Asian Indian Americans of Central Pennsylvania

2. Asian Indian Americans of Central Pennsylvania Work Life Balance THANKS TO ALL OUR SPONSORS

3. Asian Indian Americans of Central Pennsylvania Work Life Balance Living Healthy: Importance of Exercise Dr. Michael Cordas Speaker Segment Sponsor 2014 Sponsors

4. Exercise Principles & Programs Michael Cordas, DO, FAAFP, FAOASM Robert Lontz, MSPT, Cert MDT, MBA

5. Why Exercise? Sedentary lifestyles invite orthopedic and systemic diseases Exercise increases cardiovascular health Appropriate exercise decreases the likelihood of orthopedic injuries Regular exercise improves the quality of life and allows for increased ability to participate in physical activities

6. Types of Exercise • Aerobic • Increases and maintains HR at elevated level for a period of time – measured by METs or % Max HR • Strengthening • Repetitive activation of muscle groups to fatigue – builds strength and endurance • Stretching • Static vs. Dynamic • Muscle vs. dysfunctional tissue

7. Aerobic Exercise Dosages • Minimum = 150 min / week at 3.0-5.9 METs, 10 minutes minimum per session • Brisk walk (3.0 mph or faster) • Water aerobics • Bicycling < 10 mph • Alternative = 75 min / week at 7-8 METs • Jogging / running • Swimming laps • Bicycling > 10 mph • Hiking uphill with backpack • Or, mix it up between the 2 options

8. Strengthening Exercise Dosage • Minimum Strengthening = 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) per CDC. • Low load, higher reps is best for minimizing injury • Ideal training zone = 65% -75% of 1 rep maximum to obtain strength and endurance benefits • Able to perform at least 25 reps of activity before fatigue or loss of form / compensation • Use Oddvar –Holton diagram if difficult to determine training range

10. Stretching Dosage 30 second maximum hold, 3-5 reps for general muscle stretching (anything over has not been proven to be more beneficial) 10-30 seconds x 5-10 reps every 3 hours for dysfunctional tissue Opposite movement rule – if postures cause strain, intermittently stretch in opposite direction at least every hour of the activity to alleviate strain

11. Comprehensive Program Elements • Aerobic warm up • Strengthening progressions • Large to small muscle groups • Proximally to distally • Dynamic stability (a progression of strengthening with combined balance or functional activity) • Stretching / cool down

12. Common Inactivity Problems & Physical Rehab Guidelines

13. Knee Osteoarthritis / Medial Pain • Increased Knee Valgus = increased medial knee stress • Risk Factors Include: • Dynamic IR drift of hip – due to weakness of hip abduction and external rotation • Flat foot / increased foot pronation – due to weakness of Posterior Tibialis and possible structural abnormalities • Decreased flexibility in calf, ITB and hamstrings

14. Knee Osteoarthritis / Medial Pain • Aerobics = Stationary bicycle • Strengthening exercises • Posterior Tibialis (HR with slight inversion) • Quads / HS / Gluteus Medius & external hip rotators – preferably in limited weight bearing (ex, SLR, Clamshell, Hip ER sitting) • Progress to Multi-hip or open chain machine based exercises • Stretching = HS, quads, piriformis, ITB, calf

15. Lumbar HNP • Progression of postural syndrome – due to prolonged or repetitive forward bending of the lumbar spine (includes prolonged sitting in a slumped position) • Risk Factors include: • Prolonged, loaded & repetitive lumbar flexion (sitting, bending and lifting) • Decreased lumbar extension flexibility • Decreased hamstring, hip flexor and piriformis flexibility • Weakness of low back extensors, abdominals and hip abductors / external rotators

16. Lumbar HNP Aerobics = Treadmill Strengthening = Lumbar Extensors, Gluteus Medius / hip ER, Multifidus and progression to transverse abdominals Stretching = Lumbar extension HS, piriformis, hip flexors, quads

17. Shoulder Impingement • Pinching of the bursa and rotator cuff with elevation of the arm – leads to bursitis / tendinitis / tear • Risk Factors include: • Poor scapular position due to imbalance of weak extension / external rotation muscles and tight pectoral muscles • Poor posture with decreased thoracic extension mobility & strength • Prolonged or repetitive overhead reaching

18. Shoulder Impingement • Aerobics = Arm bicycle – preferably retrograde • Strengthening exercises • Rows / Extension / Push up with a plus • IR / ER / Scaption & Flexion to 90 degrees • Prone Houstons • Stretching = Corner Stretch, Thoracic extension

19. General Recipe to Avoid Injury Sedentary postures and forward biased activities significantly increase the likelihood of several common orthopedic disorders of the shoulder, low back and knee (to name a few) Exercises should focus on “doing the opposite” of what you do all day long to prevent injury – typically this is strengthening of the posterior chain and stretching of the anterior chain

20. Recipe to Avoid injury - Recap Aerobic Exercise 75-150 min / week (depending on METs) Strengthening of major muscle groups (preferably posterior chain) from large to small groups (ex, proximal to distal) – 2x / week Flexibility exercises (opposite of your typical positioning) – typically done after strengthening or after aerobics if no strengthening is performed that day