Determining Exercise Intensity

If you are new to exercise and are looking to begin a new workout program, you may be wondering what intensity level is appropriate for your goals and your fitness level. Many people aren't sure what intensity levels are defined by and avoid exercises labeled as vigorous intensity due to the fear of injury or lack of ability. As a personal trainer and exercise physiologist, it is my job to help explain these terms and concepts in a more understandable way. In this article, I will break down, light, moderate, and vigorous intensity, so that you, as a physically activity individual, are more educated and comfortable with what it is you are doing in your day to day exercises. It is recommended that a combination of moderate and vigorous exercise be done by most healthy adults, while light to moderate exercises, be performed by deconditioned persons. Intensity is individually based, meaning your intensity level is based on your physical abilities and not generalized by the abilities of others. Ideally, you would want a professional in the field to determine your intensity levels based on a guided fitness test, but I will provide you with information that will allow you to get an estimate without such resources. To do so we will use what is known as the target HR reserve method. This method begins with the HR reserve, which is defined as the difference in your resting heart rate and your maximal HR. Your HR reserve is then multiplied by the appropriate intensity percentage you are targeting, then your resting HR is added back to get your target HR reserve. Below I have demonstrated the method for moderate intensity exercise for myself.

1) To find your estimated HR max, subtract your age from 220.

220-22= 198 bpm. My estimated HR max is 198 beats per minute.

2) To find your resting heart rate, use a radial pulse or HR monitor. My resting HR is 60 beats per minute. I will now subtract my resting HR from my estimated heart rate max to determine my heart rate reserve.

198 - 60 =138 beats per minute.

3) Now I must use the heart rate reserve (HRR) and multiply it by the percentage equivalent to the intensity you are aiming to reach.

a. Light Intensity <50% HRR

b. Moderate Intensity 50-70% HRR

c. Vigorous Intensity 70%-85% HRR

In this case, I would like to exercise at moderate intensity. Therefore, I will multiply my HRR by 50% to get my lowest HR value and then by 70% to get my highest value to remain within that range for moderate intensity.

138 beats per minute X.50 = 69 beats per minute.

138 beats per minute X.70 = 96.6 beats per minute.

4) The last step in this process to get your final range of target HR reserve is to add your resting HR back to the HRR percentage. This allows the equation to consider your cardio endurance level at rest and adjusts accordingly. Below, I have demonstrated how to do so and have found my target HRR range for moderate intensity exercise.

69 beats per minute + 60 beats per minute = 129 beats per minute

96.6 beats per minute + 60 beats per minute = 156.6 beats per minute.

Target HR Range for Moderate Intensity = 129 bpm - 156.6 bpm.

Benefits of Light Intensity Exercise

Light intensity exercise is very beneficial to older adults. It allows them to remain physically active when there may be physical limitations or health concerns preventing moderate or vigorous activity. Light intensity is considered anything below 50% of the target heart rate reserve and provides many health benefits, especially to deconditioned persons. An Oregon State University study, published in the American Journal of Health Promotion, showed a significant increase in health for elderly persons, who participated in light physical activity such as walking. These individuals were less likely to develop chronic illness and had lower body mass index measurements.

Benefits of Moderate Intensity Exercise

Moderate intensity exercise is the most beneficial form of exercise. It yields an enormous amount of health benefits ranging from lower blood pressure, improved cholesterol, weight management, cancer prevention, and much more. Moderate intensity is recommended for all adults unless restricted by a doctor. Moderate intensity is anything between 50%-70% of the target HR reserve and is attainable by doing many activities, such as brisk walking, leisurely cycling, aqua aerobics, and dancing. There is a wide range of ways in which you can be physically active and yield the benefits of moderate intensity, but it begins with you taking that first step.

Benefits of Vigorous Intensity Exercise

Vigorous-intensity exercise is recommended for adults who are habitually physically active and with at least an average physical fitness level. Vigorous intensity is not power lifting or sprinting at Olympic pace. Activities of vigorous intensity include jogging, rowing, elliptical, fast dancing, and aerobics. The target HR reserve percentage is anything between 70%-85%. It is recommended that if you have a history of health-related issues or of middle age you get clearance from your doctor before performing vigorous activity. Vigorous intensity has similar benefits as moderate intensity but also comes with an increase in injury risk. It is recommended that a combination of both moderate and vigorous intensity be attained by the average adult to achieve maximum benefits from exercise.

What Now?

In conclusion, it should be known that intensity levels are of importance but they are not as intimidating as they sound. It is recommended by ACSM that a healthy adult get 30 - 60 minutes of moderate exercise or 20 - 60 minutes of vigorous exercise, or a combination of both, each day for ≥3 to 5 days per week. It is also recommended that if you only participate in moderate intensity, you do this 5 ≥ days a week and if you only participate in vigorous intensity, 3 ≥ days a week. Ask your doctor if you have any concerns about your current fitness level and your ability to perform vigorous intensity exercise. I hope you can take when was mentioned above and use it as a resource on your journey for optimal wellness.

Medical Technologies - Are They a Good Idea?

It is 2017 so I guess we shouldn't be surprised with all the advancements that are being made. Every time we think we are learning one piece of technology the newest model shows up.

In terms of medical professionals this is no different, we also have to get used to new technologies and advancements being made all the time. These technologies are put into place with the idea that they are making the lives of medical professionals easier.

Some of these technologies are proven as beneficial to medical professionals and their patients. While other technologies are questionable to whether they are beneficial or not. I am going to discuss three of these technologies and give my opinions on them.

The question I ask here is do they really make the lives of medical professionals easier or are medical professionals spending more time learning how to use these technologies than on patient care?

The first medical technology is Electronic Health Records, also known as EHR. This system allows all patient information to be added into a database and be reviewed by medical professionals. The information that is added into this system includes:

Basic patient information
Past medical history
Patient medications
Lab and x-ray information and results
Notes on patient visit
Patient diagnoses
Vital signs

Benefits of this system include:

Cutting back on paper since all patient information is entered on this database instead of being hand written.
Allows patients to review their records online through the patient portal.
Allows medical professionals to coordinate care by sending patient information to each other.
Saves space that is required to store paper medical records and allows this space to be used in better ways.
Allows 24 hour 7 days a week access.
It saves time and money.

Some cons of this system include:

Not all patients are tech savvy and won't benefit from this system.
Like with all online systems EHR systems are at risk in regards to cyber hackers and malicious hackers. This means extra diligence is necessary to prevent patient information from being accessed by unauthorized users.
If the system is not updated regularly it can cause issues with the use of the system.
If the internet goes out in a facility than this system is useless.
In my personal opinion I feel this technology is beneficial to medical professionals, as well as patients. It allows patients to be involved in their care by having access to their information instead of feeling they are in the dark and not know what's going on with their care.

This system also has many advantages for medical professionals. One big one is they have more time to communicate with their patients instead of having to spend a lot of time reviewing and charting patient care. I also feel it prevents clutter that may that happens with paper records and reducing the mistakes or errors of medical professionals.

The second medical technology is Infusion Pumps. Infusion pumps are used to deliver fluids, nutrients, and medications to patients. This device helps deliver controlled amounts of fluids to the patient's body.

Some of specific uses for an infusion pump include delivery of:

IV fluids if a patient is dehydrated.
Chemotherapy drugs.
Insulin or other hormones.
Antibiotics.
Pain relievers.

Some specific benefits to these pumps include:

The can be set so the patient only gets the amount of fluid, medication, or nutrition need.
They are easy to use.
They provide wireless drug library and pump data.
Some cons to these pumps include:
There are insufficient updates and upgrades.
Weight based dose checking only allows maximum weight to be entered.

I feel that these infusion pumps are good for patients. On the other hand I feel there needs to be some improvements made to these pumps to reduce error and to offer more update and upgrades.

The third medical technology is the Unique Device Identification Tracker, which is also known as the UDI. This technology is an implant and implantable device tracking software designed for use in an operating room. This device is Internet based and is used to manage and track of all implants.

Some specific implants that this device tracks includes:

Tissue
Orthopedic
Cardiovascular
Any other type of implant

Some specific benefits of this device include:

It allows hospital system integration, which improves workflow.
Provides expiration date alerts, which improves patient safety and reduces waste.
Provides supplier regulatory status, which allows you to view AATB, FDA, and state licenses.
Provides barcode scanning and labels to save time finding what you're looking for and eliminates error prone data entry.
Provides notifications on recalls.
Some cons of this device include:
If a professional scans the wrong item it can lead to major issues.
If the facility using this system does not offer proper training on this device it can lead to major issues or misuse of this device.

I feel this technology is very useful to medical professionals and their patients. It allows for the medical professional to focus more time on patient care and less time on paperwork.

Which makes patients feel they are a priority and that their medical teams truly cares. This device also improves safety for patients since it helps make sure any implants being used meet all requirements for safe implantation.

So my overall analysis on medical technologies is they are a good idea. They are beneficial to medical professionals, as well as their patients as long as they are used properly. I feel these medical technologies do help improve patient care and help make the job of the medical professional easier.

An Understanding of Hiatal Hernia

The term "Hernia" draws origin from the Greek latin word which means "tear" or "rupture". Anatomically it refers to any abnormal protrusion of the abdominal contents.

A "Hiatal Hernia" therefore refers to the abnormal protrusion of the Gastrointestinal Tract through the opening (hiatus) within the diaphragm.

There are two main types of hiatal hernias: sliding hiatal hernias, and paraesophageal hiatal hernias.

Sliding hiatal hernias form when the stomach and the adjoining oesophagus slide up into the chest cavity through the diaphragm. It is more common.

Paraoesophgeal hernias are less common and it occurs when a portion of the stomach squeezes past the diaphragm and is lodged and strangulated in place beside the oesophagus. Such hernias can be asymptomatic but dangerous because the portion of stomach that is strangulated above the diaphragm will have a compromised blood supply.

In most cases, hiatal hernias are asymptomatic but sometimes patients might experience heartburn or reflux. While the two conditions appear to be linked, they do not independently cause the development of the other.

In some cases of heartburn, patients might experience chest pain instead and this can be confused with chest pain caused by cardiac issues.

Causes

Often, the cause remains unknown. However, any condition predisposing to an increased pressure within the abdomen such as pregnancy, obesity, coughing or straining during bowel movements, and/or congenital situations such as a larger hiatal opening will predispose a person to developing one.

Population at risk for developing Hiatal Hernias

There's a predisposition for women, overweight individuals, and patients above fifty years of age to develop this condition.

Diagnosis

A hiatal hernia can be diagnosed with a specialized X-ray called a barium swallow that allows a doctor to see the esophagus or with endoscopy. The procedure involves the patient swallowing a radio-opaque liquid and having X-Rays of the chest and abdomen taken while in the erect posture. The radio-opaque liquid will outline the stomach lining and oesophagus, thereby demonstrating the presence/absence of the condition.

Treatment

If asymptomatic, no treatments are necessary. However, should the stomach become strangulated and there is a risk of vascular compromise to the stomach, surgery is usually needed to rectify the problem.

Other associated symptoms such as reflux disease, heartburn and chest discomfort should be treated accordingly.

When is Hiatal Hernia surgery necessary?

Surgery is indicated when the hernia becomes strangulated and the blood supply becomes compromised.

Surgical intervention for hiatal hernias is often performed laparoscopically (ie keyhole surgery) and is a day procedure. A camera and surgical tools are inserted via keyhole incisions into the abdomen and the surgeon will manipulate the surgical tools to reduce the hernia and possibly tighten the diaphragmatic hiatus. The procedure is usually done as a day procedure, involves smaller incisions, and has less pain and scarring compared to open surgery.

Most patients will be able to ambulate and walk around the next day. There are no dietary restrictions post surgery and patients resume regular activities after a week or so. Complete recovery will take up to a month and the patient should avoid hard labour and heavy lifting.

When Should I Call the Doctor About a Hiatal Hernia?

Speak with your doctor if you are symptomatic. It is difficult to diagnose and symptoms include chest pain, recurrent nausea and vomiting, poor bowel movements and non-specific symptoms like a funny sensation in the middle of the chest.

Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He is a strong believer that comprehensive healthcare at home does not need to cost an arm and a leg.

Fetal Cells, Like Cord Blood and Cord Tissue Stem Cells, Wield Influence Long After a Baby Is Born

More and more parents are now considering cord blood banking for the simple reason that it has the potential to treat many diseases and conditions even after decades of birth. And not only the child, one cord blood unit can secure entire family's future and how! We all know that the umbilical cord ties a mother with her child during birth. However, new studies and researches have shown that fetal cells travel through placenta and often rest in various body parts of the mother.

Arizona State University's Department of Psychology researcher, Amy Boddy said, "Fetal cells can act as stem cells and develop into epithelial cells, specialized heart cells, liver cells and so forth... they are very dynamic and play a huge role in the maternal body."

The presence of the cells of the fetus in mother's tissue is known as fetal microchimerism. Microchimerism, the phrase originated from the Greek mythological term, chimeras that mean creatures created from various parts of different animals. So as the original phrase suggests, microchimerism means the process in which women get cells from different contributors, such as their parents, siblings and children. These cells have the potential to benefit the health of the mother or undermine her condition after years of birth.

Fetal cells that a mother acquires during birth can remain in the maternal tissue after decades of birth. Sometimes, these cells benefit the mother by protecting her from diseases like rheumatoid arthritis and cancer. However, in some cases, it's also seen that these cells cause harmful effects in the mother. But no matter what the effects are, it's clear that these cells have a long-lasting impact on women.

It's worth a mention that fetal cells play an important role in a specific organ, female breasts. Apart from the fact that fetal cells actively participate in lactation after birth, it's also seen that poor lactation might be a result of lower count of the these cells in breasts. In case of breast cancer as well, studies suggest that fetal cells largely influence the condition. It's seen that the women with breast cancer carry fewer cells in their breast tissue. However, there are some researches as well that would suggest that these cells might increase the chance of breast cancer immediately after pregnancy.

Apart from that, fetal cells have a wide impact on the emotional and physical state of a mother. It may range from depression to morning sickness. This is the reason that these fetal cells could be used in therapies in the future to address issues like poor lactation, wounds, tumor and various psychological disorders during pregnancy in women. Athena Aktipis, a fellow ASU researcher said, "If future research bears out the predictions of this framework, it could transform the way we approach, treat and prevent a variety of diseases that affect women, especially new mothers."

Stem cells that have the ability to cure many diseases can regenerate new cells. Fetal cells, like stem cells, have the potential to protect maternal tissues from many diseases and conditions. Both of them leave a long-lasting impact after a baby is born. No wonder, more and more researches are now focusing on fetal cells.