It's important for everyone to exercise, and we should all find the preventive maintenance fitness program best suited for us. There is no alternative, nor substitute that increases the potential for a happier, healthier and improved quality of life. “If exercise could be packed into a pill, it would be the single most widely prescribed, and beneficial medicine in the nation,” says Robert N. Butler, MD, director of the National Institute on Aging.
For those with amputations it's even more important to stay fit. Lower limb amputees tend to be more sedentary than others. Physical movement needed to perform normal daily tasks decreases for most. This is why heart, lung and circulation risks are higher, and statistics show weight gain is common following an amputation. Also, the upper torso must compensate for lower limb loss (and vice-versa), so superior strength and flexibility in compensating muscles are imperative.
“People won't exercise unless they find it enjoyable,” says Bruce E. Becker, M.D., director for St. Luke's Rehabilitation Institute in Spokane, Wash. Becker says most people don't automatically relate exercise to fun — but they should. Prosthetics today provide lower-limb amputees the ability to walk, ride stationary bikes and engage in other forms of enjoyable fitness regimes. Water is the preferred fitness environment by specialists because it provides a “weightless atmosphere.”
For recent amputees, of course, the first step is a therapy and rehabilitation program. Once the patient is able to motivate, the next step is to develop a long-term fitness program that will offer the best quality of life. Regular exercise does more than keep the body fit. It relieves depression and activates the endorphins, thereby providing an ongoing supply of high energy, lower stress and tension and improved sleep patterns. When we feel energetic, we want to do things with our lives.
Getting Over The Depression — And On With Our Lives
Becker says following an amputation, many people focus their lives around the loss. “I see this in patients with stroke and muscular dystrophy as well,” he says. “Health care intervention is often ignored in light of the bigger picture — life is moving on for all of us. It's imperative to maintain an activity pattern in personal, social and business aspects. It doesn't take an overwhelming activity program to maintain a healthy life. A study conducted by the Journal of Medical Association (JAMA, vol. 277, no. 16, April 23-30, 1997) included 11,470 women to determine that many benefits come when a sedentary level is increased to merely a normal level — daily routine movement. The study revealed that the life preserving aspect of this minor change is huge.”
Becker says just as with the entire population, those with amputations are living longer today, and a good quality of life depends on staying active. “In the days of old it was believed that 30 minutes of rigorous exercise every other day was necessary,” he says. “The medical community has proven this is not true. Fitness, for everyone, should be combined with social and entertaining activity for people to remain inspired and eager to participate. This can mean a brief walk or splashing around in a pool for a few minutes.”
Everyone has individual preferences on what they find enjoyable and pleasurable, according to Becker. “Telling my patients what I think is best for them doesn't work,” he says. “I tell them to find the activity they like. Some amputees are shy about going into a public pool, for example. It won't do any good for me to try to change their minds. My work is better effective by demonstrating the many options available and letting them find their own path. As long as they're moving and active, it's a success story.”
Kinesiotherapist Speaks On The Need For Fitness Education
Ruth I. Meyer, a kinesiotherapist with the Aquatic Healing Services in Nashua, New Hampshire, says it's a big word, but it translates into “the educational model of looking at exercise and applying it therapeutically.” We work with many amputees in therapy and rehabilitation, then we help them establish an exercise program with a health club in their community,” Meyer says.
Meyer says people with amputations tend to get muscle contractions. “Since the limb isn't as long, and doesn't weigh as much, it pulls into a tightened position. Some of this is pure mechanics of how the muscular system works with lower amputees, but some has to do with the prosthetic they're using,” Meyer explains. “The goal is to get the patient from a sitting into an upright position and stretching out the hip muscles, strengthening the gludial muscles and then balancing these muscles. The same thing happens with upper torso amputees. The strength and flexibility of the biceps and triceps must be balanced. We look at posturing relative to how the body compensates for the limb loss, and attempt to stretch the torso to correct any problems. We also look at back and neck strength to determine if compensation is happening in these areas. The patient's ongoing exercise program is developed on their individual tendencies to compensate on specific areas. We also look at breathing and how posture affects it.
“The ideal long-term exercise programs includes movements that offer improved and ongoing function,” Meyers continues. “The ultimate goal is to keep people independent as long as possible. Many forms of exercises, as well as accessories like flotation devices, barbells and accessories prove helpful to amputees.”
Meyers recommends exercising at least three, preferably five times each week. “This doesn't necessarily mean going to a health club for programmed exercise,” she says. “It does mean parking further away from the market and walking a longer distance to the door, for example. It means taking an active, rather than passive role in daily routines. It's possible for people to break down their fitness regime to fit their personal lifestyle, regardless of the amputation. Joints, muscles and tissues were designed to move, and not accommodating nature's natural cravings always results in problems.”
Although phantom pains are a heart-wrenching problem with no known cure, Meyers says increasing the endorphin levels increases the body's discomfort tolerance. A runner's rush of adrenalin works on the same theory. It doesn't change the pain, but it does change the perception and tolerance level to the pain. If you're sitting home thinking about it, you're sure to feel bad. Distraction in another area helps keep your mind off the problem, thereby reducing its effect.
Aquatics — The Multi-Beneficial Environment
Mark Sutter, marketing and public relations director for Aquatic Care Programs in Humble, Texas, says trainers look at upper body strength and cardiovascular conditions. “Sedentary people can mean possible risks in these areas, so we proceed with caution. Once the rehabilitation process permits, we begin developing a long-term maintenance program,” he says.
Sutter claims they treat amputees the same as those with other disabilities. “We either stress or eliminate certain types of exercise depending on the individual's physical state,” he says. “Attention is paid to specific areas with the patient's daily activities in mind. We want them to make it through a typical day without feeling fatigued at its end. Upper body, torso and spinal areas are of prime concern. We teach them to use flotation belts that offer security and full body movement. Aquatic therapy has a number of benefits because the range of motion, assisted with buoyancy, creates resistance with gradual force. As the person grows stronger and exerts more stress on the water, the water responds by delivering higher levels of force on the body. This provides a self-regulated and progressive form of exercise. This variable resistance graduates with a person's strength.”
Joint stress and muscle pull risks are eliminated in the water, as well, according to Sutter. “We use a variety of aquatic exercises they wouldn't be able to do on dry land,” he says. “We suggest people exercise between three and five times a week for 20 to 30 minutes. This keeps the muscles limber and maintains progressive strength and endurance development.”
Sutter says aquatic research now in progress shows that phantom pains are the result of signals sent to the brain from the nerve root of the missing limb. “Results of these studies show that during exercise the sensory impulses traveling from that area of the body to the brain are increased in neural output. This helps alleviate a level pain because of the increased neural response.”
Sutter says another benefit of aquatic exercise is it eliminates the fear many people have of falling. “This is an important aspect of a progressive and successful exercise regime,” Sutter says. “Letting go of fear is the first great step in getting them back to a natural and as normal lifestyle as possible.”
Nutrition And Diet — A First Cousin To Exercise
One without the other is like eating fries without catsup — it just doesn't work as well. A regular exercise regime means eating a balanced menu of foods, watching fat intake and supplementing the diet with nutrients and vitamins. However, when people exercise regularly, their diet must compensate for the extra calories burned.
Becker says nutritionists and dietitians at St. Luke's work with amputees during the in-patient process. “We concentrate on dietary modification in terms of decreased muscle mass associated with loss of limb. The key here is that during hospitalization and rehabilitation, the patient is being overloaded with information, and dietary issues tend to take a back seat to the other issues the amputee is dealing with at the time. Nutritional issues necessitate an education so the patient will learn to use a diet program long after they are home and on their own. If they don't, weight gain is the likely result. Many people lose weight following an amputation, but as they heal, their appetites return and they don't compensate for their sedentary lifestyle or muscle loss,” he says.
A biological regulation — called a “set point,” is how the body knows if it's maintaining, gaining or losing weight. During a medical crisis such as an amputation procedure, substantial weight loss commonly results. The person upwardly regulates the set point so the body attempts to recapture the weight loss. Becker says he sees this happen frequently. “The weight regain begins, but instead of leveling off at the previous weight — the gain continues,” he notes. “The patient struggles from that point to lose the excess. We counsel patients to stay aware of this possibility by telling them what their adjusted body weight is in the absence of the portion of body weight they've lost in the amputation. We also tell them it's important to weigh themselves regularly, and to watch small weight gains carefully. I want my amputees to be very body conscious, but not to the point where it limits their social activity. This is a very important part of the mental aspects of healing, and we want them to feel better about themselves, not more of an exception.”
Becker says amputees should be aware of maintenance of bone mineral content as well. “Clearly, exercise aids this area,” he says. “Impact-loading exercises are best, but it's often harder for those with bilateral amputations than unilateral. Nutritional calcium helps to build muscle force across the spine and trunk, and mixed with impact-loading exercises is the best combination. Proper diet and nutrition is important in this population because it is harder to find ways to increase the metabolic burn rate and reduce the risk of obesity. It's hard enough to maintain an active enough lifestyle to eat up all the calories a typical American diet dictates today for those who have all their limbs – it's imperative, therefore, for those with amputations.”
Natural Herbs — Hot On The Market For Good Reason
There is more media attention on holistic and all-natural supplements today than ever before. Some medical practitioners lean away from recommending these products to patients, but current governmental and institution research may change this fact in the near future. Study results spurs increased interest and approval in the medical community, and this is what herb manufacturers and holistic healers say will create increased interest in herbology.
Medical Professionals Taking Herbology Seriously
Gary W. Elmer, Ph.D., an associate professor in the Department of Medicinal Chemistry at the University of Washington, has studied the medicinal qualities of herbs for more than 30 years. He also authored The Vitamin Book (Phantom Publishing Company, July 1999). He says strong consumer interest is fueling the scientific and clinical communities to evaluate herbal products.
“Duke University is, for first time, funding the study of St. John's Wort. It is being compared against placebos and SSRI (selective seretonin reuptake inhibitors), a group of antidepressant type drugs,” Elmer says. “Some pharmaceutical companies, mostly European, are funding some current studies as well. Echinacea is shown to be effective against colds and influenza if it's taken at the onset. People who take it all through the year, or during the cold-season months, are building up a resistance to the herb, so it isn't helpful.”
Elmer elaborated on the consumer's misunderstanding of herbal medications and how they work. “A short while ago the consumer was in an almost impossible situation because there was limited information available on herbs,” he says. “Today, however, many good books are available, so anyone interested in researching will find the information they seek. If the herbal product is not well documented these books will say so. Consumers should avoid herbal use unless they are certain the herb is harmless and doesn't interact negatively with other medications they use. Rather than using herbs based on information shared at cocktail parties, over lunch, or how much a friend says they improved when they took mega doses of an herbal supplement, people should do their own research. Each person is different, and each will react to herbs differently, just as with medications.”
The medical community is being forced to look at herbal alternatives because of consumer demand, according to Elmer. “Doctors have traditionally felt that as long as the prescription drug is helping the patient, and the patient isn't having a negative reaction, they will continue to administer FDA approved drugs,” he says. “This is changing rapidly. The government is beginning to fund research. When multiple studies indicate the same results, doctors stop and pay attention. It's coming around, but the lack of quality control of herbal products is a large detriment.”
Is The Medical Community Pressured Into Learning?
John Toerge, D.O., is senior vice president for medical affairs and medical director at the National Rehabilitation Hospital in Washington, D.C. He says doctors are being pressured by mainstream America's demand to know more about alternative medications. “Another problem is patients who come into the emergency room and are asked for a list of medications they take,” Toerge says. “They'll either not mention the herbs because they don't consider them drugs, or say, ‘Just some vitamins.' This is a tough situation to deal with because the medical establishment isn't trained enough in the field to recommend them. We don't know the dosage amounts or the effects the dosage will have.”
There is no question that doctors are beginning to take herbology as alternative medications seriously, according to Toerge. “I know doctors who have completed or currently take homeopathy courses, partially dealing with herbs,” he says. “In general, people don't like a lot of drugs pouring through their body, and doctors realize this. Conversely, as much harm can be done with herbal use. Still, doctors are hearing more and more about herbs, and are basically forced to investigate so they have the correct information to provide to patients.”
Toerge said rehabilitation is a good place to begin working with herbal alternatives because they use medications alternatively depending on the patient's problems and ability to react to substances. Yohimbie is used for sexual prowess, for example, and may prove beneficial to patients with problems in this area. Some herbs act similar to anabolic steroids, but are not steroids. They seem to increase strength and function, so there also is interest in these areas.
Toerge agrees the big drawback is major drug companies won't be inspired to fund proper research because they don't stand to make enough money to support the usual multi-million dollar research and development stages. “The FDA basically has the easy task,” Toerge continues. “All they have to do is provide oversight to what the drug companies are doing. They don't have the funding to do the research themselves, so their only responsibility is to get things off the market that are proven harmful.”
Toerge said the important thing is for those who are taking herbals to advise their doctors. “To not do so is really compromising their own care,” he says. “They should ask their physician if he is familiar with the herb, and not to run away from the doctor if he isn't. There is enough material available that the necessary answers can be found.”
People should carry a complete list of herbs, vitamins and prescriptions they take. In case of an emergency situation, this information is tremendously valuable.
Christina DeMartino is a nutritionist and a full-time freelance writer/author residing in West Palm Beach, Florida.
Herbs In Today's Spotlight — And The Believed Health Benefits
Aloe (Aloe Barbademsis)
For skin burns and wounds, Aloe is most effective when used topically in its purest form — preferably from a freshly cut stem of the plant. Administered internally, it is found effective against constipation and stomach disorders. It also is used as an antibacterial against Herpes Simplex viruses.
Cayenne (Capsicum Annum)
The drug is recommended for gastrointestinal disorders, loss of appetite, dyspepsia, diarrhea, alcoholism, seasickness, malarial, yellow and other fevers, prophylatically for arteriosclerosis, stroke and heart disease as well as to increase potency.
Yarrow (Achillea Millefolium)
Internally, Yarrow is used for loss of appetite and dyspeptic ailments such as mild, spastic discomforts of the gastrointestinal tract, including inflammation, diarrhea, bloating and cramps. Externally, it is used for healing wounds.
Garlic (Allium Sativum)
Garlic is used as a supportive to dietetic measures for elevated lipid levels in blood. The drug also is used as a preventative measure for age-related vascular changes. Other common uses include healing benefits for arteriosclerosis, common cold, coughs, bronchitis, fevers, inflammation of the mouth and pharynx, and it reduces the tendency to infection.
Ginseng (Panax Ginseng)
Ginseng is used as a tonic for invigoration and fortification in times of fatigue and debility, and for declining capacity to work and concentrate. It is used during convalescence and to increase stamina.
Purple Coneflower (Echinacea Purpurea)
Echinacea is reported to accelerate the healing of wounds and burns and to produce immune effects when given internally or parenterally. Effects include increases in the number of white blood and spleen cells. It is effective against common colds, coughs, bronchitis and fevers when administered at the onset of symptoms.
Ginkgo (Ginkgo biloba)
Ginkgo inhibits the development of traumatically or toxically induced cerebral edema and acceleration of its regression. It also aids in the symptomatic relief of organic brain dysfunction, intermittent claudication, vascular originating vertigo and vascular originating tinnitus.
St. John's Wort (Hypericum Perforatum)
A mild antidepressant, sedative and anxiolytic action of this herb and its preparations has been observed and reported by numerous doctors. Studies demonstrate the antidepressive effect may be due to the presence of a monoamine oxidase inhibiting function in the active agents. It also is used for inflammation of the skin, blunt injuries, wounds and burns.
Flaxseed (Linum Usitatissimum)
Flaxseed is used for chronic constipation, colons damaged by abuse of laxatives, irritable colon, diverticulitis and as mucilarge for gastritis and entertis. A decoction is used for bladder inflammations and gastritis.
Saw Palmetto (Serenoa Repens)
Saw Palmetto is used for urination problems in benign prostate hyperplasia stages I and II. This medication relieves only the difficulties associated with an enlarged prostate without reducing the enlargement.
Yohimbie Bark (Pausinystalia Yohimbe)
Yohimbie bark is used for sexual disorders, as an aphrodisiac and for feebleness and exhaustion.
Vervain (Verbena Officinalis)
Verbena is used for diseases and ailments of the oral and pharyngeal mucosa, including sore throats and respiratory tract conditions. Vervain is used extensively in folk medicine for pain, fatigue, digestive disorders and a malady of other conditions.
Valerian (Valeriana Officinalis)
Valerian is used for restlessness, sleeping disorders caused by nervous conditions, mental strain, lack of concentrations, headache, nervous stomach and several other conditions related to nerves and the stomach.
