SELF CARE FOR THE MASSAGE THERAPIST - AAIMT :: … · SELF CARE FOR THE MASSAGE THERAPIST ... should have a slight forward curve in the cervical area, ... We use these for antigravity

AAIMT© 1 Revised: November 3, 2011

Self Care Document

Self Care for the Massage Therapist


Self Care Document

1. BACK BASICS ................................................................................................................................... 3

Assignment 1 ....................................................................................................................................... 5

2. STEPS TO KEEP FEET HEALTHY ................................................................................................... 5

Assignment 2 ....................................................................................................................................... 7

3. LIVING WITH ARTHRITIS ............................................................................................................... 7

Assignment 3 ....................................................................................................................................... 9

4. FLEXIBILITY ..................................................................................................................................... 9

Assignment 4 ......................................................................................................................................11

5. STRENGTH TRAINING FOR THE AGING ......................................................................................11

Assignment 5 ......................................................................................................................................13

6. THE IMPORTANCE OF SLEEP ........................................................................................................13

Assignment 6 ......................................................................................................................................15

7. MEDITATION AND BIOFEEDBACK – THE RELAXATION RESPONSE .....................................15

Assignment 7 ......................................................................................................................................17

8. STRESS ..............................................................................................................................................17

Assignment 8 ......................................................................................................................................19

9. DIET AND HEART DISEASE ...........................................................................................................19

Assignment 9 ......................................................................................................................................21

10. PREVENT HYPERTENSION ..........................................................................................................22

Assignment 10 ....................................................................................................................................24

11. THE MIND AND IMMUNITY .........................................................................................................24

Assignment 11 ....................................................................................................................................26

12. VIRUSES AND PREVENTION .......................................................................................................26

Assignment 12 ....................................................................................................................................29

13. ALCOHOL – USE/ABUSE ..............................................................................................................29

Assignment 13 ....................................................................................................................................31

14. METABOLISM AND WEIGHT CONTROL ....................................................................................31

Assignment 14 ....................................................................................................................................33

15. SELF CORRECTION EXERCISE TO REGAIN BALANCE IN THE SHOULDER GIRDLE .........34

Methods for Correcting Upper Quarter Strain Patterns – Article by Robert K. King ...............................35

Assignment 15 ....................................................................................................................................43

16. STRETCHES FOR THE MASSAGE THERAPIST TO USE FOR SELF CARE ..............................43

Feel the Stretch – Article by Joe Muscolino ............................................................................................44

Assignment 16 ....................................................................................................................................53


Self Care Document

SELF CARE FOR THE MASSAGE THERAPIST

Caring for One’s Self – The Basics: Taken from Essays on Wellness by Barbara A. Brehm

1. BACK BASICS Statistics show that 8 of 10 people in North America experience back pain at some time in their lives.

Good back care includes developing and practicing good posture and body mechanics, maintaining

adequate strength and flexibility of postural muscles.

The primary opponent for good posture is gravity. It is always there as we do anything. Our neck

muscles, as an example, must be able to lift and balance a 10 to 12 pound head. Good posture happens

when our muscles maintain our skeleton in the best possible balance, keeping most stress off of our joints.

A joint should hold our weight, but in an ideal position, not a position that is off balance.

Good posture in general is maintaining the normal shape of the spine when we do anything. The spine

should have a slight forward curve in the cervical area, a backward curve in the upper thoracic area, and

another forward curve in the lumbar area. The sacrum should provide a fourth curve. If these curves are

either exaggerated or removed, injury is more likely to occur.

When standing the center of the head, shoulders and hips should fall in a line when viewed from the side.

Mostly it is rounded shoulders that are the most common posture problem. This gives us a chin that juts

forward making the abdomen protrude. Then we end up with an exaggerated lower back curve. Usually

all of these occur together after time.

When sitting the back should have the same curves as when standing. Slouching puts pressure on the

lower back that is 10 to 15 times greater than that placed on the joints when you are lying down. Use

chairs that support the curve in the lower back or add a small cushion there. This cushion could also be

used as support when driving if necessary.

To prevent rounded shoulders when working at a computer or desk, put the work at eye level with some

sort of support so that a forward head is not necessary. If work requires several hours of sitting daily, it

will be important to develop good posture habits.

Always use legs to lift heavy objects, even children. Bend the knees to do the work while keeping the

back long – never lift with a rounded back. When pushing or pulling a heavy object, bend the knees,

tighten the abdominal muscles. This will help to maintain correct spinal alignment. Carry objects close

to the body and keep the back straight.

Our posture habits from life have accumulated with the years. Those with sedentary occupations can

prevent many back problems if they were to develop work stations that promote good alignment, practice

habitual good posture and body mechanics, and maintain exercise programs to prevent physical

debilitation from inactivity.


Self Care Document

Some occupations demand unusual physical stress. Dentists and hygienists, for example, may have to sit

or stand in twisted, rounded back positions all day. Nurses, chiropractors, and physical therapists do a lot

of lifting and must work in awkward positions. Musicians will often have injuries related to long hours of

practicing in awkward positions; consider a violinist, for instance.

Extra weight in the abdominal area puts a strain on the lower back. Both pregnancy and paunches can be

a source of back problems. Also the aging process takes its toll on posture. Bone mineral is lost from the

vertebrae. Intervertebral discs “dry out.” There will be a loss of height and more rounded thoracic curve

(hyperkyphosis) occurring. This will then lead to muscle tightness and stiffness along with pain while the

body adjusts to an unnatural alignment. Maintaining healthy bones is essential for a healthy back as we

age.

Research shows that about 80% of those who go to a doctor with back complaints have no underlying

organic disease. Back care experts have noted that they are usually deficient in the strength and flexibility

of key postural muscles. These include the following:

Abdominal muscles: weak abdominal muscles allow the pelvis to tilt forward and create an

exaggerated lumbar curve (hyper lordosis).

Back muscles: the long extensor back muscles must be strong and flexible, so both strengthening

and stretching exercises are important. Upper back muscles include the shoulder and neck as well.

Leg muscles: the quadriceps in the front of the thigh along with the hamstrings in the back of the

thigh are important for a balanced posture. Inflexibility in these groups can pull the pelvis out of

alignment – usually into an anterior tilt due to the quads being much larger and stronger than the

hamstrings. We use these for antigravity support when standing, standing up from a sitting

position, and when lifting.


Self Care Document

Assignment 1

Now go to Moodle and answer the following questions.

1. What is our primary opponent for maintaining good posture?

2. How many natural curves are in the spinal column?

3. When sitting, how is abnormal pressure placed on the natural curves of the back?

4. Research has shown that 80% of patients with back pain have no underlying organic disease. What is the issue for them?

5. Which muscles is it necessary to stretch and strengthen to be able to sit all day without hurting?

2. STEPS TO KEEP FEET HEALTHY The foot is a thing to be marveled. Each has 26 bones, around 20 muscles/tendons, 33 joints and more

than 120 ligaments holding it together. This makes the foot an extremely flexible, supportive and

functional thing.

Most people don’t think of their feet unless they hurt. Even then, feet are still mistreated by wearing

shoes that are too tight while walking on concrete for long shopping trips, etc. Holding on to excess body

weight also puts additional stress on our feet.

Most foot problems are preventable. The first step to happy feet is an understanding of their structure and

function and how to use good footwear to support them properly.

Every step we take, the heel hits the ground first as the foot goes into slight supination. Next, the foot

begins to supinate as it rolls to the balls (the metatarsal heads and the metatarsalphalangeal joints). The

arch slightly flattens to absorb the weight of the body and then begins to pronate slightly as the foot “toes

off” while the other foot touches the ground. The great toe is for balance and the lateral four toes are to

give the foot resiliency. The two outer metatarsals move to accommodate an uneven surface while the

other three remain rigid to support.

The most common cause of foot issues is poorly fitting shoes. Wearing shoes that do not fit properly or

give support will interfere with the foot’s natural structure and function. Wearing high heels is a prime

example: 80% of those suffering from foot problems are women. While high heels may be “stylish,”

they were never intended for walking. When walking in high heels, the arches do not absorb the weight

of the body. Instead, all the weight falls onto the distal metatarsals and phalanges. This is unnatural

stress and can injure the soft tissue structures, joints and bones.

Sensible shoes are the way to go as they are designed to prevent many foot issues and are especially

important for walking. Often these days we see many men and women wearing good walking shoes as

part of their working attire – at least on the way to and from work.

A good shoe has a strong and flexible sole while made of material that provides a good gripping surface.

Cushioned insoles to support the arches protect from hard surfaces while allowing weight distribution to

be broader.


Self Care Document

Most people decide upon a shoe by its look rather than by how it feels and whether or not it is supportive.

A high-quality shoe is only worth buying if it fits properly. It would be better to purchase a lesser quality

shoe that fits – remember: “If the shoe fits, buy it.”

Feet are larger in the late afternoon due to fluids, use, etc. It is best to try on shoes at that time. Also, one

foot is probably larger than the other. Be sure to buy shoes to fit the larger foot. When trying on shoes,

they should feel comfortable right then and there. Don’t buy shoes that feel too tight thinking that they

will stretch out. The heel should fit snugly and the instep should not gape open. The toe box needs to be

wide enough to wiggle all of your toes, and the shoe should be as wide as your forefoot.

Many people it is alright to shove their feet into too narrow shoes, maybe thinking that this is part of the

support shoes offer. Unless you have problems with your feet, your arches give good support and shoes

are to support this function.

If you have problems with foot structure that does not allow normal movement (hyperpronation or

hypersupination), it would be best to have orthotics made for you. A custom built orthotics will change

the way your foot works.

People who place extra demands on feet should buy foot wear accordingly. When participating in a

particular sport, a well-fitting shoe to accommodate the extra demands placed upon feet should be worn.

Running or jogging places two to three times the body weight on the feet with each step taken. Running

shoes are designed to give feet extra cushioning for shock absorption, especially in the heel. Padding on

the inside of the heel helps to protect the Achilles tendon.

Walking shoes also provide support and shock absorption, but are built to accommodate the rolling

motion of the foot, rather than a pounding impact. Heel cushioning, arch support and flexible soles are

important.

Some activities, such as aerobic dance, require a repeated up – down motion. Aerobics shoes should have

good overall support and adequate cushioning. Aerobic dance also requires frequent changes in direction,

as do racquet sports and basketball. Shoes for all these activities should have good overall support to

resist twisting of the foot and ankle. Running shoes are especially dangerous for activities requiring

lateral movement due to their design.

As good shoes tend to be expensive, we often wear them longer than we should. Usually the first thing to

go in a sports shoe is its shock absorbing ability, so the shoe may still look fine, but not be performing an

important function. Running shoes usually need to be replaced after about 400 to 500 miles. Aerobic and

court shoes should be replaced after about 50 to 75 hours of use.

If the soles of your feet hurt, it is wise to only use shoes with extremely good arch supports or use custom

orthotics in shoes always! Also, get yourself a footsie roller to use each night for about 10 minutes each

foot. Then you will use a plastic water bottle filled 2/3 with water and frozen on its side to roll your foot

on for another 15 to 20 minutes. Be sure to place your feet into your supported shoes or “Birkenstock”

like sandals first thing in the morning. Do not get up from bed and walk barefoot ever again. When the

plantar fascia is inflamed or tight (as in plantar fasciitis), you will tear it if you walk barefoot first thing in


Self Care Document

the morning as your foot has been resting in plantar flexion all night long and the fascia has shortened.

You need your feet to be pain free to work as a massage therapist.

Assignment 2


1. How many bones are in each foot?

2. TRUE/FALSE: There are more than 100 ligaments in each foot.

3. What is the most common cause of foot problems?

4. What type of shoe is always considered ill-fitting?

5. If a person is a hyper-pronator, what device should they consider having made?

6. If a person has plantar fasciitis, how might they treat their own feet? Please detail the information.

3. LIVING WITH ARTHRITIS Wellness is not just for those who are already healthy. It is also for those with chronic conditions and

disabilities. Limitation is a fact of life and something each of us learns to live with at some level.

Limitation makes it more important to live in a way that maximizes our potential for health and quality of

life. The limitations imposed by arthritis provide an excellent illustration of this point.

There are many, many types of arthritis. Some estimate that there are over 100 types. Arthritis affects

one in seven people in the U.S. Mostly the causes of arthritis are not known. The symptoms vary in

severity from day to day and even within a given day. Those with arthritis often experience periods of

remission. Since no cures are available, the best way to live with it must be figured out. Education and

self-care are the basis of treatment for arthritis.

Self-care does not mean a person has to “go it alone.” Rather, self-care means knowing when to get

professional help and working with health care professionals to understand the nature of arthritis and

treatment methods. The earlier the arthritis diagnosis, the better, since although there is no cure, medical

and life-style treatment can still significantly reduce or delay its progression. The goal of arthritis medical

care is to relieve pain, reduce inflammation, and prevent deformity.

Self-care means following the recommendations of health-care professionals and adapting one’s life-style

to one’s physical limitations. The life-style modifications required by those with arthritis vary with the

severity of the condition. Many with arthritis continue to lead very active lives. A good example of this

is Billie Jean King, the tennis player. She maintained a successful career as a professional player even

though she had five bouts of knee surgery due to osteoarthritis.

For those with more severe arthritis, coping with such simple tasks as preparing a meal or cleaning the

house can be a challenge. Some problems have simple solutions, like moving dishes to lower cupboards,

using an electric can opener, and eating out more often. Relocating items and rearranging rooms can


Self Care Document

improve the comfort and safety of the home. Those confined to a wheelchair will need to make more

elaborate changes in their home environment. Self-care means managing one’s resources in order to

maximize the quality of life.

Often physical therapists play an important role in arthritis treatment. They educate the arthritis patient

about various pain-relief techniques and therapeutic exercise programs.

Pain relief techniques include hot and/or cold treatments, joint protection, and rest. Hot treatments

include hot baths and showers, hot packs, heat lamps, electric heating pads and mitts, and paraffin wax.

Cold treatments include ice packs and compresses. Both can help decrease pain and improve joint

mobility. Joint protection includes education about joint-sparing body mechanics. An example of that

would be pushing open a door using the side of the body rather than a hand if the person has arthritis in

the wrist. Joint protection also includes use of orthopedic devices such as splints, walkers, and canes to

reduce joint stress.

Rest is an important component of arthritis self-care. Prescribed rest may include complete bed rest, or

periodic resting of affected joints, and/or stress management relaxation techniques. Emotional rest

includes participation in social groups and recreation. Arthritis can be a challenge to quality of life, and

living with it requires a good attitude that can transform a potential invalid into an active person.

Being overweight is a risk factor for the development of arthritis, and extra weight increases the stress on

arthritic joints. Ten extra pounds on the torso translate into 40 extra pounds of force on the knee when

standing, for example. Weight control achieved through a well-balanced diet and a moderate exercise

program can significantly slow the development of arthritis. Good nutrition is also important for

maintaining general good health and well-being.

For years medial scientists believed that osteoarthritis and other forms were the result of wear and tear on

joints and that exercise accelerated joint degeneration. Studies have shown that exercise does not appear

to cause arthritis in healthy joints. Repetitive, high-impact movements such as running can speed the

progression of arthritis in already damaged joints, however. Unfortunately, because of the confusion that

has surrounded the arthritis vs. exercise issue, many people with arthritis have avoided all but the very

mildest forms of exercise. Many people with less severe arthritis have unnecessarily restricted aerobic

activity for fear it would worsen the disease. A lack of physical activity actually accelerates joint

degeneration and worsens arthritis symptoms. A sedentary life style leads to loss of muscle strength and

low fitness levels, which make movement even more painful and difficult, leading to further restrictions

in activity and an even greater decline in fitness. When muscles and joint atrophy, the resulting weakness

makes joints even more unstable. Recent studies have demonstrated that aerobic activities, especially

those that support body weight such as cycling and swimming, can be appropriate for people with

osteoarthritis and rheumatoid arthritis if they have good joint mobility. They can increase aerobic

capacity, muscle strength, and functional status. They can improve pain tolerance, mood and quality of

life as well.

Physical therapists help educate arthritis patients about therapeutic exercises for the maintenance of joint

function. These typically include range-of-motion exercises to increase joint mobility and resistance

exercises to increase the strength of muscles, tendons, ligaments, and other tissues that are part of the joint


Self Care Document

structure. Many PT’s recommend exercises performed with elastic tubes to give resistance. Flexibility

and strength help protect joints from stress.

Arthritis self-care means learning to balance exercise and rest. Too much exercise can lead to pain and

inflammation, while too much rest can cause joint stiffness. Exercise must often be done in small

amounts several times during the day if arthritis is severe. If pain persists for an hour or more after

exercise, the person has most likely overdone it and must reduce activity to a lower level and build up

slowly.

Assignment 3


1. Who is a wellness life-style for?

2. How many kinds of arthritis is there?

3. TRUE/FALSE: Self-care means following the recommendations of health-care professionals and adapting one’s lifestyle to one’s physical limitations.

4. Are hot and/or cold treatments included as pain relief techniques?

5. TRUE/FALSE: Being overweight is not a risk factor for the development of arthritis nor does extra weight increase stress on arthritic joints.

4. FLEXIBILITY At this point in time, scientists have come to understand the physiology of muscle tissue. Along with that,

effective methods for increasing flexibility have been devised. It used to be that during a physical

education class in school, we were taught to do what is known as ballistic stretching. This is when the

stretch position is assumed and then bounced into to force the muscle to stretch. We now know that this

is injuring muscle tissue far more that it is stretching it.

Flexibility refers to a joint’s range of motion (ROM). ROM is the maximum ability to move the bones of

a joint through an arc. For example, if an injured knee can go from a 50º angle fully flexed to a 120º

angle fully extended, the knee’s ROM is 70º. To measure improved joint mobility, we use the increase in

its ROM.

Good athletes know the importance of flexibility. Some sports like dance, gymnastics, figure skating, and

diving require a great degree of flexibility. Most sports require stretching exercises as a portion of the

workout to increase or maintain flexibility. Flexibility improves performance and prevents injury.

Runners, for example, use stretching to prevent muscle tightness in lower backs and to improve stride

length and overall running form.

Some degree of flexibility is a necessity for everyone to be able to perform daily tasks. Limitation in the

shoulder can make it difficult to pull a shirt on over the head, for instance. As we age, muscles tend to

shorten, especially if we do not stretch regularly. Shorter muscles decrease a joint’s ROM. This may be

part of the reason age is associated with stiff joints.


Self Care Document

The first step to increasing flexibility is to relax. Try not to become rigid if a stretch is uncomfortable.

Take it a bit easier – ease into the stretch while relaxing the mind.

When a muscle is stretched too fast or too far, the muscle spindle senses the stretch is too much and sends

a message to the muscle tissue to contract. This is called the stretch reflex. So, when we perform a

stretch, we must do so in a way that does not alarm the muscle spindles.

One way to do this is a static stretch in a slow and gentle way. The person takes a certain muscle or

muscle group into a full stretch and holds it for 20 to 30 seconds while relaxing into it. As it loosens, the

person takes it into more stretch during the holding time.

When holding a muscle in a stretch position for 10 seconds or more, you can feel the muscle relax more

and more, giving a greater increase in flexibility. This response is known as the inverse stretch reflex.

The sensory organs in tendons respond to increases in tension by telling the muscle to relax to prevent

injury.

A massage therapist can take advantage of our understanding of muscle physiology and apply special

stretching techniques called proprioceptive neuromuscular facilitation – PNF.

With PNF stretching, we use the contract/relax method. The goal here is to activate the inverse stretch

reflex by contracting the muscle to be stretched first while holding the contraction for about 5 to 6

seconds against resistance. Next the client relaxes and the muscle is taken into a full stretch. Usually the

muscle will stretch quite a bit at this point.

There is another type of PNF stretching called reciprocal inhibition. It too is a contract/relax type of

technique. This time the muscle or group that opposes the muscle needing to stretch is contracted. As we

know, when one muscle or group contracts, its opposing muscle or group must relax in response. After

holding the contraction in the opposing muscle for about 5 to 6 seconds, take the opposing muscle into a

stretch.

As a therapist you will have to try various methods of stretching for each client to see which variety that

person responds to best. When applying PNF the therapist must work in a very gentle manner to be sure

not to injure the client by taking the stretch too far.

When a relaxed muscle is physically stretched, its ability to elongate is limited by connective tissue

structures like fascia. Collagenous tissue stretches best when slow, gentle force is applied at elevated

tissue temperatures. An external source of heat such as a hot pack or an electric Thermophore moist

heating pad can be used. Mostly though, aerobic exercise is a more effective way to raise the muscle

temperature. It is always important to warm up prior to stretching. Stretching a cold muscle is counter

productive and may create an injury.


Self Care Document

Assignment 4


1. Which is the best way to stretch?

A. Using ballistic movements

B. Slowly and gently C. With a partner

2. TRUE/FALSE: Flexibility refers to a joint’s range of motion (ROM).

3. What is considered the first step to increasing flexibility?

A. Mind over matter

B. Relax

C. Take it a little farther than what is comfortable

4. Is it best to stretch muscles when they are cold or warmed?

5. What is the mechanism called that keeps you from injuring muscle tissue during a stretch?

5. STRENGTH TRAINING FOR THE AGING Strength training and body building are two different things, often people confuse the two. Everyone can

benefit from a well-structured strength training program.

Weight training is a form of resistance training, which means any kind of exercise in which the muscles

exert force against a resistance. Weight training uses weight machines and free weights to apply

resistance. Resistance can also be applied by using rubber tubes, another person, or even water. Often

treading water or swimming can be the best form of exercise. One big advantage of weight training is that

resistance can be applied in a measured, progressive fashion. After your strength increases enough to lift

three blocks of weight easily, you add another block.

The most well known benefit of weight training is an increase in muscle strength along with that toned

look. The benefits go further to help decrease the effects of aging. Many orthopedic issues are the result

of a person being weak and inflexible. Often these conditions are said to be the normal aging process.

This loss of physical function is actually due to inactivity and a decline in physical fitness, not to aging.

Another benefit of weight training is that other connective tissue structures like tendons and ligaments

also increase in strength. Weight training also seems to increase bone strength and may help maximize

deposition of bone mineral in young adults and prevent, or slow, its loss later in life.

Those wanting to lose weight are often told to do aerobic exercise due to it burning more calories than

weight training. Aerobic exercise requires a greater expenditure of energy per minute, while weight

training will help supplement that exercise. Weight training may help prevent injuries, especially for

those who have a low level of fitness. Often injuries occur when someone begins an exercise routine.

This is due to pushing a non-conditioned body to fast into the exercise routine. The cardiovascular and

respiratory systems often are more ready to begin exercise while the muscular and skeletal systems are


Self Care Document

not. This person would benefit from doing some form of easy form of getting into shape prior to

beginning the more extreme exercise program.

Another reason for weight training during a weight loss program is that it will help preserve or possibly

increase muscle tissue mass. Since metabolic processes occur at a much faster rate, even when at rest, in

nonfat body tissues, the greater your fat-free mass (this refers mostly to muscle tissue), the higher the

metabolic rate. The higher the metabolic rate, the more calories may be eaten without gaining weight.

Preservation of fat-free mass is another antiaging aspect of weight training, since a decline in muscle mass

is one of the main reasons metabolic rate decreases with age.

Possibly one of the best benefits of weight training is that it may help prolong independence in older

adults. As we age we often lose our ability to live independently because we cannot do the basic things

like climbing stairs, carrying things, getting up after falling, or standing up from a chair. Often it is due to

injury or illness leading to a time of bed rest or reduced activity, which creates a sharp decline in physical

fitness. Recently studies have shown dramatic illustration of the important contributions that weight

training can make to the quality of life in the elderly. Folks in their eighties and nineties who participated

in weight training programs made substantial gains in muscle strength, with strength increases of up to

30%. This significantly increased the ability of these elders to perform daily tasks easily.

Research studies have documented a small increase in cardiovascular fitness in subjects who lifted

weights; especially those who participated in a circuit training program. Circuit weight training involves

high-volume, low-resistance lifting, moving quickly from station to station. The greatest fitness benefits

occurred to those with the lowest fitness levels.

Regular weight training may also help to improve blood lipid profiles and improve the good kind of

cholesterol (HDL) while decreasing the bad type (LDL). Studies have also shown improvement in other

cardiovascular risk factors like blood sugar regulation and blood pressure control.

Weight training is a demanding form of exercise and most folks have the assumption that is appropriate

for those who are already athletic. Due to research, we now know that even those with limited physical

ability can benefit from an appropriate weight training program. The key is matching the weight training

program to an individual’s current fitness level and health issues.

Those with hypertension have been told in the past to avoid lifting heavy weights due to the rise in blood

pressure that occurs during lifting. Research on subjects who are borderline hypertensive where they

were taught correct breathing procedures show that circuit weight training with low-resistance lifting did

not elevate heart rates or blood pressures to dangerous levels.

Those with orthopedic issues, including those with arthritis, have found that the gains in strength and

flexibility from regular weight training have greatly improved their functional capacity.

While it is important for anyone new to weight training to receive proper instruction, it is also essential

that anyone with any kind of limitation seek the guidance of a health professional as he or she designs an

exercise program.


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Assignment 5

Now get on-line or go to the library and do some research on at least one method of weight training that is

appropriate for the aging. Then go to Moodle and provide us with an outline of that method along with

why you think it is a good method. What are the positive factors and what are the negative factors of this

method? Is there a type of individual that should not try this particular method? Why? Really, really

detail this information for us. Then wait a day or two and go into two others outlines and place

appropriate comments.

6. THE IMPORTANCE OF SLEEP Most of us take sleep for granted, but there are many, many people out there who would give anything for

a good night’s sleep. All of us will occasionally have some trouble sleeping through the night. Studies

show that at any one time, about 15 to 20% of adults in North America complain of problems sleeping.

Fortunately, there are no serious consequences to missing a good night’s sleep on occasion, these nights

will only make one a bit less alert than usual.

Sleep issues usually only last for very short periods of time and then go away on their own without the

need for treatment. So, however, suffer from chronic insomnia, or difficulty sleeping, that will persist for

months or years. Chronic sleep deprivation will most likely impact one’s mental and physical health in a

negative way and the ability to function effectively.

Insomnia may include any or all of the following issues:

1. Taking a long time to fall asleep.

2. Awakening frequently during the night.

3. Awakening too early in the morning.

4. Feeling tired and dissatisfied with one’s sleep when waking.

Insomnia that continues for more than a few weeks is a problem requiring medical attention because

occasionally it may signal a more serious health problem. One of these is sleep apnea, a potentially

dangerous condition that occurs when the sleeper stops breathing for a bout 30 seconds and awakens,

snoring loudly. Sleeplessness is sometimes a side effect of medication. Overuse of caffeine, alcohol,

sleeping pills, and other drugs can also cause insomnia.

Sleeping pills are among the most commonly prescribed drugs in North America today. An occasional

dose of sleep medication may be helpful when taken as directed, but, in general, medication only worsens

the problem. Sleeping pills disturb the sleep cycle, so sleep is less satisfying even though it may mean

getting more of it. These medications often leave the user with a hangover that results in daytime fatigue.

The user will build up a tolerance to the meds so that it becomes less effective within a week. This will

often lead that person to use more of the medication. One of the biggest dangers of sleeping meds is

addiction, which can be very difficult to overcome.

Some sleep medication can even cause insomnia by suppressing the brain’s production of dopamine, a

neurotransmitter that helps you go to sleep. Sleeping pills pose a danger of overdose, especially if taken

with alcohol or other drugs. Many people believe alcohol will help them relax and go to sleep, but like


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sleeping pills, alcohol disrupts the sleep cycle. While alcohol may help you fall asleep, it usually

produces light, restless sleep, and the person often awakens suddenly during the night, unable to go back

to sleep.

Mostly the problem with sleeping pills is that they do not address the real cause of the sleeping issue: bad

habits and stress.

While it is considered normal for some insomnia to occur during stressful times, it should resolve once

the stressful situation is over. When it continues, it is often due to the person developing poor sleep habits

and/or a poor sleep environment.

At times the sleep environment is the issue. This area should be comfortable, restful, and associated with

relaxation and sleep. Sleep and work area should be separate. Changing simple physical characteristics

of the sleeping area often improves sleep quality. Most people sleep best when the room temperature is

between 60 and 65 degrees. Noise level can be a more difficult problem to control. White noise machines

or tapes can provide a soothing sound that helps cover traffic and other noise. Some folks will use

earplugs. Shades that block light can help darken rooms with windows near street lights or keep out the

early morning sun.

Regular use of stimulants can interfere with one’s ability to fall and stay asleep. A decrease in the

consumption of caffeine often improves sleep quality. The nicotine in cigarettes is a stimulant and should

also be avoided. Heavy smokers experience more sleep problems.

A large meal prior to bed can inhibit sleep. A light snack, however, can help one sleep better. Exercise

helps decrease muscle tension and improve sleep quality. Exercise can also improve one’s ability to

manage stress which, in turn, helps improve sleep quality. Be careful not to exercise too close to bedtime

as it will wind you up instead of down. The sleep experts usually recommend exercising in the afternoon.

If an exercise program is making sleep worse, you are probably overdoing it.

Sleep happens more easily to those who go to bed with a peaceful mental attitude. It is helpful to relax for

at least an hour before bed. Read, listen to music, knit a sweater, take a warm shower. Avoid activities

that wake you up. A pre-bed routine helps get you ready for sleep.

When going to sleep is difficult, try a more rigorous approach called stimulus control. This consists of

adopting behaviors designed to help a person associate going to bed with sleep and sleepiness. The

following are some examples:

Only lie down to sleep when sleepy.

Do not use the bed for anything by sleep and sex.

Don’t read, watch TV, study, or eat in bed.

If you haven’t fallen asleep after 10 minutes, get up and do something else until you get sleepy.

Troubled sleepers are also advised to get up at the same time every day and not to nap during the

day.

If psychological stress is causing insomnia, it may be beneficial to enter into stress management training.

Professional counseling with someone specializing in sleep disorders can be helpful. Resolving conflicts


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and dealing with problem situations are better than worrying. Relaxation techniques will most likely be

helpful in getting a good night’s sleep too.

Assignment 6

After researching on-line or at the library for stress management programs available in your area, log onto

Moodle. Be sure to say what city you are in/near and list the various agencies and individuals along with

information about each of the stress management programs that deal with insomnia. What exactly the

program entails, what does the participant have to do in the way of activities & counseling, how long does

each participant stay with the program, etc. Also put your personal comments about each of the programs

you researched giving information about your likes/dislikes about the program and why. Be as detailed as

possible with this information and your personal comments.

Then wait a day or two and go back into Moodle to place appropriate comments after two of your

classmate’s entries.

7. MEDITATION AND BIOFEEDBACK – THE RELAXATION RESPONSE There was a time when we assumed that the functioning of the autonomic nervous system (ANS) was

outside of voluntary control. In the 1960’s interest in Eastern theories combined with the growing

technology of biofeedback produced evidence that convinced the medical community that the ANS was

not completely “automatic.” Yogis were observed decreasing metabolic rate dramatically during

meditation. In the laboratory, rats learned to slow their heart rates to receive rewards, and people

voluntarily lowered their blood pressure to hear fewer biofeedback beeps!

Meditation has been around for thousands of years, though it is somewhat new to Western medicine.

Most types of meditation consist of attempting to focus one’s attention on one thing at a time. Often that

object of focus is a word or a phrase that is repeated over and over in the mind. Others meditate on a

visual object such as a candle or a flower. Focus on breathing is also common and could be combined

with counting or repetition of a phrase. Some simply observe the thoughts that flow through the mind.

Once the mind turns quiet and focused, physical relaxation occurs as well. This state of being is called

the relaxation response.

Biofeedback machines give information about what is going on in the body while enabling one to use the

information to gain control of what is being monitored. An example is people who suffer from tension

headaches can use biofeedback to become aware of muscle tension and learn to relax. Electrodes are

used, usually on the frontalis or temporalis muscles. These detect the electrical activity from the muscle

and send this information to the biofeedback instrument. The machine converts the information into a

signal such as a beep or a flashing light that can be perceived by the patient. As the patient relaxes the

muscle, the signal will slow down; if the muscle becomes more tense, the signal speeds up. The machine

responds instantaneously to any change in muscle electrical activity, so the patient receives immediate

feedback on the success of the relaxation practice.


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If a body response can be monitored, biofeedback can be applied. Those most commonly monitored are

the most accessible. Electromyography (EMG) senses the electrical activity of muscles, as in the example

above. Electroencephalography (EEG) gives information about brain wave activity. Using EEG, patients

learn to produce the types of brain waves associated with relaxed or creative mental states. The galvanic

skin response (GSR), also known as electrodermal response (EDR), is what the lie detector tests use.

Changes in the electrical conductivity of the skin reflect minute changes in sweat gland activity and skin

cell membrane permeability, which happen in response to stress.

Biofeedback instruments can also measur3 skin temperature, which reflects vasodilation of peripheral

blood vessels. The more relaxed a person is, the greater the peripheral vasodilation, and the higher the

skin temperature. Blood pressure, heart rate and rhythm, and even stomach acid secretion can be

controlled with biofeedback training.

Meditation and biofeedback are most commonly used to reduce sympathetic arousal and achieve a more

“parasympathetic” homeostasis. They are effective for the treatment of many stress related illnesses such

as ulcers, colitis, irritable bowel syndrome, hypertension, tension and migraine headaches, and muscle

tension problems such as low back pain. They are also helpful for a disorder called Raynaud’s disease,

whose symptoms are cold extremities due to peripheral vasoconstriction. Those with this disease can

learn to warm their hands and feet by dilating constricted arteries. Temporomandibular joint disorder

(TMJD) and insomnia are also treated with meditation and biofeedback. Psychological disorders such as

anxiety and phobias often respond well to meditation and biofeedback training.

Biofeedback can also be used for certain forms of rehabilitation. It can help a person regain use of

muscles following stroke or trauma. Biofeedback instruments can sense very low levels of muscle

activity and help the patient learn to increase the level to produce muscle contraction. Biofeedback is also

used to help reduce the firing of nerves that produce muscle spasms and spastic movement.

It is unknown exactly how the autonomic functions are brought under voluntary control. Even somatic

functions that we call voluntary are not always subject to conscious control. For example, skeletal

muscles are governed by the voluntary nervous system, but a skeletal muscle spasm may not stop even

though you are willing it to do so.

People learning to use biofeedback usually work with a therapist who adjusts the instruments and gives

suggestions. When biofeedback is used to decrease sympathetic arousal, patients usually practice a

relaxation technique such as mediation. If they are trying to warm their hands, for example, they might

imagine lying in the sun or putting their hands into very warm water. That image becomes the focus for

the meditation. As the beeps slow down, they begin to associate certain images, thoughts, and sensations

with relaxation. Important in this process is an attitude of passive attention, relaxing without trying to do

so. Willing the arteries in the hand to open only leads to more tension and more constriction. Instead the

person must simply be aware, tune in, relax, and notice what seems to work for them.

An important part of meditation and biofeedback training is learning to transfer the skills learned during

practice sessions to real life situations, especially if the goal of training is daily physiological control A

person must be able to regulate blood pressure while driving in traffic, talking to friends, and performing

a job, not just when meditating in a nice, quiet room or hooked up to the biofeedback machine.


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As research into voluntary control of the ANS continues, one of the most intriguing observations is that

the more deeply into the nervous system you get, the harder it is to tell where the body ends and the mind

begins. This illustration of the intimate connection between thoughts and emotions and autonomic and

somatic functions supports the idea that a psychosomatic illness is not all in the person’s mind.

Psychosomatic means mind-body, after all!

Assignment 7

Now get on-line or go to the library and research at least three forms of biofeedback as well as at least two

forms of meditation. Write about these in Moodle, be as detailed as possible. Include information that

describes each of the techniques, how it works, what the patient does, how long a person does this as well

as how often. Of course, any other interesting piece of information you find as well should be posted.

Then discuss which method/methods you would be interested in studying further and why.

After a day or two, go back into the Moodle and place appropriate comments on at least two other

students’ work.

8. STRESS The sympathetic nervous system controls our “fight or flight” arousal. This will kick in for you when

faced with something frightening. How often in life are we faced with the type of stress that we can run

away from? Traffic jams, problematic teachers or bosses or family members, financial problems are

examples of our stress in this day and age. We cannot run away from it.

The good news is that stress is not always a bad thing and often our response to stress is not harmful to

our health. The word stress occurs whenever we must adapt in some way to a stimulus. We adapt by

recognizing the source of the stimulus. An example of this is the phone ringing where we adapt by

recognizing where the noise is coming from. A different type of stress example would be a friend asking

to borrow our car. Our thoughts from this type of stimulus could be a major source of stress.

There are positive stresses such as holidays, going to a party, giving a presentation, getting married, job

promotions, buying a house, vacations, etc. This type of stress is called eustress and is associated with

outcomes expected to be mostly positive, and with some sense of personal control over that outcome. On

the other hand, sources of distress are associated with expected negative outcomes where we feel very

little personal control. Expectations and control are the two key factors that distinguish positive verses

negative stress.

The distinction between distress and eustress sounds simple, but as we have observed over time, stress is

often caused not so much by what is actually going on, but rather by our perception of what is going on.

There are those stresses that are seen by most everyone as negative, such as sickness or death in the

family, divorce, and loss of a job. The thing is that most everyday stressors need not be as distressing as

we make them out to be.


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Think about a potentially stressful family gathering. Focus on the people you prefer not to see, their

negative comments and opinions, what they might be saying behind your back, all the work involved in

the preparation and clean up. And now enters self control.

Imagine you have no option but to attend the party. You have no control over who will corner you in

conversation, and you must behave according to your historical role in the family. I am guessing you are

feeling distress from this.

Now imagine the people you look forward to seeing, the questions you want to ask them, the children

who are a year older, the good food to eat, the fun family rituals. Pretend you are in your later years

looking back on your life. How much control do you have on your life? You are choosing to attend this

important event. Decide which people you will spend the most time with, and whom you will avoid.

What are some things you could do to make the gathering a pleasant one? A walk with your favorite

uncle? A shared confidence with a favorite cousin? Whatever you imagine, the secret to the creation of

eustress from potential distress lies in finding a meaningful perspective on the upcoming event and

devising a plan to change a potentially distressing occasion to one that is a positive experience for you.

Whether we perceive stressors as eustress or distress has major implications for our health. While at one

time it was thought that too much of any type of stress increased a person’s risk for stress related illness,

recent evidence suggests that our bodies respond differently to positive and negative stresses. In

particular, the hormonal changes that occur in response to eustress are less harmful than those produced in

response to distress. Under many conditions these physiological responses to eustress help us cope more

effectively with the source of stress. Negative health consequences associated with stress, such as decline

in immune system functions, are more often associated with distress that eustress.

Early research on Type A personalities and heart disease suggested that Type “A people were more prone

to heart attack. Type A people were characterized as time conscious, high achievers who hate to wait in

line and are always in a hurry. The research that followed has shown that it is not the general Type A

behavior pattern that is related to heart disease, but rather certain elements associated with this behavior

pattern, specifically feelings of anger, hostility, and distrust.

Those who view most stress as distress seem to upset the physiological balance of the sympathetic and

parasympathetic branches of the autonomic nervous system. Cynical, hostile people spend too much time

wound up, high on epinephrine, norephinephrine, and other hormones, such as cortisol, which contribute

to hypertension and arterial disease.

How we choose to deal with stress develops over the course of our lives, partly as learned behavior. They

can be unlearned with dedicated practice. Stress management courses can help us learn better ways to

cope with stress. We can improve our ability to deal directly with sources of stress, learn how to say no,

and manage our time more effectively. We can monitor our thoughts, question mistrusting assumptions

that may not be true, and replace them with more open and positive observations.

Cultivating a sense of humor and an ability to relax are also important. Many stress management

programs teach exercises that promote the relaxation response, including biofeedback and meditation.

Developing better communications skills, learning to really listen to others, and practicing trust and

forgiveness can help us cultivate a more relaxed personality.


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The Chinese character for the word crisis is a good representation of the dual nature of stress, since it is

formed from the characters for danger and opportunity – see below.

Assignment 8

Now go to Moodle and answer the following questions:

1. TRUE/FALSE: We perceive all stressors as distress.

2. TRUE/FALSE: Eustress is a positive type of stress.

3. TRUE/FALSE: To focus on the positive aspects of an upcoming event rather than on the negative

aspects, is one way to change your experience from distress to eustress.

4. TRUE/FALSE: The hormonal changes that occur in response to eustress are less harmful than those produced in response to distress.

5. TRUE/FALSE: Mostly our stress styles develop as a result of learned behavior. We cannot unlearn

them.

9. DIET AND HEART DISEASE A person’s diet has a strong influence on four risk factors associated with heart disease: high blood

cholesterol, high blood pressure, obesity, and diabetes mellitus. Anyone watching those four things

should be monitoring their diet.

There are dietary guidelines and recommendations from public health officials available to help folks eat

a heart healthy diet. This is to help prevent coronary artery disease, the leading cause of death in North

America. There is no one food to prevent heart disease. There is no short term eating plan that will

reverse atherosclerosis. A heart healthy diet consists of making the right daily food choices that add up to

a lifetime of good dietary habits.

One of the first principles to a good diet is limiting the amount of fat you intake – anything more than

what we need is extra calories. Recent research shows that a given number of calories consumed as fat

results in more fat storage than the same number of calories consumed as carbohydrate or protein. This

means that it is metabolically efficient to store fat in adipose tissue, but not as efficient to turn

carbohydrate or protein into fat.

http://www.thequietman.org/imagenes/chinese-crisis-2.jpg


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A diet high in fat, in particular saturated fat, also raises blood cholesterol levels. Foods high in saturated

fat include butter, cream, whole milk, cheese, some shortenings and margarines, and palm and coconut

oils. Some food labels list how much and what types of fat have been added to food products. Lean cuts

of meat, poultry and fish have less saturated fat than fatty cuts such as prime rib. Chicken fat is found

under the skin, so by trimming the skin you remove most of the fat. Broiling or baking are preferable to

frying.

Cholesterol intake should be limited by restricting consumption of egg yolks, meats, and organ meats.

Cholesterol is found in muscle tissue itself, so simply trimming the visible fat from meats does little to

decrease its cholesterol contents.

Research has shown that folks who include fish in their diet have a lower risk or heart disease. Cold

water fish, like salmon, mackerel, trout, bluefish, and herring contain omega-3 fatty acids. These fatty

acids may prevent heart disease by decreasing the tendency of platelets to clump and perhaps by lowering

total serum cholesterol as well.

People who consume diets high in fish oils produce less thromboxane, which promotes platelet clumping

and is a powerful vasoconstrictor. Fewer clots and more open arteries mean a lower risk of blockage.

Although fish oil contains substantial amounts of cholesterol, some studies have shown that people who

consumed fish oil reduced their serum cholesterol levels.

Scientists are reluctant to recommend fish oil supplements at this point, because their safety for long term

consumption is now known. But eating more fish is a good idea. A study from the Netherlands found

that those who eat only one of two meals of any type of fish a week, had a lower incidence of heart

disease than those who ate less fish.

Carbohydrate foods do not increase total serum cholesterol and are less likely to cause obesity than fatty

foods, although too much of any food means extra calories. Complex carbohydrates are very good for us

due to their having lots of nutrition per calorie along with being rich in vitamins and minerals. They are

also high in water soluble fiber to help decrease serum cholesterol. Complex carbs include grains like

wheat, rice, corn, oats, and products made with them. Those products include cereals, breads and pasta.

Peas and beans, lentils, chick peas and starchy vegetables like potatoes, yams, and winter squashes also

fall into this category.

Some research shows that folks consuming a diet high in complex carbs can maintain or even lose weight

while eating as much as they want of these foods. They do not count calories or portions, and eat until

they are full. Researchers theorize that those consuming a diet high in complex carbs feel full and quit

eating before they have consumed too many calories. Just the opposite can happen with foods high in fat.

Since there are many, many calories in very small volumes of fatty foods, you can eat hundreds of

calories in a very short period of time. Just think of that jelly filled donut, even a smaller one is most

likely at least 800 calories, with most over 1,000 calories!!!

It is unfortunate that dieters have shunned complex carbohydrates for years. Many people would still

omit the potato rather than the steak when trying to lose weight. A very small steak is high in fat and may

be over 400 calories for one that weighs 4 ounces. A baked potato has no fat and only about 90 calories.


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It might be important to prepare complex carb foods without high fat sauces or other added fats. The 90

calorie baked potato becomes a high fat, high calorie dish once you add the butter and sour cream.

Simple sugars are found naturally in fruits, vegetables, and dairy products. Refined sugars (sucrose,

dextrose, syrups, and other sugar products) provide empty calories; they have no other beneficial

nutrients. Also they are often eaten with fats in pies, pastries, cakes, cookies, and candies – all very high

calorie foods.

Hypertension, or high blood pressure, is more prevalent in population groups that consume high levels of

sodium. A taste for salt developed early in life can lead to hypertension in later years. Some research

suggests that it may take years for a high salt intake to cause hypertension, so most people do not realize

that their salt intake is harming their health. Think of how much salt is in any pre-prepared junk type of

food.

Sodium in the form of salt or monosodium glutamate is fond in most prepared foods such as soups,

sauces, and canned fish and meat, condiments, pickled and cured foods, and salty foods. High sodium

levels are also present in some vegetables like celery and mushrooms.

Too much alcohol is associated with increased risk of hypertension as well. No one can say exactly how

much is too much, but most authorities agree one or two drinks per day are most likely safe. Alcoholic

drinks are empty calories and will also contribute obesity.

Assignment 9

Now answer the following questions in Moodle:

1. A person’s diet influences four risk factors associated with heart disease, they are?

A. heart attack, stroke, heart palpitations, angina

B. high blood cholesterol, high blood pressure, obesity, diabetes mellitus

C. stress, poor exercise habits, poor quality of sleep, obesity

2. TRUE/FALSE: We need only a very small amount of fat in the diet to maintain good health.

3. TRUE/FALSE: A diet high in fat also raises blood cholesterol levels.

4. TRUE/FALSE: Research shows that eating a diet that includes fish will not have any impact on the risk of heart disease.

5. TRUE/FALSE: Simple sugars are found naturally in meats.

6. What is the one type of food that will not increase total serum cholesterol and are less likely to cause

obesity than fatty foods?

A. Carbohydrates

B. Foods high in sugars

C. Alcohol

D. Meats


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10. PREVENT HYPERTENSION While there are many people out there with hypertension, there is still no cure. Medicine to control

hypertension can be lifesaving, but it does not correct the underlying cause of the disorder. Mostly the

cause of hypertension is unknown. There was a time when it was thought that a rise in blood pressure

was a normal and necessary part of the aging process, which is why hypertension that was not caused by

some underlying disease was known as essential hypertension. Increased blood pressure was thought to

be essential to maintain adequate circulation in older adults.

In other cultures, blood pressure does not increase with age, especially in non-industrialized countries.

Yet, 50% of Americans have hypertension by age 74. What is it about the American way of life that

makes us so prone to this disorder? Most likely we need an understanding of the relationship between life

style and the development of hypertension to help us prevent this disorder.

Hypertension seems to have genetic and environmental causes. Many risk factors for the development of

hypertension have been identified. Unmodifiable risk factors include family history of hypertension, age,

ethnicity, and gender. Do you have parents or siblings that have developed hypertension? With age, the

risk increases. Also black Americans have a greater risk and men have more hypertension between the

ages of 18 and 54, while women have more hypertension after age 65.

Those who fall into a high-risk group should not worry; this will only increase your blood pressure.

Rather, a wellness life style can significantly reduce a person’s risk of developing hypertension and

decrease its severity should it develop. Life style change is particularly effective in helping to lower

blood pressure for those with borderline or mild hypertension; or 80% of hypertensives.

A healthy diet can help prevent hypertension. Have you heard that by minimizing sodium intake could be

important? Sodium sensitivity often develops with age, so even though excess sodium does not currently

raise your blood pressure, it may in the future. Anyone at risk for hypertension, and those planning to

grow old, may benefit from not eating highly salted food from an early age. Animal studies suggest that a

salty diet may damage arteries without causing an increase in blood pressure. In one study, rats fed high

salt diets experienced only a slight rise in blood pressure, but all died much earlier than littermates on low

salt diets. Autopsies showed a great deal of arterial damage that included atherosclerosis, and associated

damage to brain cells supplied by the damaged arteries. Epidemiological studies support the dangers of

high salt diets as well. An example is that those who live in northern Japan consume high salt diets and

also have a very high incidence of stroke.

Some studies have found that an increased intake of calcium and potassium helps lower blood pressure.

Calcium is found in dairy products, dark green vegetables, and calcium enriched foods such as orange

juice and soy milk. Potassium is found in many fruits and vegetables.

An adequate intake of magnesium may also help regulate blood pressure. In animal studies, magnesium

deficiency increases vascular muscle tone, thus increasing peripheral resistance to blood flow.

Magnesium is found in legumes, nuts, whole grains, and meat.

Alcohol consumption has been strongly associated with hypertension. The more a person takes in

alcohol, the greater the risk of hypertension. Many find that their blood pressure improves when they


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decrease their alcohol consumption. Caffeine is a stimulant and increases blood pressure, so it should be

limited if one has or is at risk for developing hypertension.

Those who are more than 20% above their desirable weight have twice as much hypertension. Extra fat in

the abdominal region is more strongly associated with hypertension than excess fat in the hips and thighs.

A small weight loss could significantly decrease blood pressure, even if the person does not lose all of the

extra weight.

Abdominal obesity is also associated with insulin resistance. People with insulin resistance produce

enough insulin, but the insulin receptors located in the cell membrane are not sensitive enough to respond

correctly, and blood insulin levels rise. Insulin stimulates sympathetic nervous system activity, similar to

the stress response that causes blood pressure to rise. Insulin may also lead to fluid retention with

increases blood pressure. Weight loss often helps restore insulin sensitivity.

Nicotine is a potent vasoconstrictor; so, another reason not to smoke cigarettes. When smoking these,

nicotine enters the blood immediately, and vasoconstriction occurs systemically. The more nicotine and

the more frequently one smokes, the greater the vasoconstriction. Smokers usually have chronically

elevated blood nicotine levels and increased vascular resistance.

Many studies have found that regular aerobic exercise can normalize blood pressure in people with

borderline hypertension. Epidemiological studies have also found that exercise can improve the health of

people with this condition. In fact, one study showed that hypertensives who exercised regularly had

almost the same mortality rates as those with normal blood pressure.

Exercise may exert this protective effect partly by contributing to a person’s weight control efforts.

Regular aerobic exercise may also lead to decreased vascular resistance, perhaps by increasing

parasympathetic output when at rest – the relaxation response.

Insulin sensitivity improves for many hours after exercise. As mentioned above, this could prevent the

sympathetic nervous system activity and fluid retention that may contribute to high blood pressure.

Many people find that exercise helps them relax and decreases their stress reactivity. Things do not upset

them as easily. Several studies have demonstrated an association between stress and hypertension, so

exercise may be helpful because it reduces a person’s stress response.

It has been hypothesized that chronic stress may lead to a chronic elevation in sympathetic nervous

system activity. This includes an elevation in the hormones associated with the stress response, including

epinephrine and norepinephrine, which might cause chronic high blood pressure. Stress management

techniqu3es can help a person learn relaxation skills that decrease sympathetic output and thus, reduce

blood pressure.


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Assignment 10


1. TRUE/FALSE: A healthy diet can help prevent hypertension.

2. TRUE/FALSE: In other cultures there is no evidence that blood pressure increases with age.

3. TRUE/FALSE: While there are genetic causes for hypertension, there are no environmental causes.

4. TRUE/FALSE: There is no difference with gender regarding hypertension.

5. TRUE/FALSE: Autopsies of rats that died early due to high salt diets did not show any sign of arterial damage.

6. TRUE/FALSE: There are studies that show that increasing intake of calcium, potassium and

magnesium will help lower blood pressure.

7. TRUE/FALSE: Alcohol consumption is strongly associated with hypertension.

8. TRUE/FALSE: Those who are 10% above their desirable weight have twice as much hypertension.

9. TRUE/FALSE: Other than hypertension, there is nothing else related or associated with those with abdominal obesity.

10. TRUE/FALSE: Nicotine is a powerful vasoconstrictor that can be systemic.

11. TRUE/FALSE: With exercise, insulin sensitivity improves for many hours.

12. TRUE/FALSE: Stress management is unnecessary if you are hypertensive.

11. THE MIND AND IMMUNITY Immunity is extremely important to us all. Have you ever wondered why some of us seem to be more

immune to things than others?

Subjects in a study designed to evaluate the effectiveness of a painkiller experience symptom relief after

receiving inactive “sugar pills.” People with asthma suffer asthma attacks when they believe they are

being exposed to allergens, even though the allergens are imaginary. Students experience the most

psychological stress during exam periods come down with more colds than their easy going friends.

Researchers are now finally beginning to explore the physiological bases of the body-mind relationship

and to find the ways our thoughts and feelings can influence the physiological processes that affect our

health. Many scientists are discovering that we can best understand physical health with a holistic

outlook that includes the functioning of the mind. Psychoneuroimunology (PNI) is the study of the

interrelationships of the three body-mind systems that serve as communication networks within

homeostasis: the nervous, endocrine and immune systems.

There was a time when physiologists thought the immune system functioned independently. Now,

anatomical and physiological evidence points to extensive communication between the immune system

and the nervous and endocrine systems. Several organs of the immune system, including the spleen,

thymus, and lymph nodes, receive sympathetic nervous system (SNS) innervation. In animal studies,

when this innervation is tampered with, changes in immune responses occur. In the spleen and thymus,


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the SNS nerve endings have a synapse-like connection, as with the nervous system, with lymphocytes (a

type of white blood cell), and appear to communicate in some way with these immune cells. In

experiments with laboratory animals, injury to certain areas of the brain leads to immune system changes.

These changes affect specific resistance to disease, which refers to the immune system’s ability to

recognize, attack, and remember particular foreign molecules such as viruses and bacteria. Specific

resistance to disease is carried out by several types of white blood cells called B cells and T cells. Lesions

to one part of the brain (the anterior hypothalamus) interfere with the activity of antibody secreting B

cells, while damage to another area (the posterior hypothalamus) reduces the effectiveness of the memory

T cells.

Neurotransmitters, a type of chemical messenger found in the immune system particularly in the bone

marrow and thymus gland. Many types of immune cells have receptors for neurotransmitters and

hormones, and it has been demonstrated that the immune system can respond to neurotransmitters and

hormones. For example, at low concentrations, norepinephrine stimulates the immune system. Cortisol, a

hormone secreted by the adrenal cortex in association with the stress response, acts to inhibit immune

system activity, perhaps one of its energy conservation effects. An elevation in cortisol has been observed

in a significant number of people with major depressive illness, so endocrine effects may help explain the

link between depression and decreased immune response.

Some researchers believe the opioid peptides (endorphins, for instance) may be another vehicle for

communication. Opioid peptides are manufactured by some lymphocytes as well as by nerves in the

central nervous system (CNS), which comprises the brain and spinal cord. Opioid receptor sites have

been located on some white blood cells.

Communication between the immune system and the CNS goes both ways. The immune system does not

simply respond to messages from above, but seems to inform the brain and endocrine organs. Small

protein hormones called cytokines are secreted by many types of white blood cells and also in the brain.

Cytokines appear to act as chemical messengers in this communication network.

Most of us are familiar with stories of lowered resistance to disease in people experiencing death of a

loved one, divorce, job loss, etc. Finding the phychophysilogical explanation for these observations still

eludes us, however. The challenge to scientists is to figure out exactly how PNI can explain real life

changes in the immune response. Humans are ex\specially difficult to study because under stress,

behavior varies: Some may get less sleep, eat differently, drink more alcohol, take drugs, and so on. All

of these things can influence immune responses.

PNI researchers are making some headway in understanding the types of effects our thoughts and feelings

can have on the immune system. One study found that men who exhibited a strong SNS response to

frustration showed a greater number of suppressor T cells, which inhibit immune response, and a lower

rate of lymphocyte proliferation than men with a milder response. Another study found no relationship

between stress and numbers of lymphocytes or other immune cells, but did find certain changes in

lymphocyte proliferation and antibody reactions. The studies continue, so we will see what more we learn

in the future about this.

PNI research appears to justify what many health care workers have observed since the beginning of time:

One’s thoughts, feelings, moods, and beliefs influence one’s level of health and the course of disease.


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Especially harmful appear to be feelings of helplessness, hopelessness, fear, and social isolation, all

common to the experience of being sick, and especially to being a patient in a hospital. While conclusive

studies are still lacking, preliminary data suggest that the use of positive imagery, relaxation techniques,

phychotherapy, and humor can help patients feel much better, and may have a positive influence on the

course of a disease.

Assignment 11


1. TRUE/FALSE: PNI, or psychoneuroimmunology, is the study of the immune system only.

2. TRUE/FALSE: It is now known that there is extensive communication between the immune system and the nervous and endocrine systems.

3. There are several organs of the immune system that receive sympathetic nervous system innervation;

they are:

A. Stomach, kidneys and liver

B. Spleen, thymus and lymph nodes

C. Pancreas, gallbladder and liver D. Kidneys, thymus and gallbladder

4. Can an injury to certain areas of the brain lead to immune system changes?

5. TRUE/FALSE: The above changes to the immune system affect specific resistance to disease.

6. Neurotransmitters are a type of chemical messenger found in the nervous system. Where are they also

found within the immune system?

A. Thymus gland and bone marrow

B. Thyroid and pineal glands

C. Thyroid and thymus glands

D. Bone marrow and red blood cells

7. TRUE/FALSE: An opioid peptide is a type of endorphin.

8. TRUE/FALSE: Communication between the CNS and the immune system only goes one way, from the CNS to the immune system.

12. VIRUSES AND PREVENTION The respiratory system seems to take the majority of the suffering when we catch a cold virus. Cold

symptoms are not produced directly by the cold virus, but by the body’s nonspecific defenses as they fight

the virus.

The immune system learns to recognize specific disease agents through exposure to them. This exposure

can occur through vaccination or by natural means. We acquire immunity to chicken pox, measles,

mumps, tetanus, cholera, smallpox, and many other life threatening diseases. So, why can’t our immune

systems keep us from catching the common cold?


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We are susceptible to at least 200 different cold type viruses. The most common types, rhinoviruses

(literally means nose virus), cause about 40% of all colds in adults. As soon as the immune system learns

to recognize and defend us from one, another comes along, and then another. This viral diversity creates

quite a challenge for the immune system, so much so that most people succumb to one to six colds per

year.

Research evidence indicates that cold viruses may be transmitted from the hands of an infected person to

the hands of another person who is susceptible. The virus can survive on the skin for only a few hours and

must reach the nose in order to invade the body. On the face near the nose will not work because the skin

provides an effective barrier. Since the mucous membranes of the mouth are also an inhospitable

environment, kissing seldom spreads colds.

Regarding the virus, eventually the hand delivers the virus to its new home, the person’s respiratory

system, by touching the mucous membranes of the nose or the eyes (the virus can travel down the tear

duct to the upper nose area). One study found that 40% to 90% of people with colds had rhinoviruses on

their hands. The viruses wer3e also found on about 15% of nearby objects like doorknobs, telephones and

coffee cups. Some evidence also suggests that cold viruses are airborne and go to other noses. They most

likely are spread when expelled by a cough or a sneeze.

It is not known what makes some people more susceptible to colds. Small children are the most

susceptible, because their immune systems are still immature and have not learned to recognize as many

pathogens. People who are around children a lot also get colds more often. Smokers are more likely to

catch colds than nonsmokers, partly because smoking inhibits the airway cilia that help move mucus.

Some studies have shown that stress can decrease the effectiveness of the immune system, and some

evidence suggests that stress and fatigue increase susceptibility to colds.

Given what we know about the transmission of colds, the single best way to prevent one is frequent hand

washing, especially when you are around those with a cold. Avoid sharing telephones, glasses, towels,

and other objects with a person who has a cold. Try not to touch your nose or eyes, especially at those

times. Those with colds should cough and sneeze into facial tissues and then throw the tissues away.

They then should wash their hands right away.

Getting enough rest, eating well, exercising moderately, and managing stress will never hurt and it will

most likely help keep your resistance up. If you are a smoker, cold prevention is yet another good reason

to stop!

Although studies have failed to show that vitamin C prevents colds, some research has found that it may

lessen the severity of cold symptoms. Vitamin C also increases the integrity of cell membranes and may

make it more difficult for a virus to penetrate.

As there is no cure for a cold, we must treat the symptoms. It has been said that with aggressive medical

treatment, a cold will disappear in seven days, while if left alone a cold will last a week. In any case,

treatment of the symptoms can make us feel better until the cold has run its course.

The first step in cold self care is to decide whether your symptoms are those of a cold or something more

serious requiring medical attention. People who have heart disease, emphysema, diabetes, or other health


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conditions should get professional advice before taking over the counter medication. Pregnant and

lactating women should also check with their doctors before taking the OTC medications.

Symptoms that indicate your infection may be more than a cold include:

1. Oral temperature over 103 F.

2. Sore throat with temperature above 101 F for over 24 hours.

3. Temperature over 100 F for three days.

4. Severe pain in ears, head, chest or stomach.

5. Symptoms that persist more than a week.

6. Enlarged lymph nodes.

7. In a child, difficulty breathing, or greater than normal irritability or lethargy.

Once you decide you have a cold, there are several things you can do to help yourself feel better. These

include:

1. Chicken soup, broth, or other hot drinks. Hot drinks help relieve congestion by increasing

the flow of nasal secretions. They also soothe irritated throats.

2. Gargle with salt water to soothe a sore throat.

3. Use a vaporizer or humidifier to increase humidity, especially if the air is very dry. Humid

air is gentler on the nose and throat.

4. Breathing steam gives your nose a temporary fever, creating an inhospitable environment

for the virus. It also helps to thin the mucus causing a stuffy nose and temporarily relieves

congestion. The steam may also feel soothing to irritated throats and nasal passages.

5. While rest may not hasten your recovery, it may help you feel better. It is good to stay out

of circulation for the first few days of a cold to keep others from getting it and to be sure

that what you have is a cold and not something more serious.

6. Many over the counter cold medications are available. If you decide you need something,

avoid combination drugs that contain several active ingredients to treat several symptoms.

If instead, you buy single drugs for the symptoms you wish to treat, you will avoid taking

unnecessary drugs and decrease unpleasant side effects.

To avoid getting a virus, you might want to try some or all of the following:

Try using the blend of therapeutic grade oil by Young Living called “Thieves.” It was

made to help you fight off viruses. It only takes one drop per day massaged into the soles

of your feet.

Wash your hands or use a hand sanitizer often (try the Young Living Thieves hand

purifier). After touching door knobs, telephones, staplers, etc. that others have touched,

wash or sanitize your hands immediately.

Be sure not to rub your eyes, put your hands into your mouth or pick your nose after

touching anything that others have touched.

If you think you have been “touched” by a virus, try putting 5 – 8 drops of the Thieves

blend into an empty capsule and ingesting it at bedtime.

Take 1000 mg or more of vitamin C each day.


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Assignment 12


1. TRUE/FALSE: We get colds due to a virus catching us.

2. TRUE/FALSE: We are susceptible to at least 200 different cold-causing viruses.

3. TRUE/FALSE: The most common type of virus out there is called rhinovirus, or “nose virus.”

4. TRUE/FALSE: Mostly we catch a virus due to others touching us with their hands.

5. TRUE/FALSE: We know exactly why some of us are more susceptible to viruses than others.

6. TRUE/FALSE: There is a cure for the common cold virus out there.

7. TRUE/FALSE: It is unwise to treat yourself with over the counter drugs for a cold.

8. TRUE/FALSE: Chicken soup does help us feel better when we have a cold due to it helping relieve congestion because it is a hot liquid.

9. TRUE/FALSE: If you have enlarged lymph nodes, simply treat it as if it were a cold.

10. TRUE/FALSE: When you have a cold, it is alright to sneeze into the air as these types of viruses are

not airborne.

13. ALCOHOL – USE/ABUSE When we think of drug abuse, we conjure up junkies with needles, etc. What abut that person who simply

drinks too much? Alcohol is the number one drug abuse and mental health issue in North America!!! Far

more people abuse alcohol than any other drug! Over 20 million Americans consume excessive amount

of alcohol (14 or more drinks per week). Fifty percent of all alcohol is consumed by 10% of all drinkers.

The digestive system is affected in several ways by over consumption of alcohol. Alcohol causes an

increase in stomach secretions, which can lead to gastritis, or inflammation of the stomach lining.

Alcohol also interferes with the ability of the small intestine to absorb and transport nutrients, especially

the vitamins thiamine and folic acid, and minerals. Impaired nutrient absorption and transport enhances

the tendency of alcoholics to be malnourished. Those who consume large amounts of alcohol also tend to

have a poor diet. This malnutrition occurs even though the alcohol is consuming plenty of calories.

Alcohol is calorically dense and those calories are considered empty, because they do not supply the

protein, vitamins, fiber or minerals of the foods they are replacing. Heavy drinking can also cause

diarrhea, which decreases nutrient absorption from the small intestine.

The organ that sustains the most damage from alcohol abuse is the liver, which processes 95% of the

alcohol intake. The liver converts alcohol into acetaldehyde, which is even more toxic to the body than

alcohol. This process is associated with the deposition of fatty compounds in the liver, causing fatty liver,

a common condition in alcoholics. If drinking stops, this condition is reversible. If drinking continues, it

progresses to an inflammatory condition called alcoholic hepatitis, and then to cirrhosis. In cirrhosis,

functional liver cells are replaced by nonfunctional scar tissue, liver function declines, and the result may

be death. Damaged livers are also more susceptible to hemorrhage, and risk of cancer of the liver is 30%

higher in those with cirrhosis.


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Alcohol consumption is also associated with hypertension, which is reversible if the drinking stops.

Alcohol abuse can also lead to the development of fat deposits in the heart muscle, which weaken

contractile force and reduce cardiac output. Alcoholics have an increased risk of cardiac arrhythmias and

stroke. Muscle atrophy and weakness often result from alcohol abuse. Skin disorders are also common

symptoms of alcohol abuse, and result from liver damage, poor nutrition, and the effects of alcohol and

acetaldehyde.

Alcohol is a nervous system depressant and impairs brain function. Long term effects include brain

damage, especially in the cerebral cortex. Alcoholics may experience memory loss, confusion, even

hallucinations and psychotic behavior. Damage to the peripheral nerves, called alcoholic neuropathy,

may also occur.

The immune system may become suppressed if too much alcohol is consumed. Alcohol inhibits the bone

marrow’s ability to produce the white blood cells that destroy harmful bacteria. People whose immune

systems are already weakened due to other illness should be especially careful about alcohol

consumption.

Alcohol use has been associated with several types of cancers, especially cancers of the stomach, liver,

lung, pancreas, colon, and tongue. Alcohol and smoking together increase the risk for cancers of the

mouth, larynx, and esophagus. Some evidence suggests a relationship between alcohol and the risk of

breast cancer.

A woman who consumes alcohol while pregnant exposes the developing fetus to alcohol’s damaging

effects. Drinking while pregnant is one of the leading causes of birth defects in North America. Alcohol

diffuses freely across the placenta, so the alcohol level in the fetus’ rapidly growing tissues, especially the

brain. Fetal alcohol syndrome (FAS) is characterized by stunted growth, mental retardation, malformed

facial features, and heart defects. The damage is irreversible. FAS is found in babies of light drinkers as

well as heavier abusers.

It is hard to tell how much alcohol is too much. Individual tolerance varies greatly, so that two people

consuming similar amounts may experience very different health effects. On the average, men who drink

more than three drinks a day and women who drink more than one and a half drinks a day experience a

higher incidence of liver disease. A drink is equivalent to a 12 ounce bottle of beer, a 5 ounce glass of

table wine, or a cocktail with 1.5 ounces of liquor. All contain the same amount of alcohol, about 0.6

ounces. Rates of liver disease rise in proportion to the amount of alcohol consumed. People prone to a

drinking problem may find that no level of alcohol consumption is safe if they are unable to stop after the

first drink.

Women appear to be more susceptible to the effects of alcohol. This is due in part to differences in size.

Women are generally smaller than men, and a given amount of alcohol is more concentrated in a smaller

body. But there is far more to it than size. When men and women of the same size ingest he same

amount of alcohol, women tend to have higher blood alcohol levels. Recent research has found that

women do not digest alcohol as effectively as men do. The enzyme alcohol dehydrogenase begins to

digest alcohol in the stomach. The enzymes of the women in one study broke down less than one fourth

as much alcohol as those of the men. Alcoholic subjects had an even lower stomach enzyme activity.

This research helps to explain why women develop liver disease at lower alcohol intakes than do men.


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Alcohol is a very potent drug, and must be recognized as such. People who choose to consume alcohol

should understand alcohol’s effects and use it only in a safe environment. People with a family history of

alcoholism should be aware of their parents’ patterns of alcohol use and develop more effective drinking

strategies. The safe drinker drinks for positive reasons: to celebrate, share, and communicate, not to

relieve pain, forget problems, or overcome fears. Abstaining periodically from alcohol use helps one

avoid developing a tolerance to this addictive drug.

Assignment 13

Now go to Moodle to answer the following questions:

1. Which is the most used drug in America?

A. Cocaine

B. Marijuana

C. Valium

D. Alcohol

2. TRUE/FALSE: Alcohol increases stomach secretions leading to gastritis or inflammation of the stomach lining.

3. TRUE/FALSE: Alcohol interferes with the ability of the small intestine to absorb and transport nutrients such as vitamins thiamine and folic acid along with minerals.

4. TRUE/FALSE: The above two questions tell us why often alcoholics are malnourished.

5. TRUE/FALSE: the organ that sustains the most damage from alcohol abuse is the stomach.

6. TRUE/FALSE: Alcohol consumption is associated with hypertension. When this happens it is

irreversible.

7. TRUE/FALSE: The liver converts alcohol into acetaldehyde, which is even more toxic to the body than alcohol.

8. TRUE/FALSE: Alcohol use has never been associated with cancers.

9. TRUE/FALSE: Pregnant woman who drink alcohol can damage a developing fetus.

10. TRUE/FALSE: Drinking while pregnant is the leading cause of birth defects in North America.

11. TRUE/FALSE: Women and men have the same amount of susceptibility to the effects of alcohol.

14. METABOLISM AND WEIGHT CONTROL Losing weight is simple, it is metabolic balance. All we need to do is adjust our activity level and food

intake so the number of calories use is more than the number of calories consumed. An energy deficit

means that energy stores such as fat cells will be used up and not replenished.

It is not an easy task to calculate the effect of a given caloric intake. Research suggests that some calories

are more fattening than others. It is still true that 1g of fat contains 9kcal and 1g of protein or

carbohydrate contains 4kcal. But a certain amount of energy is required to convert energy nutrients into

storage fuels. For example, it is metabolically very efficient to convert triglyceride molecules from


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dietary fat into triglyceride molecules in fat cells; the conversion is relatively easy and requires very little

energy. Meanwhile, the conversion of dietary carbohydrate into adipose triglyceride is metabolically

costly as it takes several steps and some energy is actually expended during this conversion process. Fats

are more fattening, if you will, so a person trying to lose weight will most likely benefit from eating foods

low in fat.

Using a very low calorie diet, known as a crash diet, will be ineffective for weight loss and may be

harmful to your health. This type of diet will usually allow the dieter to consume a very limited an often

bizarre selection of foods or food substitutes (these substitutes usually cost quite a bit of money and have

no flavor as they are frozen or dried and cheaply produced). The dieter is not educated about making

correct food choices, so once the diet ends the dieter usually gains back most of or all of the weight lost.

Sometimes the dieter will gain back the weight and then more!

There are some common side effects of a very low calorie diet. These are feelings of deprivation and

depression along with powerful food cravings. The cravings can lead to food binges during which the

dieter eats as much of the forbidden foods as he can. Binging is usually followed by stricter dieting,

greater cravings and more misery. It is not uncommon for this type of harmful pattern to evolve into a

real eating disorder.

There has been interest recently in caloric restriction and metabolic rate due to a desire to understand why

some of us have a great deal of difficulty losing weight, even though we may be eating very little food.

According to standard metabolic calculations, we should be losing steadily, but we are not. It used to be

that if you were one of these people who dieted but did not lose weight, you were suspected of cheating or

lying. You were accused of underestimating your food intake, fudging your calorie counts, and failing to

follow the diet.

Many of those who do not lose weight on very low-calorie diets may be experiencing a metabolic

adaptation to what their bodies perceive as starvation. In the face of starvation, basal metabolic rate

(BMR) may decline as the body attempts to conserve energy. This response appears to become stronger

the more frequently a person undergoes severe caloric restriction.

Frequent dieting interspersed with periods of normal or greater than normal caloric intake is common in

those attempting to lose weight. The same 10 or 20 pounds may be lost and regained many, many times

in what has become known as yo-yo dieting or weight cycling. These people seem to be especially

vulnerable to metabolic adaptation to a very low calorie diet.

Weight cycling appears to have other harmful side effects that include increased risk of developing

hypertension, artery and gallbladder disease. Research indicates that moderately obese people who don’t

try to lose weight are healthier than obese people who have experienced frequent fluctuations in body

weight.

Some evidence suggests that weight cycling may lead to a replacement of muscle with adipose tissue.

Each time a person follows a very low calorie diet, the dieter loses some muscle tissue. Each time the

weight is regained, more fat is gained. The person may weight the same before and after the diet, but be

relatively fatter after the diet. It is ironic that dieting behavior may actually be responsible for the obesity

the dieter was trying to ride himself of.


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You have heard it before: Successful weight control programs are based on behavior change, on

developing nutritious eating habits that can be lived with. While some caloric restriction may be

necessary to create a negative energy balance, a person should not consume fewer than 10kcals pr pound

of ideal weight, and never fewer than 1200kcals. Moderately low calorie diets do not seem to cause a

drop in BMR for most.

Dieters are fond of reminding us that to burn off the calories in one piece of pecan pie, you would have to

run four miles. All that work for 400 calories! What most do not mention is the fact that exercise confers

more benefits than simple caloric expenditure. Exercise helps a person build or maintain muscle tissue.

Since muscle tissue is metabolically active, the more muscle you have, the higher your BMR. Crash diets

that lead to loss of muscle tissue result in a decline in BMR. A moderately low calorie diet combined

with a somewhat vigorous exercise program will result in a negative energy balance and no drop in

resting energy expenditure.

Research shows that a person can lose weight on just about any kind of diet. The variable that best

discriminates between those who manage to maintain the weight loss and those who do not is

participation in regular exercise. Exercise appears to be vital to maintenance of weight loss.

Exercise also improves the mood and self esteem while decreasing the risk of heart disease, hypertension

and other disorders associated with a sedentary life style. Aerobic exercise is the best type of exercise for

burning calories. Resistance exercise, such as weight lifting, does not burn as many calories as the

aerobic exercise, but it does increase muscle mass and can help maintain metabolic rate. Those who are

very overweight should get their physician’s exercise recommendations before beginning a program of

vigorous exercise.

Assignment 14

OK, now for Moodle, answer the following questions:

1. TRUE/FALSE: Weight loss is a simple question of metabolic balance.

2. TRUE/FALSE: The same amount of fat and carbohydrates contain the same amount of calories.

3. TRUE/FALSE: The energy spent converting fats and carbohydrates into energy fuel for the body is the

same.

4. TRUE/FALSE: Crash diets are very effective as a weight control/loss method.

5. TRUE/FALSE: Keeping up the body’s basal metabolic rate is very important when losing weight.

6. TRUE/FALSE: Often those who use crash diets end up yo-yoing, which is dangerous to your health.

7. There are certain risks to weight cycling, they are:

A. Development of extreme flatulence

B. Development of hypertension, artery and gallbladder disease

C. Development of weak muscles

D. Development of severe headaches

8. TRUE/FALSE: Weight cycling may lead a person to replacement of muscle with adipose tissue.


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9. TRUE/FALSE: Successful weight control programs are based on behavior change, developing nutritious, low fat eating habits for life.

10. TRUE/FALSE: Exercise on a regular basis is essential to maintain a good weight after losing.

11. TRUE/FALSE: Exercise does nothing for the mood and self esteem.

15. SELF CORRECTION EXERCISE TO REGAIN BALANCE IN THE SHOULDER GIRDLE Following is an article by Bob King of Chicago, IL entitled Methods for Correcting Upper Quarter Strain

Patterns. This was originally printed in the Massage Therapy Journal, Summer of 2010 and Bob has

kindly given us permission to use it.

Please read this information carefully and then begin to practice the exercises. As the majority of us have

shoulder imbalance to one degree or another, these exercises and stretches are extremely appropriate for

massage therapists to practice daily. These may mean you stay a massage therapist for life with the

ability to take a full schedule of appointments rather than opting out of the profession due to

shoulder/neck strains that affect the arms and hands. Many, many massage therapists make the mistake of

not taking care of themselves and then end up with an injury or two that makes it impossible for them to

stay in this profession. Don’t let that happen to you; begin now to self correct and maintain. That is an

important aspect of professionalism as well.


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Methods for Correcting Upper Quarter Strain Patterns – Article by Robert K. King Massage Therapy Journal, Spring 2005


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Assignment 15

Perform your exercises for 10-14 days straight on a daily basis, go into Moodle and write about your

experience. Discuss what it felt like to begin, and then how your progression has been over the 10-14

days, do you need to change your approach, etc. Then write appropriate comments on two of your

classmates' experiences.

16. STRETCHES FOR THE MASSAGE THERAPIST TO USE FOR SELF CARE The following is an article on stretching by Joe Muscolino who has kindly given us permission to use it.

It is called “Feel the Stretch” and was originally published in the Massage Therapy Journal June, 2010.

As discussed above for the Bob King article. This may be the most important thing you begin to practice

on a regular basis for yourself. This may be what keeps you in business working strain free!! Please

begin to practice these stretches on a daily basis.


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Feel the Stretch – Article by Joe Muscolino June 21, 2010

Receiving massage therapy can be extremely relaxing and therapeutically beneficial for the client. for the massage therapist, however, giving massage can be a strenuous physical activity.

Over time, an accumulation of physical stress can begin to take a toll on our muscles and joints. Overuse of muscles can cause them to become chronically tight and sore; and compression and torque forces on the joints can lead to joint dysfunction and pain. In turn, joint pain can lead to further tightening of the muscles via protective muscle splinting and the pain-spasm-pain cycle. Tight muscles can then further limit joint motion, leading to fascial adhesions. This cycle, once begun, can be difficult to stop.

The key is to be proactive and practice self-care so that we prevent problems from occurring in the first place. One aspect of self-care for the therapist is to employ good body mechanics. However, even the best body mechanics do not eliminate physical stress to the therapist’s body; they simply minimize it. It is also wise to space out the scheduling of clients to give our body time to rest and heal. And certainly, if we recommend to our clients that they receive massage for their well-being, we should do the same and receive massage ourselves. However, as important as these things are, perhaps no aspect of self-care is more important than regular stretching.

Stretching is very simple. The essence of stretching is that it lengthens soft tissues. Taut soft tissues limit motion, whether they are tight muscles or any soft tissue that has accumulated fascial adhesions. Stretching can help to reverse this process. Even better, stretching on a regular basis can prevent soft tissues from becoming taut in the first place.

When and How to Stretch

There are a number of choices when it comes to stretching. Perhaps the first question is: When should we stretch? Interestingly, the answer to this question largely rests on what type of stretching is done. Stretching can be broadly divided into two main types: classic, static stretching and dynamic stretching.

Static stretching, as its name implies, involves a stretching position that is statically held; that is, it is held for a prolonged period of time, usually between 10 and 20 seconds (although some advocates recommend holding the stretch for several minutes). Three repetitions are usually performed. Dynamic stretching, on the other hand, is a more movement-oriented style of stretching in which the position of the stretch is held for only a very short period of time, usually between one and three seconds. A greater number of repetitions, usually between five and 10, are performed. Also known as mobilization stretching, dynamic stretching is actually as much a warm-up activity for the body as a stretch.


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Returning to our question of when to stretch, conventional wisdom now states that classic static stretching should be done only after the tissues of the body are first warmed up by physical movement. For the massage therapist, this means that we should statically stretch after giving massage, or after engaging in some other physical activity, such as exercise. Alternately, we could statically stretch after warming the body via the use of heat, perhaps a shower, bath or even a heating pad.

If static stretching is best performed after giving massage, then dynamic stretching is best done as a combination warm-up mobilization and stretch before giving massage.The movement aspect of dynamic stretching better increases local blood circulation and moves synovial fluid, aiding in better nutrition to the joint surfaces. And, of course,the soft tissues on the other side of the joint are lengthened and therefore stretched.

How hard should we stretch?

Stretching is like the proverbial Goldilocks and the Three Bears story. Too gentle and nothing is accomplished; too strong and the muscle will respond with a muscle spindle stretch reflex that causes a spasm. Muscle spindle stretch reflexes are triggered by a stretch that is either too strong or too fast. Therefore, the force of a stretch needs to be just right, and it needs to be done slowly.

When stretching a muscle, bring the muscle to the point of tension where it just starts to resist the stretch; then the muscle should be slowly stretched, just slightly longer than the point where tissue tension was reached.

How much time should we spend stretching?

How much time we spend stretching is largely determined by the logistics of our schedule and how much of our body we want to stretch. Engaging in a stretching program that the entire body is optimal. If time is tight, however, there are certain key regions of the massage therapist’s body that tend to be physically stressed more than the others. These regions are the shoulder and forearm of the upper extremity, posterior trunk and neck muscles of the spine, and the hip flexors, hamstrings and plantarflexors of the lower extremity.

The figures below demonstrate a stretch for each of these key regions. They should be performed bilaterally. If we assume that a stretch of a muscle/muscle group typically takes between 30 and 60 seconds, then the following routine should require approximately 10–15 minutes. Of course, if one of these specific regions is tighter than the rest, then it may be desirable to stretch that region more often than the other regions. If a stretch is performed correctly—not done too forcefully, too fast, and does not cause pain—then it can be repeated during the day as often as desired

UPPER EXTREMITY: Most often when massaging, we contact the client with our hand or occasionally our forearm or elbow. This means that the pressure that we are exerting into the client passes through our upper extremity. Further, the posture of massaging the client often results in a rounded shoulder posture (scapular protraction with glenohumeral joint medial rotation). For this reason, it is especially important to address the musculature of this region. Figures 1-5 demonstrate stretches for the upper extremity.

SPINE: Because we are so often posturally inclined forward when massaging the client, the posterior extensor musculature of our trunk and neck is especially used/overused to isometrically contract to maintain this imbalanced posture.Therefore it is important to stretch these muscle groups. If we lean to the side when working, the lateral trunk musculature should also be stretched. Figures 6–8 demonstrate stretches for the trunk and neck.


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LOWER EXTREMITY: Much of the force that we create during a massage can and should be generated from the lower extremities. It is especially important to stretch the gluteal, hip flexor, hamstring, and gastrocnemius/ soleus groups. Figures 9–12 demonstrate stretches for these groups of the lower extremity.

12 STRETCHES THAT SHOULD BE A PART OF YOUR SELF-CARE PROGRAM.

ILLUSTRATIONS © MOSBY/ THE MUSCLE AND BONE PALPATION MANUAL, WITH TRIGGER POINTS, REFERRAL PATTERNS, AND STRETCHING

FIGURE 1 demonstrates a stretch of the pectoral and anterior deltoid regions.

Place the forearm against a door frame and lean into the doorway. Note: The arm is shown abducted to ninety degrees (i.e., horizontal); it could be abducted more or less to better stretch lower or upper fibers of the region respectively.


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FIGURE 2 demonstrates a stretch of the posterior shoulder and shoulder girdle

region. The arm is moved or brought forward and across the chest. Changing the height of the arm can alter which fibers are optimally stretched.

FIGURE 3 demonstrates a stretch of the muscles of the glenohumeral joint. A

towel is used to facilitate this stretch. Pulling upward with the left hand stretches the right shoulder region; pulling downward with the right hand stretches the left shoulder region.


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FIGURE 4 demonstrates stretches of the muscles of the wrist and fingers. A, flexors; B, extensors. Note: Extreme caution should be used when performing wrist joint stretches because of the increased compression force that is placed into the carpal tunnel. If these stretches cause any pain or discomfort in the wrist, they should be discontinued. The muscles of the forearm and hand that are involved in these stretches are easily accessible and can be self-massaged instead.

FIGURE 5 demonstrates a stretch of the flexors and adductors of the thumb.


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FIGURE 6 demonstrates two stretches for the extensor muscles of the posterior neck. Both stretches involve flexing and laterally flexing the neck and head. In A, ipsilateral rotation is added; in B, contralateral rotation is added.

FIGURE 7 demonstrates a stretch for the extensor muscles of the posterior trunk. Both knees are drawn into the chest. To increase the stretch for the extensor muscles on one side, deviating the thighs toward the opposite side can be added to the stretch.


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FIGURE 8 demonstrates a stretch for the lateral trunk.

FIGURE 9 demonstrates a stretch for the gluteal region. The thigh is drawn up

and across the body. Varying the exact angle of the thigh can optimally stretch different fibers of the gluteal region.


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FIGURE 10 demonstrates a stretch for the hip flexor group. Note: When performing this stretch, it is important to keep the trunk vertical.

FIGURE 11 demonstrates a stretch for the hamstring group. With the knee joint fully extended, rock forward with the pelvis (the spine does not need to bend).


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FIGURE 12 demonstrates a stretch for the plantarfl exors of the posterior leg. A, for the gastrocnemius, the knee joint must be extended. B, for the soleus, the knee joint should be flexed. For both muscles, the heel must remain flat on the floor.

When stretching a muscle, bring the muscle to the point of tension where it just starts to resist the stretch. Then the muscle should be slowly stretched, just slightly longer than the point where tissue tension was reached.

Adding neural inhibition to the stretch

A stretch can be enhanced by adding a neural inhibition component, whether performed statically or dynamically. Neural inhibition involves the nervous system inhibiting; in other words, relaxing a muscle so that it can be stretched more effectively. Two nervous system reflexes can be utilized for this: reciprocal inhibition reflex and the Golgi tendon organ reflex.

RECIPROCAL INHIBITION is a reflex that inhibits/relaxes the antagonist muscles when an agonist (mover) muscle is contracted. The key to using this reflex is to create a scenario in which our target muscle (the muscle to be stretched) is the antagonist of a joint motion. It’s quite simple to do. We contract our musculature to actively move our body into the position of stretch of the target muscle. For example, if our target muscles are the hip fl exors, we simply move the thigh into extension at the hip joint.

In effect, any dynamic stretch adds the component of reciprocal inhibition if we actively move the body part into the position of the stretch instead of passively moving it there. For example, when stretching the posterior shoulder region as seen in Figure 2, instead of using the left hand to bring the right upper extremity into the position of stretch, we contract the anterior shoulder musculature of the right upper extremity to actively move it into the position of stretch. In addition to the mechanical component of stretching the posterior soft tissues, the posterior muscles will be reciprocally inhibited so they can then be stretched more effectively.


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Once the position of stretch is reached, we then further stretch the target musculature; this is done passively by using the left hand to stretch the right upper extremity. Stretches that utilize reciprocal inhibition are called agonist contract (AC) stretches. Aaron Mattes’ technique, active isolated stretching, is a form of AC stretching. AC stretches are usually performed dynamically; therefore the position of stretch is only held for a couple of seconds and eight to 10 repetitions are performed.

THE GOLGI TENDON ORGAN REFLEX inhibits a muscle from contracting if that muscle is first contracted with moderate or greater force. To utilize this reflex when stretching, we need to first actively contract our target musculature. This is usually done isometrically against the resistance of our own body. If the right-sided posterior neck musculature in Figure 6 are our target muscles, instead of simply stretching the neck with the left hand, we would contract the right-sided posterior neck muscles against resistance provided by our left hand. Then we would use our left hand to bring the neck into a position of greater stretch (flexion and left lateral flexion).

Stretches that utilize the Golgi tendon organ reflex are called contract relax (CR) stretches. They are also known as post-isometric relaxation (PIR) and proprioceptive neuromuscular facilitation (PNF) stretches (Note: AC stretching is also sometimes known as PNF stretching). The isometric contraction of a CR stretch is held between five and 10 seconds, and three to four repetitions are usually performed.

Any stretch can have a neural inhibition component of CR or AC stretching added to it. Logistically though, it is sometimes easier to convert a stretch into one or the other depending upon the mechanics of the situation. Because both CR and AC stretching require active contraction of musculature, they have the added benefit of strengthening musculature and improving neural pathways from the central nervous system.

Joseph E. Muscolino, DC, has been a massage therapy educator for 24 years and currently teaches anatomy and physiology at Purchase College. He is the owner of The Art and Science of Kinesiology in Stamford, Connecticut, and the author of The Muscle and Bone Palpation Manual, The Muscular System Manual and Kinesiology, The Skeletal System and Muscle Function textbooks (Elsevier, 2009, 2010 and 2006). Visit Joseph’s website at www.learnmuscles.com.

- End of Article

Assignment 16

Perform your exercises for 10-14 days straight on a daily basis, go into Moodle and write about your

experience. Discuss what it felt like to begin, and then how your progression has been over the 10-14

days, do you need to change your approach, etc. Then write appropriate comments on two of your

classmates' experiences.

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