Fatigue can be a very frustrating and elusive condition. Fatigue is often confused with “tiredness”. Tiredness is commonly experienced after certain activities or at the end of a long day. Fatigue is defined as generalized lack of energy not relieved by sleep. It can be “acute” and last one month or “chronic” and last greater than six months. Despite the high prevalence of fatigue, little is known about the etiology. It can arise from both physical and psychological stresses. Possible causes should be explored with a health care provider. Some examples of physical causes include hypothyroidism, heart disease, rheumatoid arthritis, asthma, diabetes, emphysema, cancer, congestive heart failure, severe anemia, hepatitis, lyme disease, mononucleosis and other infections. Possible psychological causes are depression, anxiety, sleep disorders or boredom. Medications that treat high blood pressure, allergies, anxiety or depression may have the side effect of fatigue.

It is important to recognize that the term “fatigue” is often used to describe actual muscle weakness, lack of endurance or sleepiness. Regardless of the cause, there are actions that can be taken to help manage fatigue.

1) Keep a Log
Evaluating a daily log will help identify triggers that affect your level of energy. Understanding patterns of fatigue can assist in developing energy conversation techniques.

2) Energy Conservation Techniques
Pace yourself or rest to save energy for participating in activities you enjoy. Taking periodic naps may help but should be limited to one hour. Longer naps may interfere with the ability to sleep at night.

3) Avoid Heat and Humidity
Hot weather and dehydration can contribute to fatigue. An outdoor walk in cool weather has shown to decrease fatigue in a study of nursing home patients. Drinking 64 oz. of water daily is recommended.

4) Proper Nutrition
Balancing your intake of carbohydrates, protein and fat will provide a source of energy for your body. A daily multi-vitamin and minimizing alcohol to 1-2 drinks per day may also be helpful.

5) Weight Loss
Over-eating can exacerbate fatigue. Moving an over weight body can also be very tiring. A ten-pound weight loss can make a difference.

6) Managing Disease
Controlling conditions such as diabetes, pain, asthma, and heart disease can help combat the associated fatigue caused by systemic diseases.

7) Sleep Hygiene
Poor sleep patterns can lead to daytime fatigue. Avoiding caffeine, going to bed at a specific hour daily, and minimizing your restless time in bed are some examples that may improve sleep quality.

Stress Management
Meditation or relaxation techniques can help alleviate muscle tension that can lead to fatigue or poor sleep.

9) Exercise
Although exercise is often the most difficult to do when tired, it may help the most. Endurance exercise such as walking, swimming or bicycling can improve air exchange and the efficiency of the heart. Strengthening exercises can improve posture and weak muscles that contribute to generalized fatigue after prolonged standing or physical activity.

10) Managing Depression
Depression plays a role in 80% of people complaining of fatigue, according to a large study at Lahey Clinic. Seeking professional help may assist in recognizing and treating this common condition.

Fatigue can be very powerful and interfere with a person’s quality of life. Practicing healthy lifestyle activities can make a difference and help return energy to your life.

Do you want to learn more about causes of fatigue and ways to improve your energy level? Come to a FREE public lecture at Chatham Health & Swim Club,
Saturday, Sept. 26, 10 – 11am. Call 508-945-3555 to reserve.

Carol Penfield M.S. is the owner of Chatham Health & Swim Club, a nurse practitioner, certified personal trainer and nutritionist. She instructs private and small group fitness programs to members and non-members. Her office phone is 509-945-7761.

Vitamin D is a fat-soluble vitamin that helps maintain normal levels of calcium and phosphorus in the blood. Certain wavelengths of ultraviolet light prompt our bodies to synthesize vitamin D which controls how the body uses calcium and mineralizes bone. However, living in New England during the winter months or wearing sun block interferes with obtaining adequate levels. The updated recommended daily allowance has increased to 400 IUs daily, but researchers are still unsure of the proper adequate intake. Individuals over age 50 who are found to be deficient may require doses starting at 2,000 IUs. How much of the vitamin the body can process varies, thus requiring some individuals to need larger doses (by prescription). Don’t move to Florida yet! Just 10 minutes of sunlight on 40% of the body is sufficient, or consulting your primary care provider for adequate supplementation during the winter months is recommended.
Carol Penfield MS, Nurse Practitioner. Her office phone is 508-945-7761

Back and knee saving techniques during gardening and other activities

A) What causes back pain?

Pathophysiology of the spine (vertebrae, nerves, disc, muscle)

1) Why posture, flexibility, is so important.

2) Why muscle strengthening is important.

Examples:
Prolonged bending over, reaching with a heavy item, dropped head forward, lifting heavy loam.

B) What causes knee pain?

Pathophysiology of the knee joint (cartilage, meniscus, joint fluid)

1) Why leg flexibility and balance is important

2) Why strengthening is important

Examples:
Stooping or squatting for prolonged periods, kneeling, lifting with the legs.

Solutions:

Backs: Avoid bend and twist by facing your work.
Keep items close to your torso
Change positions frequently
Stretch afterwards and during the day
Do daily posture and back exercises
Use a chair or torso support structure such as a stool
Do your work on a table or have raised beds
Use lunging with raking

Knees: Keep proper alignment of joints
Change positions frequently
Use a knee pad or chair

Exercise examples:

Stretches: Forward dangle,
Knee to chest,
Hamstring/quad/groin stretch,
Slow twist with reach,
Reach backs

Strengthening:
4-stage upper back,
Opp. arm/leg reach,
Seated quad. lift
Curl backs and reach forward seated

By Carol Penfield RN, MS, NPc
Owner and Program Director of Chatham Health and Swim Club
Nurse Practitioner, Certified Personal Trainer, Stott trained Pilates Instructor
251 Crowell Rd. Chatham, MA 02633
508-945-3555 club
508-945-7761 office
www.chathamhealthclub.com

The opportunity to hear good news likely caught your attention, why?
Presently everything you read or watch on T.V. is stress producing. With the troubled economy, the stress level for Americans has increased. Now is the time to evaluate your strategies for managing your concerns and fears in an effective way. It is good news to know that there are options that can help. Although the physical reaction to stress may not go away, you can offset the effects with exercise and healthy living!
Exercise is a natural remedy that helps the body reach homeostasis in a hectic world that is continuously trying to throw us out of balance. Stress related issues are often translated into being “all in the mind”, but prolonged emotional stress can have an adverse physical effect.
When threatened or stressed our bodies produce a chemical response that not only affects our outlook but also has physiological effects. Long-term stress plays a role in damaging the immune system, accelerating aging and chronic disease. Adrenaline (a stress hormone) is produced in the body during stressful times. If it remains in the body, it can produce harmful side affects such as elevated blood pressure, pain and other conditions. When exercising, the body utilizes the excess adrenaline that is produced thereby minimizing damage to the body. In addition, during fitness activities the body also releases helpful natural “feel-good” chemicals called endorphins that give the individual a sense of well-being. Mood elevation is very helpful in offsetting the depression produced by challenging times.
You don’t have to take on the stress alone. During difficult times, people stay closer to home and many individuals become isolated and depressed. Exercising in a health club setting has shown to improve socialization and allow people to feel more like a part of a community. Adhering to an exercise routine gives a sense of accomplishment and sharing this empowers other people to be successful.
More good news……..Exercise gives your mind a break!
Fitness programs provide a “time out” to focus on the activity that you are presently performing and away from daily issues. As you concentrate on proper form or breathing techniques, the mind is unable to wander onto undesirable thoughts. The body becomes energized and creative problem solving may be stimulated. If anger is a concern, the physical release of energy dissipates feelings of frustration in a positive way.
According to CIGNA research (a global health service company) one-third of Americans find that the economy is affecting their health and other studies have shown that as many as 92% of corporate employees are losing sleep. Good news again! Exercised muscles relax better at night and physical fatigue from movement helps improve the sleep cycle. It is evident that individuals hold stress in their bodies in different ways. Wherever the body is weakest, pain, tension or possible injury can occur. Strengthening exercises allow the body to manage physical as well as psychological challenges.
There is even more good news, this time for your finances. Investing in an exercise regime can pay off! Health promoting exercise can help offset the need for expensive medications and/or medical care. It can replace poor coping habits that are costly such as excessive drinking or over-eating.
What kind of exercise is best? For those who are seated all day, consider swimming, walking or a structured fitness class. For individuals on their feet all day, the Nu-step (seated elliptical), cycling or mat Pilates classes are suggestions.
Ready to get started? Most people consult their physician prior to starting to exercise for a stress test. It may be more appropriate to consult your doctor before settling into your lounge chair for a day of “bad news” on the T.V.
Fitness is a necessity not a luxury. You cannot live without your health!

Carol Penfield RN, MS, Nurse Practitioner and owner of Chatham Health & Swim Club.

TOO BUSY TO FEEL BETTER?
IT MAY ONLY TAKE 10 MINUTES!

Busy lifestyles have contributed to keeping Americans from exercising for health benefits. The common perception is that most feel “too busy” to commit time to an exercise regime and therefore do nothing.
Research has been able to demonstrate that episodic 10-minute bouts of exercise can help you feel better. It can contribute to weight loss, mood elevation, heart health, and lower triglycerides.
According to the national weight loss register, dieters who exercise for 10 minutes four times a day lost as much weight as those who exercised daily for a continuous 40 minutes. That is exciting news for people who have pain or medical conditions that limit the amount of time that they can exercise.
Psychology researchers have shown that people with depression experience the same amount of mood elevation after 10 minutes of exercise as those who exercise for 20 or 30 sustained minutes. Just a quick 10-minute brisk walk can be a help to those struggling with lack of motivation due to depression. The release of the “feel good” chemicals in the body called endorphins can occur in a short period of time.
The cardiac literature also has shown that interval exercise helps strengthen the heart. Most exercisers perform their endurance exercise at a steady pace. However, people who exercised at varying intensities for 10-minute episodes showed to have additional benefit. More recently, a study at the University of Missouri showed that three 10-minute workouts daily were more effective at lowering triglyceride levels than 30 minutes of uninterrupted activity.
For people with arthritis or orthopedic problems, just ten minutes on a stationary bike can help loosen up the knees, and a few stretches in bed prior to arising can decrease morning stiffness and back pain. Ten minutes of movement each hour during prolonged car ride, flights or meetings can ward off aches and stiffness.
For the maximum health benefit, it is suggested that an individual’s exercise regime should include both short and long workouts. So for those who are too busy, consider periodic 10-minute workouts and reap the benefits.

Summer on Cape Cod can be very busy for the residents. Guests come and visit and we feel obligated to serve fancy appetizers, dinners and desserts. Why not also go out for ice cream! Cookouts, family gatherings and lots of fabulous seasonal restaurants to choose from also add to the common outcome, weight gain. Now that the fall season has arrived, our outdoor activities are dwindling and before we know it the holiday season will be upon us with new dietary challenges. It is very easy for “life” to get in the way of our attempts to lose weight.

Weight loss must be approached not by diet alone, but coupled with exercise. It has been well proven by the National Weight Loss Registry that 95% of people who successfully lose weight exercise regularly. The challenge is maintaining a fitness program. The most common barriers are; lack of time, convenience, decreased self confidence due to a history of failed attempts, finances, lack of support, and lack of motivation. The most commonly used and most socially acceptable excuse is, “I am too busy to exercise”. Individuals are moving less due to the conveniences of technology but feel busier as they try to keep up with the demands.
There are some strategies that can help. If you are:
• A “multi-tasker”; Try exercising as you catch up with the news on TV or follow-up on emails on your lap top while you stationary bike.

• “Willing to do anything BUT exercise”: If your day gets too busy and you keep choosing other projects or work rather than fitness, then consider exercising first thing in the morning before your day gets away from you.

• “Feeling exercise is TOO BORING”: Does the thought of walking/biking/swimming for 30 – 60 min. turn you off? Try to change the type of exercise you are doing every 5 – 10 minutes. If 30 minutes is too much time then divide your exercise routine into two 15-minute sessions or three 10-minute sessions during the day. A fitness class also offers variety.

• “Fed up and keep giving up”: Being accountable to a workout partner, taking a scheduled class or making an appointment with a personal trainer help keep you on track. If you choose a workout partner, choose one who is more motivated than you!

“Discouraged because it takes too long to burn off a cookie”: Interval or circuit exercise is the choice for you. For example: a 150 pound person who walks 3 miles in one hour burns 270 calories but if that same person jogged for 20 min. at 8 mph they would burn 320 calories in a shorter period of time. Picking a routine that varies the intensity level in a way that you can tolerate helps burn calories faster.

Interval exercise programs are becoming a more effective way of helping people lose weight. Interval exercise is simply alternating bursts of intense activity with intervals of lighter activity depending on your level of fitness. How much you pick up the pace, how often or for how long, is up to you. For example; coupling strengthening exercises with endurance exercises to help elevate the heart rate for short periods of time helps burn more calories in a shorter period of time. Changing the intensity of a regime every 1 – 3 minutes can also help the exerciser who is getting bored or frustrated from not seeing weight loss results. A personal trainer or other expert can help you time the intensity or duration of your intervals depending on the style of movement patterns that you prefer. Establishing your target heart rate is a good resource for assisting you with a base-line plan to perform a routine you can manage.

Interval classes are also available at Chatham Health and Swim Club for members and non-members. Come visit during MOTIVATING MONDAY, the first Monday of every month at 10:30 am for a FREE workshop to help you learn how to adjust your fitness routine or start one!

Workshops are instructed by Carol Penfield RN, MS, Nurse Practitioner who can address any medical concerns you may have.

Now is a perfect time to exercise and lose the weight!

Your blood pressure and serum cholesterol level remain the most common screening tools for evaluating your risk for cardiac disease. The following is a list of general ranges.

Total Cholesterol: Less than 200mg/dl = ideal
Above 200 – 239 = borderline high
Over 240 = high

LDL (bad) cholesterol: Below 100mg/dl = Optimal
100 – 129 = above optimal
130 – 159 = borderline high
Over 160 = high

HDL (good) cholesterol: Less than 50mg/dl for women = Low (a major heart disease risk)
Less than 40mg/dl for men = Low
Above 60 = ideal

Triglycerides: Less than 150 = normal
150 – 199 = borderline
Greater than 200 = high risk

Blood Pressure: Less than 120/80 mm Hg = Normal
120/80 – 139/89 = pre-hypertension with twice the risk of developing
hypertension
140/90 or above = hypertension (stage 1), over 160/100 (stage 2)
Exercise can help decrease our blood pressure, cholesterol levels and triglycerides. It also helps raise the “good” cholesterol. Come visit Chatham Health & Swim Club for more information on how to protect your heart and be healthy! We are now offering a Heart Healthy Program for both members and non-members for prevention and/or recovery from heart disease or stroke.

Choices in nutrition may help slow down the skin’s aging process from the inside, however, it does little to protect from the damaging factors of the outside world. The sun’s harmful UVA and UVB rays cause wrinkles by speeding up the skin’s aging process. This is why it is very important to always wear a sunscreen with SPF 30, or higher, no matter where you live or what the weather is like outside. Smoking speeds up the skin’s aging process as well, also creating wrinkles. It is important that you drink plenty of water in order to keep your skin hydrated, 6 to 8 (8 oz.) glasses daily has been recommended. Vitamins, minerals, and essential fatty-acids help keep the skin healthy and rejuvenated. They can be obtained by eating fresh fruits and vegetables.

Heart disease remains the #1 killer for Americans. Staying fit is essential for heart health. The heart is a muscle that needs to stay strong and free from plaque buildup for prevention of heart attacks and stroke. Walking is the most common form of exercise practiced. It can decrease the risk factors for heart disease by lowering cholesterol, improving blood sugar control, assisting with weight management, and lowering blood pressure. The recommended amount of exercise for general health is 30 – 60 minutes 5-6 days per week. Walking the same route at the same speed is good for general health but may not continue to lead to improved heart strength. The heart needs to be challenged in order to respond to unexpected “stressors” during the day. For strengthening the heart, adding variations to a walking workout is helpful. This can be accomplished by increasing the speed of the walk, the amount of time walking or the intensity. One example is an interval workout. That can be performed by warming up with a 5 minute walk then increasing the pace to a level that is considered “somewhat hard” for 2 minutes then return to a comfortable walking pace for 4 minutes. Interval walking programs can vary in length but a common technique is to keep the intense portion of the interval workout to be half as long as the recovery time. The intervals can be repeated throughout the walking program. Adding hills and swinging the arms are also options to help increase the challenge of a walking program. For the exerciser that is trying to lose weight, interval-walking programs can also help maximize calorie burning. Fitness studies have shown that this form of exercise can be safe, however, it is important to consult with your healthcare provider or cardiologist prior to starting or changing your fitness routine. Good luck!

Carol Penfield, RN, MS, NPc is a nurse practitioner, certified personal trainer and owner of Chatham Health and Swim Club. She can be reached at 508-945-3555 or carol@chathamhealthclub.com

For decades health has been referred to as ‘the absence of disease”. Health care providers specialized in treatments and cures. Active preventative health care came to the forefront when the US Surgeon General promulgated the landmark report on tobacco use and its effects on health. Now the emphasis for achieving health has shifted to the patient’s behaviors, requiring life-style modifications.

A new era of incentives for healthier living is dawning. Although the focus of the health care industry remains “remedial” rather than proactive, preventative care is beginning to be respected enough to be reimbursed. Insurance companies initially became involved by covering preventative care such as screening tests and vaccinations. Unfortunately they did not cover weight gain and inactivity in the same fashion. Recent evidence is clearly showing that healthier people are more productive employees and file fewer insurance claims. Finally Medicare has broken new ground in 2004 and recognized obesity as an illness, allowing Americans to file medical claims for diet counseling, medications, and obesity-related surgery.

HMOs, other health insurers, corporations and governmental agencies are now getting into the act and initiating incentive programs. For example, in 2005 physician prescribed “remedial” exercise programs for specific health issues qualified for a tax write off as a medical expense. Some states such as Michigan and Washington have developed smoking cessation, weight control and improved disease management programs. In addition, health insurance plans including Aetna and BC/BS are now offering $150-$200 discounts toward longer term health club membership fees. The fact that 4 out of 5 individuals are relatively inactive and 2 out of 3 Americans are overweight is finally being recognized.

It is surprising how many health club members are unaware of the potential for an insurance benefit for club utilization. I recommend to our members of the Chatham Health club that they should check their policies, and we are happy to provide the necessary receipts for those eligible. Members of other health clubs should do the same, because any opportunity to reduce barriers to fitness must be pursued. Fitness facilities are a critical component for future improvement in the health of our society. Opportunities abound for education about health, diet, and improved lifestyle while exercising. Integration of medical professionals into the fitness industry will further benefit the health of their patients. Ultimately, the cost of remedial health care can decrease for our society.