it this was a chart that is called the rating of perceived exist exertion scale it's a very important way for individuals to monitor their intensity a ranges from six as you can see here which would be my exertion right now I'm just sitting here reviewing some slides with all of you not exerting at all 20 on the other hand would be extreme exertion to the point where I feel like I'm going to collapse with everyday exercis we don't want to be on either end of that Spectrum again this is a perceived workload that considers everything from my breathing leg fatigue any aches or pains all into one number moderate intensity training would be at 12 to 14 on this scale again I feel like I'm able to converse with someone next to me H but it also feels like a good challenge interval training or vigorous training would be more in that 15 to 17 range where it feels like even after maybe a minute or two you're going to need a bit of a rest because it's such a good challenge now oftentimes with intensity people will ask me about target heart rates what should my target heart rate zone be what would you recommend and in short we don't ever really use target heart rate zones to prescribe exercise unless we have a very recent clinically supervised exercise test the reason being is that's what we would get our Peak heart rate from when you're using exercise equipment maybe at a gym or at home there's often times a nice neat little chart that says if your age is this your target heart rate zone should be this um that comes from estimated information oftentimes an equation like 220 minus your age that gives us this theoretical predicted max heart rate but it's open to a lot of estimation error in other words if you use that it might be right on or it might be causing you to over or undere exert the other thing to consider is that people are on medication sometimes that affect their heart rate a very common one we experience or work with is beta blockers that can decrease heart rate by 10 to 30 beats per minutes so again I I wouldn't necessarily worry about re reaching a target heart rate zone unless there's a very recent stress test available and that would be implemented if your doctor requested it or needed it uh for those who really like to monitor heart rate anyways what I suggest to them is to Simply keep track of what it is during your workouts that way you'll kind of develop a lot of these data points and you'll say well usually when I'm working out my heart rates between this and this that's very valuable also be it moderate intensity or vigorous intensity that's a good way to go about it without being overly maybe obsessed even with keeping it within a certain range so that is for again aerobic exercise here's a look at a couple of individuals doing what looks to be maybe even some interval training and we like to post that scale that I just showed you on all of our exercise equipment so that patients can often refer back to it to make sure they're at the right level how about resistance training this is oftentimes called weightlifting where you're aiming to improve your muscular strength and endurance typically this will be performed two to three days per week and ideally even on non-consecutive days per week so that you allow your muscles to rest in between now some people like to exercise every day when they're doing weightlifting and that's okay but I'd encourage those individuals to alternate muscle groups maybe upper body one day lower the next core the next otherwise if you want to get it all done in one bouts every other day is sufficient the intensity again what we recommend is to fatigue but not failure in other words it feels like a good challenge get kind of a comfortable burn you might be able to kind of associate with that and again you can use that perceived exertion chart to gauge how hard you're working other ways to go about it if you're working with Fitness professionals they might determine a one repetition Max or how much you could lift in one lift and give you some zones based off of that but it doesn't need to be that in depth for most individuals again it should feel like you're reaching a point of fatigue where you don't feel like you have to drop the weight or that you're having to hold your breath nothing like that one way to determine if you're working at this appropriate zon is how many times you could lift the weight it might be your body weight or others but essentially we like patients to be able to lift it at least eight times if you can't do it at least eight times it's probably a little too heavy and you should feel tired by the time you hit at least 12 maybe 15 repetitions if you could do 20 30 40 it's probably a little too light which I mean that's okay but you could just get more work done in a shorter period of time a little bit more efficient with your time in other words and oftentimes people can rest from one to three minutes between exercises that should be adequate so let's say I go through a number of exercises like one for my arms and then my legs and one from my core that would be called one set I did one time through each of those for beginners or people who are hoping to maintain or maybe improve just a bit that's perfectly fine if you get more into it and you really enjoy it want to progress more even two to three sets is fine even more than that for some that can be individualized based off of the person's goals and needs and limitations and so forth four so again between 8 to 12 times you should be able to lift it you want to select exercises that focus on all major muscle groups so again chest back upper body lower body core everything so you're not neglecting any particular area while still respecting any muscle or joint issues that might be in place so that is a summary of resistance training and and when choosing different types of equipment never has to be fancy body weight exercises are great for things like body weight squats calf raises modified push-ups things like that but elastic bands machines hand weights are all great as well whatever you have at your disposal will most often suffice even during the height of the pandemic we did a lot of virtual based consultations and we'd have people use fluid containers such as milk jug or juice jug filled with water and then we determine the weight of that and they could use those if they had nothing else so again it doesn't have to be fancy or expensive here's a look at an individual doing the leg press it simulates squatting so you'll encounter these types of things in clinical Fitness settings or gym settings all kinds of nice things that can usually accommodate all types of ability levels and experience levels and another important type of training to consider is flexibility right being able to move the joints and muscles through a full range of motion this should be done at least two to three days a week preferably all if possible and the stretch should be done only to the point of tension never pain we don't want stretching to hurt and there are number of different types of stretching regimens different ways to go about it often times s and probably even the most common is what's called static stretching where you simply hold the joint in place for an extended period of time without bouncing so it might look like an arm stretch where you're holding your arm across your torso and counting to 15 or timing it that allows you to get the benefit of that stretching exercise if you do it too quickly or if you bounce it might be counterproductive so you want to hold it for an extended period of time and similar to weight training or resistance training you'd want to incorporate stretches that focus on the major muscle groups and Joints again T entire body think of it as and you can also supplement with things like Tai Chi Yoga again you you'll have to approach those on an individualized basis but oftentimes those are really nice ways to incorporate some of these things while adding in some variety as well and also before we discuss a program that we offer uh you might also consider really focusing in on areas that remain tight from perhaps a therapy that you underwent it might be surgery it might be others but oftentimes physical therapists can do a really excellent job also in restoring full range emotion uh so that you're able to participate in things that you're wanting to accomplish and moving forward towards those goals and so generally there are several different groups of cancer survivors one may go to their provider and say you know I'd really like to get back into my exercise regimen I'm very experienced with it I just need the okay and the provider might say that's great start out gradually progresses tolerated they're ready to go another group might also get the okay they CM start out gradually have fun with it let me know if you have questions with the individual might think well you know I'd like to have a little bit of guidance perhaps I'd like a little bit more supervision so I know I'm doing things safe and another group The Physician themselves or provider might say I think you should exercise but I would like you to have some clinical supervision all right for the latter two groups we offer a program that can help fill that need we offer a cardio oncology exercise program here we essentially serve all cancer survivors at any point in the survivorship Spectrum including those going through therapy currently those who are post therapy really again any point in the Spectrum would be considered eligible uh we might do some conversation to see if there are other appropriate Avenues but in general just about anyone can participate the team is comprised of doctors nurses and exercise physiologists all trained in working with cancer survivors and it's comprised of of course clinically supervised exercise it might be one session it might be more uh with that comes along individualized exercise prescriptions again catered towards each unique case very important it also includes some physical and well-being assessments to help us track where patients are at and also track their progress one of the programs we offer is patients can visit with us one time and we'll talk about their cancer history treatments that they underwent or are currently going through any concerns limitations that they have and then provide them with that individualized exercise prescription what we can also do is exercise right on site here allowing you to take part in aerobic exercise strengthening get a feel for what it it looks like practically all right and we also offer an extended program for those who feel like they might get some addition benefit from a longer period of time with us where you can attend even for up to six weeks working with us gradually adding in new features as time goes on we realize that a lot of individuals live out of state or maybe not even within driving distance so we do offer video visits as well those can take place just over over Zoom also it's been pretty popular since the covid pandemic so that's another service and importantly a lot of specialty consultations we work closely with Physical Medicine physical therapists cardio oncology practitioners and other Support Services oncology trained dietitians we work closely with social work so a whole host of individuals this is just one example of programs out there there are many cardio oncology exercise programs throughout the United States and so in summary and I'd like to reinforce that exercise has been deemed safe both during and after treatments currently however only a small percentage of people during treatment exercise and certainly less than ideal even afterwards exercise guidelines remember for cancer survivors are similar to those for the general population we don't want to give cancer survivors the impression that they should avoid exercise because in fact can be very very safe to do so and highly encouraged except to make sure we're approaching it right and taking some considerations and and applying them to each individual's program comprehensive programs including the things we talked about and some other things provide a wide array of preventive and therapeutic benefits but of course we always encourage touching base with your Healthcare team before starting a new regimen so I know it's a lot of information in pretty short period of time we can talk all day about these things but I hope that's helpful with giving some insights into some of the core components of it and I'm certainly looking forward to any questions you have and you starting some discussion here so thank you for your time I appreciate it well thank you Adam for all of that information um lots of good statistics um and research to support what you say um lots of good motivation too just as far as starting where you're at to continue to go and um reaping the benefit whether you're a Survivor or haven't experienced cancer and just want to um know that exercise thwarts cancer just as much as not smoking and some other things that we really know um in general everyday life are good cancer prevention me measures for all of us to take so he Adam said that he would be available for for some question and answer time so if you want to send a question in if you can um send that question through the chat function so one person has asked you need a physician referral to enter the program and is it covered by insurance I think the insurance part probably depends on who your insurer is but you probably can answer better on the physician referral portion of it Adam yeah it's a great question to enroll in our program we do require a physician referral then that individual serves as someone that we can touch base with should any questions come up or we just want to make sure that we're doing things in line with you know the best possible evidence in mind yes and as far as insurance you're exactly right what we find is that a large percentage of our patients do have some coverage we just encourage that patients to reach out to their individual insurance provider to verify that but again most of our patients uh do receive you coverage via one way or another yeah it's good to do that insurance check beforehand because there is a lot of variability there um we have another comment that comes from someone who says I was fortunate to use this Mayo cardio oncology Rehab Center Post chemo I felt so much better and gained stamina and strength I did finally try going off on my own to a local gym but then covid hit and I was stuck working remotely and the local gyms closed any suggestions on how to start over with a good routine um with a local YMCA or other facility someone may have available in their Community I'm I want to know what you say about this too I think we can all benefit from that motivation it's easy to fall off the wagon but how do we get back on well I'm so glad to hear you're able to participate in our program and for first thank you thanks for the the feedback certainly means a lot and glad to hear you're able to continue some of those efforts but it's very common where you know one thing or another will come up and we you know tail off of our program that's it's again very common and nothing to get down on yourself about I often say that kind of the driers ship road is up and down right it's not steadily increasing the whole time there's some hills along the way and so I would say maybe ask yourself how much do I think I could do right now to get started and I would cut that in half and start at that so just starting out conservatively thinking what sounds reasonable and starting well below that just to make sure that it's it's going to be tolerable and that it's going to be you know motivational to start Gra gradually and get back into it and I would use those same principles or maybe adding just one to five minutes you might even consider if you feel you've really become deconditioned do five or 10 minutes two or three times a day if possible and build up from there a lot of programs again are offered YMCA has some great Services cancer survivors will often ask will I be able to receive some help at my local facility and of course it depends but I always encourage people to ask and if they're comfortable sharing because say I have some health history that I want to be sure staff is able and willing to help me with and you can just you know ask if they're familiar with working uh with that type of scenario and if not you might consider another another one but yeah definitely the camaraderie associated with those programs can be fantastic and it's just nice to have a social support system you might also consider if you would like to touch base back with us to even maybe do a video visit but those are some ways to get started if I didn't answer your question as thoroughly as you'd like let me know I'm happy to kind of dig back into it hopefully that's a good start yeah I would also like to just give a plug for people who have a YMCA in their Community to check out a potential Liv strong program that might be there um I know Rochester has offered that I I guess I'm not exactly sure what statuses are with um covid if people are still offering those as they had in the past but um I know we've heard lots of really great comments from people that have participated in Liv strong programs um that are affiliated with YMCA or YWCA that may be in your community I see there are a few um questions also on the chat feature so maybe I'll pull up a few of those there was a question about any advice for dealing with neuropathy in the hands and feet due to chemotherapy yeah that's a great question it's something that we see a lot there are different things to consider usually neuropathy is a is it can vary to the severity of course some people need to use walking devices and so forth having neuropathy doesn't preclude someone from doing walking for exercise but it just brings onto the table extra concern for Falls and so if in a supervised setting I I still encourage people to walk and do those things as tolerated because it's so important for day-to-day living if you're in an area where maybe you don't feel safe or you have to exercise independently you might consider something like a a stationary bike perhaps stationary pedler things that you don't have to worry about Falls oftentimes you find that that's helpful and if people have have lack of sensation in the hands oftentimes machine weights can be beneficial so you don't have to worry about dropping hand weights on your feet or things like that so those are a few recommendations U I hope hope you find that helpful but that very common concern and something that that's usually how we would approach it on the same vein there's a person that asked about considerations for handling neuropathy especially when running um any ideas there yeah it's similar we can see different degrees to which people experience the neuropathy and as most people if not all people with neuropathy can speak to you have to be very careful about Foot Care also to make sure that there aren't any small sores or things going unnoticed that can lead to complications but certainly if you're able to run and you feel like it's well Toler ated the balance is there I wouldn't tell people not to again this is from this isn't a setting where I'm not familiar with the entire health history but if you've been doing it and it's well tolerated it sounds like it's going well you can always touch Bas with your a local provider too just to verify that and any other concerns that go along with it but that's great I'm going to just put a plugin to someone else um put in a reminder that silver sneaker is another program that's associated with YMCAs and that's for um older more mature people but that might be another resource and something to check out it's called silver sneakers at the YMCA so thank you for putting that forward um yeah no it's great some uh comment or question is what are some of the main complaints you might hear from patients when they're beginning exercises and then how do we keep motivation going going to to encourage that to be continued yeah it's a good question sometimes especially when getting started it feels like maybe it's a it's a chore to get into the routine dedicating this time off to the side an already very busy day and it seems like that can persist for maybe a few weeks maybe longer but believe it or not and maybe a lot of you can attest to it there is a transition point where you go from suddenly feeling like wow this is a a chore to maintain it to I don't feel as good now if I don't exercise and so if you can stick with it I think what you'll find is that it just becomes part of your routine and you realize some of those benefits and that can be very motivational but again getting started is oftentimes the hardest part for people that they mention to me and uh also they want to be sure that they're doing it doing it safely so some of the issues that people bring up while I've been told from this person or that person to avoid this uh everyone has family members and loved ones that are having the utmost concern for them and sometimes are maybe overly protective and say I don't think you should do any exercise just yet but just rest assured it's been shown to be very safe to start out gradually and very important to do so in fact so those are a couple things that come up sure well I was going to just interject too that oftentimes I'll share with patients when we talk about this when they come into the education center that I know in my younger years I exercise more for vanity sake right I wanted to look good I wanted to have a toned body um and now that has shifted that my motivator is less on a vanity perspective and is much more for that health benefit so if you even can view it as much like a prescription so if I have a medication that I'm recommended to take or like eating healthy would be another Health Habit to have but to just to put it on that same level of importance as it would be to take my daily medication or to eat my fruits and vegetables to say that um this exercise is is doing the body good whether it's in a small amount or it doesn't have to be an Olympic Training event it just has to be something that we can do to benefit our overall health and a little bit is better than nothing so yeah and I've also found because I can be an exercise resistant person so I think it's uh what has been helpful for me is to have a little bit of a commitment with a a good friend it's not pushing me too much but it's it makes it a little more fun but I have a commitment to meet that person or even if I have a commitment uh with at a gy to meet like an exercise Specialist or somebody there to help me that helps motivate me also those are really good points I've encouraged people to even put it on the calendar make an appointment with themselves people have reported to me that that's very helpful and always keeping that goal in mind what is it that I'm wanting to exercise for we know everyone knows the health benefits but oftentimes it's those things like attending a wedding playing with uh their kids attending this event those are the things that oftentimes can be a little extra nudge to keep people adherent to an exercise regimen you we have a question on thoughts on the use of infrared sauna any thoughts there that's a good question and I I really don't I I think it's it'd be beyond my expertise to comment on them one way or another I think if you have any questions about that just to discuss it with your with your doctors but good question I know that sound as something that comes up a lot nowadays it's more prevalent in literature but I I don't have any comments one way or another to be honest I wish I did sure another question is is there as much benefit to splitting exercise in a day as there is to doing the exercises all at once for example doing one set in the morning and one set in the evening for weight training yeah that's a that's a a good approach I haven't heard before of people kind of splitting it up resistance training a set in the morning and a set in the afternoon but certainly if that's way that you find allows you to sneak it in then then great oftentimes the the benefit of doing just a short rest between sets is that there's already that little bit of fatigue that may perh perhaps help with your uh adaptations to it but as long as you're doing each of those sets to fatigue I think that's a a nice way to incorporate it good job finding ways to sneak it into your day thank thank you and then another good question is what's the best contact info to discuss some options with your program so if someone is interested in trying to set up an appointment what what Avenue do you think that they should take yeah great question there are a few routes that I would recommend if you have care here at the mail clinic at any site I'd recommend that you touch base with your mail provider and ask them about it otherwise the most direct way I'm going to share my screen again briefly is to uh feel free to reach out to me our team directly let me just pull this up please the number that you see listed here will contact you with our program any staff member that answers should have a you know good knowledge of our program and answer any specific questions that you have and you can always ask for me too if you're comfortable just leaving your number I'll give you a call back as soon as possible yeah all right thank you for that offer Adam there's one more question I see here is how to start exercise after being diagnosed with low calcium and Osteo or probably osteopenia I'm guessing yeah another good question with low bone density if maybe referring to osteopenia osteoporosis there couple of different approaches for osteopenia there's the risk of progressing to further bone density Decline and often for that case weightbearing exercise is really recommended to help maintain it walking is a is a good example not so much unweighted exercise such as cycling it doesn't have the same benefit but still beneficial from aerobic perspective but also the resistance training will often be recommended if someone progresses into osteoporosis then there are certain things you want to avoid such as forceful twisting or bending of the spine that can lead to some issues with structural Integrity compression fractures and so forth uh but walking and things like that are are always recommended yeah okay question and here's another one this is a good one any insight on how long a person should warm up before aerobic or strength training exercise and if and if a person needs to cool down to prevent soreness so how should we begin and end that exercise session what would you recommend for that the standard warm-up duration is five minutes five minutes uh sometimes can be an All Out Workout for some the warmup might actually feel like a really tough workout for someone who maybe is very deconditioned so you might even consider a minute or two of even seated marching where while you're sitting in a chair bringing your knees up and down and pumping your arms at the same time otherwise if you're looking for a traditional warmup you might consider walking at a leisurely Pace again even below that moderate intensity where it feels like you're breathing a little heavier it should feel like a window stroll do that for five minutes and that will allow your heart rate your blood pressure and your blood vessels to get acclimated it'll help your nervous system and Joints get ready for the exercise so that's a really good question for some populations even a longer warmup is recommended maybe for those who have coronary artery disease maybe five or even up to 10 minutes might be better to allow yourself to really get your engine ready so to speak for the activity as far as the cool down again about five minutes that's an opportunity to gradually take your yourself out of that exercise intensity to allow your body to get back down to that more resting state and I if you can I'd encourage even some stretching after your cool down we find at least antidotal evidence people report to us a lot that's the stretching after the coold down even will help with some of that soreness
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