Category: General

The Heart Matters – Part 2

By: Brad Hankins

Since the muscle cells of our heart regenerate at a very slow pace — to the point that we may still have up to 50% of those cells from birth — protecting them is extremely important. Improving their strength and function is equally important.

Developing an effective cardio (heart- and lung-specific) exercise routine requires thought and planning. It should fit your schedule and the time you have available, respect where you are starting, and be flexible enough to accommodate changes in your goals and health. At the same time, there needs to be enough physical effort to challenge the heart and lungs on a regular basis.

When it comes to cardio exercise, there is a difference between an activity and an exercise. Cardio exercise increases your heart rate and sustains it over time, while an activity allows the heart rate to rise and fall. For example, dog walking is a wonderful activity; however, it is not typically considered cardio exercise because your dog stops to do dog things, you may stop to talk with a neighbor, and your dog likely has dog friends to visit too. These stops and starts cause your heart rate to rise and fall, taking the exercise load off the heart.

What we want is a cardio practice that increases the heart rate and keeps it elevated. Walking, swimming, biking, and running are all excellent cardio exercises, with the overall goal being to increase endurance and stamina while improving heart, lung, and vascular health.

Cardio exercise can be done indoors or outdoors and is inexpensive to begin. All you need is a pair of comfortable shoes, loose-fitting clothing, and a jacket. The goal is to increase your heart rate to near your target maximum heart rate and sustain it over time. Target maximum heart rate is calculated by subtracting your age from 220 and then multiplying that number by 80%. If you have a chronic health condition, consult your doctor before beginning or increasing any form of cardio exercise.

Your first goal should be to maintain this heart rate for 20 minutes without stopping. If you start with five minutes, that is great. Slowly work your way toward 20 minutes by increasing your exercise time by no more than 10% per session. Three days a week of cardio exercise will meet most goals, especially when combined with another three days of movement or resistance training.

To begin, first pick a type of cardio exercise that interests you. It could be a cycling class, lap swimming, or a walking/running program. Again, most of us already have everything we need to start a cardio exercise program in our closet (yes, it’s time for that headband you wore at Monterey Pop in ’68 to see the light of day again). There is no need for expensive shoes or clothing until you begin putting in the miles.

For indoor cardio, your SSYMCA membership gives you access to stationary bikes, treadmills, and elliptical machines, as well as classes such as studio cycling and water aerobics (some of which may have a slight additional cost).

When beginning a cardio exercise program, start with a two- to three-minute warm-up to bring your heart rate close to your target maximum number, then sustain that heart rate for a preselected amount of time. A good initial goal is 20 minutes of sustained exercise. Again, if you can sustain your target heart rate for only a few minutes at first, that is a great start. Slowly work your way toward 20 minutes in small increments of no more than 10% per session. Once you reach 20 minutes, set your sights on 30 minutes, with an eventual goal of 50 minutes.

You will find that most cardio exercise equipment at your SSYMCA branch has built-in heart rate monitors. Look for the shiny areas on the handles or near the seats. When you place your hands on them, your heart rate will appear on the screen. Please see SSYMCA staff for instructions on how to set up and safely use the cardio equipment.

Begin your cardio exercise gently, then slowly increase intensity as your endurance and stamina improve. Don’t get frustrated — there will be days of struggle and others of steady progress. That is simply the way the process works.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

The Heart Matters – Part 1

By: Brad Hankins

The next few months, we will focus on the cardiovascular system (the heart and blood vessels) and the pulmonary system (the lungs). We’ll explore each system, its function, some common issues associated with it, and what we can do to keep our heart, lungs, and blood vessels healthy. Let’s start with the heart.

The ancient Greeks believed the heart was the center of intellect, emotions, and the soul. The ancient Chinese believed the heart was the seat of intelligence and the mind; to them, the heart ruled the body. In 170 CE, Galen, a curious Greek physician living in Rome, discovered that the heart is a muscle—but one unlike the rest of the body, as its fibers run in multiple directions rather than in a single direction like other muscles. Galen’s work was largely ignored until the 1700s, when it was recognized that the heart is a pump that delivers blood to every cell in the body.

In some ways, both the Greeks and the Chinese were correct. The heart does “rule” the body in that if it stops functioning for just two or three minutes, other body systems begin to die. Interestingly, the heart contains neurons—about 40,000 of them—compared to the brain’s 86 billion. These neurons are thought to have both long- and short-term memory. They allow the heart to function somewhat independently of the brain by helping regulate heart rate and how much blood is pumped. At the same time, the heart works closely with the brain through a specialized network of nerves, with about 80% of signals traveling from the heart to the brain—not the other way around. In this sense, the Greeks and Chinese may have been onto something: the heart does have a small “mind” of its own.

The heart functions as a pump (https://my.clevelandclinic.org/health/body/21704-heart) with three main systems, much like the pump that supplies water to your home. It has a mechanical system of valves and chambers that control pressure and output, an electrical system that energizes the mechanical system in sequence, and a built-in plumbing system that meets its own internal needs. All three systems work together, in a precise order, to ensure oxygenated blood reaches every cell in your body.

The cells of the heart, called cardiomyocytes, are highly specialized muscle cells. They contain more mitochondria (the cell’s “power plants”) than most other cells and consume a tremendous amount of energy. Perhaps the most fascinating aspect of these cells is that many of them are as old as you are. You were born with about 50 to 60 percent of the heart cells you have today—possibly more. While your body regenerates red blood cells every four months and liver cells every six months to a year, your heart does not fully regenerate over your lifetime.

Another way to think about this: have you ever heard of heart cancer? While primary heart cancer does exist, and metastatic cancer (which spreads from elsewhere in the body) can reach the heart, both are extremely rare. Why? Because cancer, simply put, is a disruption of cellular regeneration—and most heart cells rarely, if ever, regenerate.

Even if you are in your 70s or 80s, some of your heart cells have been beating since the day you were born. Up to half of your current heart cells have been beating 60 to 70 times per minute through kindergarten, high school PE, college exams, and decades of work.

These lifelong cells pump up to a gallon and a half of blood per minute, about 100 gallons per hour, and roughly 51 million gallons (about 1 million barrels) over the course of your life. Day and night, every day of your life, without any conscious effort, your heart is always at work.

It goes without saying: you want to do everything you can to keep your heart healthy. Since many heart cells stay with you for life and may not regenerate if damaged, it’s important to care for them and avoid injury whenever possible.

Fortunately, the heart—like all muscles—benefits from regular exercise. Physical activity, combined with a balanced diet, forms the foundation of heart health. Next month, we’ll explore cardiovascular exercise and strategies for maintaining a healthy heart throughout life.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

Hips – Part 2

By: Brad Hankins

Previously, we looked at hips, some possible hip injuries, as well as how to strengthen the hip and its surrounding muscles. This month, we will explore the various ways hips can be repaired and replaced, as well as what can be done both before and after hip surgery to shorten recovery time.

The members I am currently training are between 64 and 84 (except one youngster who is 51), and over half of them have had hip or knee replacements—and in two cases, both hip and knee replacements. Several others receive routine hip injections, and others are contemplating hip interventions in the near future. Unfortunately, hip issues are common as we age, with conditions ranging from being occasionally problematic to causing some degree of immobility. Let’s look at the various hip interventions and surgeries, and what can be done to improve the results.

I suggest considering prehabilitation for any planned orthopedic surgery. Prehabilitation involves exercise and dietary changes (within individual limits) that help improve surgical outcomes. First, consult your general healthcare provider and orthopedic surgeon for appropriate medical clearance and exercise and diet recommendations. Then, with those in hand, you can work with a SSYMCA Personal Trainer to help increase overall strength and stamina while strengthening the muscles surrounding the surgical joint. Decreasing body weight is another important part of prehabilitation, which will help with immediate post-operative recovery as well as long-term physical therapy and rehabilitation.

Non-surgical hip interventions can help decrease pain, improve joint stability, and enhance mobility. These approaches generally focus on strengthening the glutes, hips, and core muscles. Consult your general healthcare provider for appropriate exercises or a referral to a physical therapist. A SSYMCA Personal Trainer can also help you develop a hip-friendly exercise plan in line with your doctor’s recommendations.

Hip injections are usually the first intervention for escalating hip pain. Using ultrasound or X-ray guidance, a steroid and local anesthetic are injected directly into the hip joint. The procedure is often done in-clinic and typically takes 15 to 20 minutes. Ice and rest for 24–48 hours after the procedure are usually recommended. Results vary, but many people experience relief for several weeks to several months, which can allow them to defer surgery. Hip injections are often limited to two to three times per year, as steroids can weaken surrounding tissue.

Hip arthroscopy (https://my.clevelandclinic.org/health/treatments/22195-hip-arthroscopy) is a common, less invasive surgical procedure that uses scopes and small instruments to address hip alignment, repair labral (the cartilage surrounding the hip joint) tears, remove bone chips, and repair tendon injuries. Hip arthroscopy is performed in an outpatient surgical setting, with patients usually going home the same day. Rest and physical therapy typically follow.

Total hip replacement (https://my.clevelandclinic.org/health/treatments/17102-hip-replacement) involves the removal and replacement of the hip joint. These surgeries are now often done with patients going home the same day or occasionally requiring an overnight stay. Initial recovery is followed by several weeks of physical therapy as you regain strength and confidence. After being released from physical therapy, you can take your exercise list and meet with a SSYMCA Personal Trainer to discuss how best to continue your recovery.

I continue to be amazed at the short recovery times of members who have had hip surgeries, including total joint replacements. The common path includes staying committed to your recovery plan, becoming more active as your recovery allows, and incorporating overall exercise into your daily routine.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

Hips – Part 1

By: Brad Hankins

The past two months, we explored knees. This month, we will move up the body a bit and look at hips. Hips (https://my.clevelandclinic.org/health/body/24675-hip-joint) are ball-and-socket joints (as opposed to the knee’s hinge joints) that allow the bone of the upper leg (the femur) to move in multiple directions. These multi-directional movements allow each leg to bend, squat, push, and pull independently of the other leg. The hip muscles are the body’s largest, with the glutes (the three muscles of your buttocks), quadriceps in the front of your thighs, and hamstrings in the back of your thighs, along with numerous accessory muscles powering these complex movements.

As we age, many hip issues involve—or often begin with—the continuing loss of hip strength and flexibility. These losses can make us susceptible to muscle strain, tendon and ligament tears, worsening osteoarthritis, fractures, and even low back issues. In my opinion, the best prevention of major hip issues is building strength and flexibility in the muscles surrounding and powering the hips.

The single most common hip issue is osteoarthritis (OA). There are other types of arthritis that can affect the hip joint, with OA (usually caused by decades of wear and tear or joint trauma) typically affecting individuals over the age of 60 and a disproportionate number of women. The pain and decreased joint function often lead to disability and are the primary reasons for total hip replacement.

Osteoporosis is another common cause of hip issues. Osteoporosis is the weakening of bone, making it susceptible to fracture and/or misalignment. Unfortunately, osteoporosis itself usually does not cause symptoms. If you are over the age of 50 or have a family history of osteoporosis, please talk with your medical provider about bone density testing.

Hip trauma, including hip dislocations, is often caused by high-energy accidents such as falls and car crashes, though sports injuries, as well as slips and trips, can also be contributors. Hip dislocations can sometimes be reduced in emergency rooms, while in other cases, a trip to the operating room is necessary. Hip dislocations can reoccur if the muscles around the hip are not strengthened.

Hip fractures (https://my.clevelandclinic.org/health/diseases/17101-hip-fracture) involve the bone in your upper leg, the femur. The femur is the longest and strongest bone in the body; when it fractures, the narrowest part (the surgical neck) is typically the fracture point. The surgical neck is where the femur bends nearly 90 degrees and connects to the pelvis. Hip fractures are true medical emergencies and usually require some type of surgery, ranging from pinning (using small-diameter steel pins to hold the bone together as it heals) to total hip replacement. Next month, we will review the various types of surgical and non-surgical hip repairs.

Rehabilitating hip injuries, or reducing the worsening of them, is not only important but, if not done correctly, can make things worse instead of better. First, consult your medical provider and/or orthopedic provider for a list of exercises that would be helpful for you specifically. If you are currently in physical therapy, be sure to ask for a list of exercises you can do once you are released from care. Next, with your exercise list(s) in hand, meet with a SSYMCA Personal Trainer to see how these exercises can be incorporated into your overall exercise plan.

If you have healthy hips and want to decrease the risk of future injury, there are a myriad of exercises to consider. The focus should be on exercising all the muscles of the leg and hip. Leg machines, including leg extensions, leg curls, and leg presses, are all great. Hip machines are a must, as well as step-ups, lunges, hip thrusts, and leg crosses. Also, don’t forget the muscles of the lower leg—the calf muscles and the much smaller pretibial muscles in the front of the lower leg.

Squats are a very effective—but high-risk—leg and glute exercise that is not for everyone. A healthy and strong lower back and extremely strong core muscles are mandatory prerequisites to prevent injury. Strict form and 100% mental focus are not optional when squatting. Before adding squats to your exercise plan, please consult a SSYMCA Personal Trainer to help with developing a squat plan, weight selection, form, and mental awareness.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

Brad Hankins RN, CPT

Knees – Part 2

By: Brad Hankins

This month we are taking a further look at knees https://my.clevelandclinic.org/health/body/24777-knee-joint and the various interventional and surgical options available when knees become so worn that they negatively impact our day-to-day lives.  We will also explore what we can do to prepare for knee procedures and surgery.

The most common knee procedure is arthroscopy or knee scoping https://my.clevelandclinic.org/health/treatments/17153-knee-arthroscopy .  Knee scopes are typically done as day surgery and can be performed under a variety of anesthesia to include general anesthesia and spinal blocks as well as local anesthetic to help numb the surgical area.  Soft tissue injuries such a meniscus tears, torn tendons (ACL and MCL tears), bursitis and even minor fractures are some of the knee conditions that are routinely repaired with knee scopes.   The procedure itself involves several small incisions made in the knee so a camera (not the camera itself, an extremely small diameter lens at the end of a thin tube) and instruments can be inserted into the knee compartments.  Typically physical therapy follows knee scopes with most people returning to normal activity in weeks to months.

A relatively new surgical procedure is partial knee replacement or knee compartment replacement https://my.clevelandclinic.org/health/treatments/14599–partial-knee-replacement . In these procedures one of the three knee compartments is replaced leaving the others intact.  The knee has three compartments the medial (inside), lateral (outside) and patellofemoral (under the kneecap).  Though not as common as total knee replacement due to arthritis often affecting all three compartments simultaneously, there are still almost one million partial knee replacements per year.  People who have compartment replacements can eventually need total knee replacement, but total replacement can be delayed for several years.  This procedure is typically done as a day surgery with people recovering in six weeks to several months.

Total knee replacement https://my.clevelandclinic.org/health/treatments/8512-knee-replacement is a common surgical procedure that can be done as a day surgery with the procedure itself typically lasting one to two hours. The knee joint is replaced with a prosthetic made of titanium and plastic composites that is extremely durable with most lasting 15 to 20 years and 80-90% of current replacements often remain functional for more than 20 years.   Recovery can take months to a year depending on the age, overall health, activity level and, in my opinion, the presurgical preparedness of the patient.

Other options to increase the milage of worn knees include Platelet Rich Plasma Therapy (PRP) https://my.clevelandclinic.org/health/treatments/platelet-rich-plasma-prp-injection .  Platelet Rich Plasma Therapy is a process where components of your own blood are injected into the knee to decrease inflammation and stimulate growth of new tissue.  Please talk with your medical provider to explore PRP and other non-surgical options.

Preparing for any knee procedure is a vital step in ensuring a good result and quick recovery.  Often post procedure rehabilitation is prescribed after knee interventions but, again in my opinion, just as critical is prehabilitation before knee procedures.  What can be done before knee procedures to ensure the best outcome:

• First and foremost, lose weight. This seems counterintuitive as knee problems often lead to inactivity which leads to weight gain.  This is why prehabilitation should begin as soon, or preferably well before, the procedure is scheduled.  With help (please visit a SSSYMCA Personal Trainer) activity levels and exercise can be adapted to fit knee limitations.  Adaptive exercise combined with sustainable dietary changes can result in appreciable presurgical weight loss.
• Improve overall strength and stamina with a focus on core and leg muscles. Leg and glute muscles can strengthen, even if a (or both) knee restrict range of motion. Isometric exercises, the use of recumbent bikes and rowing machines are just some of the adaptive approaches.
• Improve your balance by using chairs and balance balls if your knee will not allow you to fully bear standing weight.   Standing balance exercises can be performed using the non-operative leg which will in turn improve overall balance.   Again, please visit with a SSYMCA Personal Trainer to help get started.
• In the days close to your procedure:

1. Schedule a dental exam and tooth cleaning to decrease the chance of bacteria entering your blood system.
2. Ensure you are well hydrated beginning 48 hours before your procedure and follow your medical providers instructions to stop drinking fluids before your procedure – usually 12 hours before your procedure start time.
3. Schedule a rest day, or two, immediately before your procedure.
4. Take your medications as prescribed and follow your medical providers pre-procedure medication orders.

As always I would enjoy hearing your fitness journey, please feel free to email me at hankinsb@ssymca.net

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT