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MS Research Update: How reliable are biomarkers measured by multiple providers?

Mobility issues secondary to strength, balance, and walking problems affect up to 80 percent of people with multiple sclerosis (MS). Providers and therapists use a variety of scales and tools to measure the extent of these issues such as:

 

  • The Berg Balance Scale (BBS) is a measure of balance that uses a 14-item scale and is scored based upon the results 0-56.
  • The 6-minute walk (6MW) is a measure of walking endurance.
  • Handheld Dynamometry (HHD) is a way to quantify manual muscle strength testing.

 

There is a lot of emerging research about “MS biomarkers,” which are values that look for ways to predict how patients will do in the future. The above tests are “physical biomarkers” of patient performance that may be able to be used as measures of disease state and change over time.

 

Often patients and clinicians are left wondering how accurate the results of these tests are. For instance, if provider A performs a functional test on a patient, will provider B get the same results if administering the same test to the same patient?

Mother Nature’s Role in Healing Our Children

I am a pediatric hospitalist. That is, I am a pediatrician who takes care of children sick enough to be hospitalized. So my writing about the importance of children spending time outdoors and enjoying nature might be surprising. Even though I may only take care of a child for the worst few days of their life, I am still quite passionate about the fundamental role of outdoor play in a child’s health and well-being.

Even during acute illness, I find that children often heal faster when they are given more opportunities to be playful and (illness-allowing) go outdoors to allow Mother Nature to heal them from within. So needless to say, I am often amazed at how little exposure many of these children have had, even prior to becoming ill, to spend time playing outdoors and getting to know their environment.

Now especially, as the days begin to get longer, and the refreshing spring air returns to our beautiful Pacific Northwest, I start thinking about all the wonderful outdoor fun I used to have as a child, and the importance such activities had on my own health and overall sense of well-being.

I worry that children of today encounter ....

Free Class on Nutrition for Young Athletes to be Held at Swedish/Issaquah Feb. 20

ISSAQUAH, WA, Jan. 23, 2013 - With spring sports starting, don't drop the ball on nutrition. Nutrition is just as important as physical conditioning for athletes. So, as spring sports begin, let Swedish help you and your children prepare to hit it out of the park. Join Registered Dietitian Ally Colson for an interactive training on game-winning meals and snacks and help your young athlete become a nutrition champion.

Exercising in the heat

Even though regular exercise is important for cardiovascular health, exercising in hot weather can lead to heat exhaustion or even heat stroke. These conditions result from the production of excess body heat, overwhelming the body’s capacity for heat release and raising the core body temperature.

What you should know:

The signs and symptoms of heat exhaustion include:

  • heavy sweating
  • fatigue
  • headache
  • pale and clammy skin
  • thirst
  • increased heart rate
  • dizziness or fainting
  • nausea and vomiting
  • muscle and abdominal cramps
  • elevated temperature.

What is heat stroke?

Heat stroke occurs when the core body temperature exceeds 104 degrees F, accompanied by seizure or coma. The primary cause of heat exhaustion and stroke is dehydration with inadequate fluid and electrolyte repletion. Those with the following risk factors are particularly prone to heat exhaustion and stroke: extreme young or old, pregnancy, chronic illness (in particular cardiac or respiratory diseases), alcohol consumption, extreme physical exertion, and certain medications.

So how do I exercise in the heat?

Organized sports activities: safety and benefits

A lot of children are now enrolled in organized sports activities, and more and more children are starting at a younger age. Children are enticed by successful professional sports players and strive to be like them. Many parents enroll their children in organized sports activities with the hope that their child would get an athletic scholarship for college and go on to become a professional player. However, parents must realize that only a few children end up becoming successful professional players.

It is important for children to be physically active, and organized sports can be a part of this healthy lifestyle. Studies have shown that children and adolescents who are physically active do well academically in school, have greater self-esteem, sleep well and have less behavioral/emotional problems. Children and adolescents who are active every day tend to develop less health problems like hypertension, obesity and hyperlipidemia , and grow to become healthy adults.

Here are some important ideas to keep in mind when your child is enrolled in organized sports activity:

Let it snow

Have you been outside enjoying this weekend's snow fall?. Whether or not you were able to play outside, we thought we'd share some new videos in our robotic surgery series that don't require going out in the cold..and might give you inspiration of a craft project to do with your kids.

In Seattle, we can make a snowman:

And not only can our robots (driven by our robotic surgeons)
fold paper airplanes, but they can also make a snowflake:

Childhood obesity

Eating healthy and being physically active are important things to keep in mind during and especially after the holidays when an abundance of food is present.

Parents often have questions about their child’s weight such as: Is my child’s weight appropriate? Is there a difference between being overweight and being obese? When should we be worried about his or her weight? If I am overweight, what is the risk that my child may become overweight?

Physicians often use the term BMI (body mass index) to define the terms overweight and obese, and this provides physicians and parents with a guide to monitor weight in children. BMI can be calculated using the weight and height (weight in kilo divided by square of height in meters; this can also be calculated using the BMI calculator. A child is considered overweight if the BMI is greater than the 85th percentile and obese if greater than 95th percentile. Once a child is obese, they are at risk of developing complications like hypertension, high cholesterol levels, diabetes, etc.

Physical activity should be a significant part of everyday life of your child. Each child should aim to be active for a minimum of 30 minutes per day. They can be enrolled in an organized sports activity program like football, soccer, baseball, or swimming, or they can remain active by riding a bike, jogging and so on. Parents need to be aware if their child is playing video games for hours at a time and restrict the amount of screen time if necessary. Reduced television watching and computer use may reduce BMI and sedentary behavior.

Eating healthy plays an essential role in the well-being of every child. Studies have shown a lower prevalence of obesity in children who eat a healthy breakfast every day. Parents need to provide children with healthy food options at home so that they can develop a habit of eating healthy. It is important for children to try to eat all food groups, including grains, vegetables, fruits, dairy, and meat or fish. Fats, oils and sweets must be consumed in limited amounts. Lifestyle modification involving the whole family is a key factor in maintaining healthy weight in children.

What if my child is obese or overweight?

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