Strike up the Band?

In all of my years as a personal trainer and my involvement in the weight loss industry, I think that the single most frequently asked question today isn’t “What piece of exercise equipment should I buy”?...and this was definitely THE question for many years.  But lately, it is much more the question, “What do you think of getting the band for weight loss?” 

The overweight/obesity epidemic is out of hand. The situation has now reached a point that the harm to the public health, which translates into harm for quality of life and definitely harm to everyone’s wallet has reached epidemic proportion, and the situation is not improving. 

Recent studies tell us that if the obesity trends continue as they are now, by 2030 nearly half of all Americans will be obese.  Consequently there will be an additional 6-8.5 million cases of diabetes, 5.7-7.3 million more cases of heart disease and stroke, and up to an additional 669,000 cases of cancer.  Now get this—treatment for all preventable diseases will increase by $48 billion to $65 billion per year by 2030.  We fully understand the problem and the terrible consequences of not reversing this trend.  Nevertheless, instead of taking responsibility for ourselves and taking concrete steps to help ourselves, we still search for some easy way out.  Taking a pill to lose weight would certainly be the easiest solution, but every weight loss pill to date has ended up with side effects so pronounced that they had to be pulled from the market. Out of desperation, we look for something invasive, such as bariatric surgery or gastric banding.  However, even that is showing mixed results.

A new study done in Europe has questioned the long-term effectiveness of the LAP banding device, finding that many patients suffered major complications and half of them eventually had the device removed. The report, published Monday in the Archives of Surgery, focused on 82 surgeries performed between 1994 and 1997. Even though patients reported losing significant weight, complications such as band erosion and infections led researchers to conclude the surgery had "relatively poor long-term outcomes."  Four patients have died within the last two years following Lap-Band surgeries performed in Southern California, prompting medical malpractice lawsuits and investigations by the Medical Board of California. None of the patients involved in the European study died as a result of the surgeries. But 32 of 82 reported major complications, and 49 of them had additional surgeries, either to correct problems or because of a lack of weight loss.

What are the possible complications of the banding? 

·         Infection and migration. An infection may develop either in the port area or in the abdomen, and in some instances this may cause the band to migrate into the stomach.

·         Leakage.  Leakage from the SAGB or from the connecting tube between the balloon and the port may require reoperation. The balloon is made of fragile material, and leakage can occur either shortly after surgery or many years later.

·         Slippage of the band and pouch dilatation. The band may slip, and the pouch (the part of the stomach above the band) may become too enlarged, and a reoperation may be necessary.

·         Punctures in the silicone band and port dislocation The injection port may dislocate and

when injecting into the port, there is always the risk of puncturing the silicone tube.

·         Patients may vomit or feel pain after food intake. This can be caused either by a poor eating behavior, or by the narrowing of the SAGB following the injection of fluid into the balloon.

 

One more thing, nobody on the band will lose all the weight they may need to.  They may lose enough weight to make a huge positive difference in their health, but you can’t lose it all that way. 

 

If you your doctor suggested this procedure to you, be sure you have really tried everything else first.  Have you done a course of behavioral therapy coupled with exercise and proper diet under strict supervision from qualified professionals?  And just as important: HAVE YOU STAYED AWAY FROM THE WEIGHTLOSS GIMMICKS THAT PERMEATE OUR LIVES THROUGH ATTRACTIVE ADS BUT DO NOTHING FOR LONG TERM WEIGHTLOSS?  An effective program to lose weight has you losing your extra kilos (pounds) at a slow, but steady rate.  Extremely low calorie programs, supplements in the form of pills and hormonal injections just don’t do it—even if they tell you otherwise. 

 

Invasive procedures into the body of any nature carry risk.  But then again, so does being obese.  But when “weighing” this decision, consider another finding from a study last year done in Holland.  Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients. Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting that five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%). Using 40% excess weight loss as the standard, resulted in a five-year success rate of about 50%, which declined to 20% at 10 years.

So if you are viewing this as an automatic fix to your weight problem, don’t.  Fortunately, there is a risk-free and safe solution to the obesity epidemic.  It takes longer and requires hard work but can reverse this dangerous trend permanently.  And if you have a positive attitude towards it and have the patience it takes, then losing weight without the band might be the better way to go.

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  www.loseit.co.il

USA Line 1-516-568-5027

More on Risk Factors

Some time ago, I wrote an article on the top risk factors for heart disease (almost all risk factors for heart disease apply to other areas of health as well).  That article was based on research that was current at that time.  Everything in that piece is still relevant.  However, some fascinating new research has come out over the past year which now attributes a much higher importance to one risk factor in particular in comparison to all the others, and that is something called low Cardiorespiratory Fitness (CRF).  Cardiorespiratory Fitness is the ability of respiratory, circulatory and muscular systems to consume, distribute and utilize oxygen during continuous activity.  . 

Let’s put this in perspective.  If we look at two different cases, we have two males in their upper 40s who both see their physician for standard checkups.  A. is a little bit over weight (BMI of 26) and his cholesterol is slightly above 200 and his blood pressure is 124/84.  A. is an exerciser who does 30-35 minutes of brisk walking or slow jogging every week.  He is also careful to use the stairs insteadof the elevator unless he has heavy packages and tries to walk, whenever possible.  B. has cholesterol of 187 and even his ratio of HDL (good cholesterol) to his overall cholesterol is very good.  His blood pressure is 118/78 and his weight is normal (MBI of 23.5).  But B. has leads a sedentary lifestyle and doesn’t do any formal exercise.  He uses elevators, parks as close as possible to his destinations, and sits in his office all day long on the computer and telephone.  Who has the higher risk of heart disease and who has the higher risk of all-cause mortality?  You might be surprised, but B. is probably in more trouble that A. 

As I have stated previously, we have all heard about the risk factors for heart disease and coronary artery disease.  There are about 20 together, and we can certainly control most of them (although some are beyond our control).  Every hour of every day, we are all aging; we can’t turn back the chronological clock or change our family history. And if we were born with a low birth weight, there isn’t much we can do about that either. We can do something about most risk factors, and not necessarily with drug intervention. Case in point: a smoker can stop smoking. But there are many misconceptions when it comes to risk factors, and often, those things that really matter the most are not necessarily diagnosed through a blood test. Consequently, the underlying issue is that we have don’t always have accurate information as to what those risk factors actually are.  CRF is one of the risk factors that we most certainly can do something about at just about any point of our lives.  To simplify this, if you have trouble walking up hill or stairs, or even walking a reasonable distance on a flatter surface, you probably have this risk factor.

Unfortunately, when we go for a check up to the doctor, the emphasis is put on other risk factors like high blood pressure, diabetes, high cholesterol or weight.  But those are easy to measure through blood tests, a blood pressure cuff, or a scale.  Assessing our level of Cardiorespiratory Fitness is a little more difficult to measure accurately outside of the laboratory.  Nevertheless, even an informal measure would tell us a lot. 

Lee, D., et al investigated several research studies in 2010 that demonstrated beyond a doubt that moderate to high levels of CRF are associated with reduced risk of Cardiovascular disease (CVD).  In 2009, Kodama et al. reviewed 33 investigations into this topic.  They found that each MET (a unit of measure of energy expenditure) more that a person expends in exercise is worth a 13%-15% reduction in all-cause mortality and for the chance of having a cardiac event.  The main finding however is everyone, regardless of age, gender, smoking status and weight (as measured with BMI) has reduced mortality rates from all causes, the more fit they are.  One study found that even small, incremental improvements reaped large benefits. 

But why is the level of CRF so pronounced as a risk factor?  One of the most marked ways is that being fit reduces insulin resistance and allows your cells to use glucose as fuel better, and it prevents diabetes.  Also, higher CRF shows a lower risk of all variables in metabolic syndrome (waist circumference, triglycerides, HDL-cholesterol, fasting blood sugar).  Also, we know that people who have a higher level of Cardiorespiratory Fitness tend to have lower blood pressure.  A study several years ago in Japan showed a direct correlation between lowering of blood pressure and people who walked to work- the longer the walk, the lower the blood pressure. 

In order to increase your CVF, you don’t need to join a gym or go to exercise class.  It’s free.  Begin a walking program (okay, spend money on a good pair of running shoes) and start out slowly—even 3, 10 minute increments is useful at the beginning.  But slowly build up your stamina and your distance.  Remember, over time, if you can begin brisk walking, power walking or even some jogging, you will definitely reap even more benefit.  This is less expensive than all the medications you may have to take if you don’t do this, and it is more beneficial in the long run (pun inteneded!). 

The American Heart Association wants to improve the cardiovascular health of all Americans by 20% by the year 2020 while reducing deaths from cardiovascular diseases and stroke by 20%.  All the “wonder drugs” that have come out in the last 30 years for cholesterol and blood pressure and diabetes haven’t really made much of a dent in the realm of public health.  Could it be that we all just starting taking care of our fitness (and make a few subtle changes in our diets) that it will make a difference?  I think so!

Becoming fit and bettering your Cardiorespiratory Fitness is another way to “add hours to your day, days to your year and years to your life.” 

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il  www.loseit.co.il

USA Line 1-516-568-5027

Go for the Whole Grains

Why in the world would someone take whole wheat grain, crack the grain, pulverize it with rollers, and separate the endosperm from the dark, fibrous bran and the wheat embryo?  Why would they take out important nutrients, vitamins, unsaturated fats, fiber and magnesium?  And if intact grains are so healthy, why did we stop eating them and shift to highly refined grains? Especially when study after study has shown the ill effects of white, refined grains on our health? 

White flour was a novelty for the upper classes.  When rollers where introduced in the early 19^th century in the milling process, that is when everything changed. Before roller milling was introduced, “white” flour was very expensive and only affordable to the wealthy. The poor used what we would call whole wheat flour today and the truly poor could only afford rye or barley flour. Once roller mills made it more affordable, white flour’s popularity exploded and everyone felt wealthy to have it. The fact that you could take this brown, grainy flour and “purify” it also helped make bread and cakes lighter, airier and fluffier.  Buying white flour became a status symbol.  White flour can also survive longer without refrigeration and as all processed foods, has a longer shelf-life.  What is good for business and sales isn’t necessarily what is good for our health. The damage we have done to ourselves in the process has been severe.

Whole grains protect against diabetes.  According to two large ongoing studies, people who consume whole grains are 30% less likely to develop diabetes.  Because whole grains take longer to digest, you don’t get repeated insulin spikes, which lead to Type II diabetes.

Intact grains mean less heart disease.  Also according to a large study, women who consume more whole grains were 30% less likely to develop heart disease than those who consumed refined grains. 

Less refined grains mean better GI health.  The fiber in whole grains helps keep the stool soft and bulky.  This prevents constipation, which is the number one gastrointestinal complaint in the United States.  725 million dollars is spent annually on over-the-counter laxatives. Whole grains also help to prevent diverticulitis and diverticulosis.

Whole grains may prevent cancer.  A recent overview of 40 control studies indicated that whole-grain consumption reduced the chances of developing mouth, stomach, colon, gallbladder and ovarian cancer.

A very recent study found a troubling link between higher consumption of white rice and Type 2 diabetes, a disease that in some countries is becoming an epidemic. "What we've found is white rice is likely to increase the risk of Type 2 diabetes, especially at high consumption levels such as in Asian populations,"  according to Qi Sun of the Harvard School of Public Health ."But at the same time people should pay close attention to the other things they eat."It's very important to address not just a single food but the whole pattern of consumption."

In the British Medical Journal (BMJ), Sun's team said the link emerged from an analysis of four previously published studies, carried out in China, Japan, Australia and the United States. These studies followed 350,000 people over a timescale from four to 22 years. More than 13,000 people developed Type 2 diabetes. In the studies carried out in China and Japan, those who ate most rice were 55 percent likelier to develop the disease than those who ate the least. In the United States and Australia, where consumption of rice is far lower, the difference was 12 percent.

Be sure the products you are buying are truly whole-grain.  Often, breads are brown in color, but are made with white processed flour.  Check the ingredients carefully to be sure.  If the taste of a whole-grain food like pasta or brown rice isn’t palatable to you, begin by mixing it with the white refined version and slowly increasing the ratio of intact grains to refined grains.  Speak to people who have made the switch.  Once they reacquire their taste-buds and get used to whole grain products, it is difficult to return to the white flour products and some even refer to the taste and texture similar of the white stuff like eating cardboard.  Remember - the more any food is processed, the more nutrients, minerals and vitamins are lost. 

Whereas at one time, you could only find whole wheat, whole rye, brown rice and whole grain pasta in health food stores, now they are available just about everywhere.  According to the USDA, only 1% of ingested food in the United States is unrefined as opposed to 20% for refined grains.  Studies suggest that the more this ratio changes in favor of whole grains, the less disease there will be.  Once you make the change, you will realize how much natural flavor and taste are in whole grains and you may never want that piece of white bread again. 

Whether it is pasta, bread, rice, couscous or any other grain, eating whole, unrefined grains is another way to “add hours to your day, days to your year and years to your life.” 

Alan Freishtat i

 www.loseit.co.il     

1-516-568-5027

972-2-654-0728

Exercise and your Emotional Well Being Part 4

This is the fourth and final article in 4-part series focusing on Depression, Postpartum Depression, Anxiety, Attention Deficit Disorder (ADD/ADHD), Obsessive Compulsive Disorder (OCD) and Panic Disorder, and how exercise can be effective in their treatment.

Panic Disorder

Panic Disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral changes lasting at least a month, and ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks (DSM-IVR). Panic disorder is not the same as agoraphobia (fear of crowded places and awkward social settings), although many with panic disorder also suffer from agoraphobia. Panic attacks cannot be predicted; therefore, an individual may become stressed, anxious or worried wondering when the next panic attack will occur. (There are other schools of thought that panic disorder is differentiated as a medical condition or chemical imbalance).

Panic Disorder and Anxiety are different. Panic attacks have a sudden or out-of-the-blue cause, and are short in duration but with more intense symptoms. Anxiety attacks have stressors that build to less severe reactions that can last for weeks or months. Panic attacks can occur in children as well as adults. Panic in young people may be particularly distressing because the child has less insight as to what is happening, and his/her parent is also likely to experience distress when attacks occur. Some of the symptoms of Panic Disorder that last for one minute or more are:

• Intentional hyperventilation – creates lightheadedness, derealization, blurred vision, dizziness
• Spinning in a chair – creates dizziness, disorientation
• Straw breathing – creates dyspnea, airway constriction
• Breath holding – creates sensation of being out of breath
• Running in place – creates increased heart rate, respiration, perspiration
• Body tensing – creates feelings of being tense and over alert

The common treatment for Panic Disorder is the identification of treatments that engender as full a response as possible, and at the same time, minimize relapse; this is imperative. CBT is the treatment of choice for panic disorder. When CBT is not an option, pharmacotherapy can be used. SSRIs (antidepressants) are considered a first-line medication option.

Here also, we see that exercise is helpful.  In a study that appeared in the American Journal of Psychiatry in 1998, 46 outpatients suffering from moderate to severe panic disorder with or without agoraphobia were randomly assigned to a 10-week treatment protocol of regular aerobic exercise (running), the drug clomipramine or placebos. In comparison to the group which received the placebos, both exercise and clomipramine led to a significant decrease in symptoms, according to all criteria of the study. A direct comparison of exercise and clomipramine revealed that the drug treatment improved anxiety symptoms significantly earlier and more effectively. Depressive symptoms were also significantly improved by exercise and clomipramine treatment. These results suggest that regular aerobic exercise alone, as opposed to placebos, is associated with significant clinical improvement in patients suffering from panic disorder, but that it is less effective than treatment with clomipramine. Either way, it is clear that a well-rounded and balanced program of exercise can aid in treatment and cure. 

In Conclusion:  It wasn’t very long ago that society would write off the mentally ill.  Today, people with all types of mental health disorders are functioning members of society.  They can do well in school, university, and in every single field of the workplace one can imagine.  Therapies and drugs now exist to help those who need help.  And now, we also know that exercise has yet again begun to prove itself as the one thing that really can never hurt and can only help.  Exercise not only helps us physiologically, but psychologically as well.  Whether you have depression, anxiety, OCD, ADD, or panic disorder, incorporating a balanced exercise program into your life will help you improve the quality of your life - perhaps even significantly. 

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the Co-Director of the Jerusalem-based weight loss and stress management center Lose It! along with Linda Holtz M.Sc. They are available for private consultations, assessments and personalized workout programs. They have begun working with Dr. Michael Bunzel, M.D., a psychologist in Bnei Brak, Israel on incorporating exercise as a therapy for several mental health disorders.  Alan can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il. You can also visit the Lose It! website at www.loseit.co.il

U.S. Line 516-568-5027

Exercise and your Emotional Well Being Part 3

Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry, and is characterized by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions. Symptoms of the disorder include excessive washing or cleaning, repeated checking, extreme hoarding, preoccupation with religious thought, aversion to particular numbers, and nervous rituals such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The actions of those who have OCD may appear paranoid and potentially psychotic. (OCD sufferers generally recognize that their obsessions and compulsions are irrational; however, they may become further distressed by this realization.)

OCD is the fourth most common mental disorder, and is diagnosed nearly as often as asthma and diabetes mellitus. In the United States, one in 50 adults suffers from OCD. It affects children and adolescents as well as adults. Roughly 33-50% of adults with OCD report a childhood onset of the disorder, suggesting the continuum of anxiety disorders across the life span. 

According to a team of Duke University-led psychiatrists, Behavioral Therapy (BT), Cognitive Behavioral Therapy and medications should all be regarded as first-line treatments for OCD.  Medications include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline, fluoxetine, escitalopram and fluvoxamine, and the tricyclic antidepressants - in particular, clomipramine.

In a review of three separate meta-analyses, investigators at Arizona State University found that patients who participated in at least 21 minutes daily of aerobic exercise experienced a reduction in anxiety (Petruzzello SJ et al; 1991). A more recent study from Canadian researchers at the University of Manitoba in Winnipeg noted that regular exercise may help people who suffer from OCD, phobias and other psychiatric disorders. When the investigators examined studies of anxiety disorder and exercise dating back to 1981, they found that strength training, running, walking, and other forms of aerobic exercise help relieve mild to moderate depression and may also help treat anxiety and substance abuse.

Part IV in this series will explore the effects of exercise and Panic Disorder.

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the Co-Director of the Jerusalem-based weight loss and stress management center Lose It! along with Linda Holtz M.Sc. They are available for private consultations, assessments and personalized workout programs. They have begun working with Dr. Michael Bunzel, M.D., a psychologist in Bnei Brak, Israel on incorporating exercise as a therapy for several mental health disorders.  Alan can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il. You can also visit the Lose It! website at www.loseit.co.il

U.S. Line 516-568-5027

Exercise and Mental Health Part 3

This is the second article in 4-part series focusing on Depression, Postpartum Depression, Anxiety, Attention Deficit Disorder (ADD/ADHD), Obsessive Compulsive Disorder (OCD) and Panic Disorder, and how exercise can be effective in their treatment.

Anxiety

Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components.^[2] The root meaning of the word anxiety is 'to vex or trouble'; in present or absent of psychological stress, anxiety can create feelings of fear, worry, uneasiness and dread.^[3] Anxiety is considered to be a normal reaction to a stressor. It may help someone to deal with a difficult situation by prompting them to cope with it. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder.  In the United States today, slightly more than 18% of the population suffers from all types of anxiety, and 25% of teenagers between the ages of 13-18 have various forms of anxiety during those years. 

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friend and  relationship problems or work difficulties. Individuals often exhibit a variety of physical symptoms including fatigue, fidgeting, headaches, nausea, numbness in the  hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing,  trembling, twitching, irritability, agitation, sweating, restlessness difficulty concentrating, insomnia, hot flashes and rashes. These symptoms must be consistent and ongoing, persisting for at least six months, in order for a formal diagnosis of GAD to be introduced. Approximately 6.8 million American adults experience GAD, and 2% of adult Europeans, in any given year, experience GAD.

The common treatment for Anxiety and Anxiety Disorder is Cognitive Behavioral Therapy (CBT) coupled with relaxation techniques that incorporate learning how to calm down quickly.  Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present. It deals directly with your thoughts, emotions and behaviors and aims at changing the thought process.  It generally works in a short amount of time compared to other types of therapy.  Drug therapy for anxiety includes antidepressants, Buspirone (BuSpar) and Benzodiazepines.  But here also, exercise can play a very important role. 

Three researchers from the Department of Kinesiology at the University of Georgia - Ramsey Center assessed whether exercise training would help improve anxiety symptoms. They estimated the exercise training effects on anxiety and also explored important variables that could moderate the effect. They performed a meta-analysis of 40 English-language articles publishes from January 1995 to December 2008 in scholarly journals involving sedentary adults with chronic illness and found that, compared with no treatment conditions, exercise training significantly reduced anxiety symptoms. The largest anxiety improvements resulted from exercise programs lasting no more than 12 weeks, using session durations of at least 30 minutes and an anxiety report time frame greater than the past week. Their conclusion was that exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness.

ADD/ADHD - Attention Deficit Disorder

Attention Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a developmental disorder.  It is primarily characterized by "the co-existence of attention problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age.

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3-5% of children globally. It is diagnosed in approximately 2-16 % of school-aged children. It is a chronic disorder with 30-50% of those individuals diagnosed in childhood continuing to have symptoms into adulthood. It is estimated that 4.7% of American adults live with ADHD. 

The evidence is strong for the effectiveness of behavioral treatments in ADHD. It is recommended first-line in those who have mild symptoms, and in preschool-aged children. Psychological therapies include psychoeducational input, behavior therapy, Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), family therapy, school-based interventions, social skills training and parent management training. Parent training and education have been found to have short-term benefits. Family therapy has shown to be of little use in the treatment of ADHD; however, several ADHD-specific support groups exist as informational sources and to help families cope with challenges associated with dealing with ADHD.

Stimulant medications are the medical treatment of choice.  There are a number of non-stimulant medications, such as atomoxetine, that may be used as alternatives.  There are no conclusive studies to date of comparative effectiveness between various medications, and there is a lack of evidence on their effects on academic performance and social behaviors. While stimulants and atomoxetine are generally safe, there are side effects and contraindications to their use. Medications are not recommended for preschool children, as their long-term effects in such young people are unknown. There is very little data on the long-term adverse effects or benefits of stimulants for ADHD.  Guidelines on when to use medications vary internationally, with the UK's National Institute of Clinical Excellence, for example, only recommending use in severe cases, while most United States guidelines recommend medications in nearly all cases.

John J. Ratey, M.D., advocates that exercise should be included in the treatment regimen, and that exercise can even reduce or eliminate the need for medication. An Associate Clinical Professor of Psychiatry at Harvard Medical School, Cambridge, Massachusetts, Dr. Ratey is author of the book Spark: The Revolutionary New Science of Exercise and the Brain.  In an interview with Medscape, he stated the following in regard to using exercise in the treatment of ADD:  There are 2 basic ways of thinking about ADD in relation to exercise: One is about the neurotransmitters norepinephrine and dopamine, both believed to be drivers of the attention system. Exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. I have always said that a dose of exercise is like taking a bit of methylphenidate (Ritalin®) or amphetamine/dextroamphetamine (Adderall®); it's similar to taking a stimulant. Second, over time, exercise helps build up the machinery to increase the amount of neurotransmitters in the brain as well as their postsynaptic receptors. Chronic exercise eventually causes growth of the system. The more fit that you are, the better the system works.”

Dr. Ratey continues: “People are just beginning to pay attention to this. It was only 2 years ago that the American Medical Association (AMA) president, in his inaugural address, said that "Exercise is medicine." He said that every physician, no matter their specialty, should ask every patient at every meeting about their exercise regimen and encourage them to pursue this. Neurology is paying more attention to exercise, with whole conferences looking specifically at exercise and Parkinson's disease, for instance. If exercise can help protect against some of the symptoms in Parkinson's disease, then it should also affect ADD, because the diseases have overlapping features.”

Dr. Ratey also says that “the effects of exercise on self-efficacy are huge. Although exercise helps balance brain chemistry, there are helpful incidental effects, such as self-efficacy.”  It is well-known that many ADHD children and adults experience low self-esteem because of the inability to perform well in school or the work place.  So for them, exercise can have this wonderful secondary effect; they see progress in all areas of exercise, which brings tremendous self-efficacy and confidence.  This new ability to believe in one’s self goes a long way to elevate the mood and overall attitude in both children and adults. 

Part III in this series will explore the effect of exercise Obsessive Compulsive Disorder.

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the Co-Director of the Jerusalem-based weight loss and stress management center Lose It! along with Linda Holtz M.Sc. They are available for private consultations, assessments and personalized workout programs. They have begun working with Dr. Michael Bunzel, M.D., a psychologist in Bnei Brak, Israel on incorporating exercise as a therapy for several mental health disorders.  Alan can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il. You can also visit the Lose It! website at www.loseit.co.il

U.S. Line 516-568-5027

Exercise and your Emotional Well Being Part 2

This is the first article in 4-part series focusing on Depression, Postpartum Depression, Anxiety, Attention Deficit Disorder (ADD/ADHD), Obsessive Compulsive Disorder (OCD) and Panic Disorder, and how exercise can be effective in their treatment.   

Depression

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being.  Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, or have difficulty concentrating, remembering details or making decisions. Additionally, they may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present.^[1]

Depressed mood is a normal reaction to certain life events, a symptom of many medical conditions and a feature of certain psychiatric syndromes.  It affects more than 21 million American children and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44.   Lost revenue due to U.S. workers who are experiencing depression is estimated to be in excess of $31 billion per year.  

Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer and chronic pain, and is associated with poor health.

Once you have a diagnosis of depression, your doctor will discuss the different treatment options with you. The treatment that is best for you depends on the type of depression you have. For example, some patients with clinical depression are treated with psychotherapy, and some are prescribed antidepressants. Others may undergo electroconvulsive therapy (ECT), also called electroshock therapy. This treatment may be used with patients who do not respond to standard depression treatment options.

Medication can help lift your mood and ease your feelings of sadness and hopelessness. You'll need to work with your doctor to find the drug that is most effective with the fewest side effects. It is thought that three chemical messengers are involved with depression: norepinephrine, serotonin, and dopamine. These messengers are classified as neurotransmitters, and are responsible for sending electrical signals between brain cells.

Researchers have found a link between depression and chemical imbalance in these neurotransmitters. Antidepressant medications increase the availability of neurotransmitters by changing the sensitivity of the receptors for these chemical messengers. It is believed that modifying these brain chemicals can help improve mood, although the exact way it works is still unclear.

Recent research has shown that exercise can play a significant role in the treatment of depression.  In many people, the amount of serotonin that is manufactured in the brain by moderate to intense exercise is similar to the amount of increase brought about by the popular group of antidepressant drugs known as SSRIs.  

The Harvard Medical School published the results of a study that originally appeared in the Archives of Internal Medicine in 1999. 156 men and women with depression divided into three groups. One group took part in an aerobic exercise program, another took the SSRI sertraline (Zoloft), and a third did both. At the 16-week mark, depression had eased in all three groups. About 60%–70% of the people in all three groups could no longer be classed as having major depression. In fact, group scores on two rating scales of depression were essentially the same. This suggests that for those who need or wish to avoid drugs, exercise might be an acceptable alternative to antidepressants. Keep in mind, though, that the swiftest response occurred in the group taking antidepressants, and that it can be difficult to stay motivated to exercise when you’re depressed.

A follow-up to that study found that exercise’s effects lasted longer than those of antidepressants. Researchers checked in with 133 of the original patients 6 months after the first study ended. They found that the people who exercised regularly after completing the study, regardless of which treatment they were on originally, were less likely to relapse into depression.

A study published in 2005 found that walking fast for about 35 minutes a day five times a week, or 60 minutes a day three times a week, had a significant influence on mild to moderate depression symptoms. Walking fast for only 15 minutes a day five times a week or doing stretching exercises three times a week did not help as much. (These exercise lengths were calculated for someone who weighs about 150 pounds. If you weigh more, longer exercise times apply, while the opposite is true if you weigh less than 150 pounds.)

Part II in this series will explore the effects of exercise on anxiety and ADD/ADHD.

ALAN FREISHTAT is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 15 years of professional experience. He is the Co-Director of the Jerusalem-based weight loss and stress management center Lose It! along with Linda Holtz M.Sc. They are available for private consultations, assessments and personalized workout programs. They have begun working with Dr. Michael Bunzel, M.D., a psychiatrist in Bnei Brak, Israel on incorporating exercise as a therapy for several mental health disorders.  Alan can be reached at 02-651-8502 or 050-555-7175, or by email at alan@loseit.co.il. You can also visit the Lose It! website at www.loseit.co.il

U.S. Line 516-568-5027