Previously Asked Questions

Actually, you should be looking to impact your knees, in a positive way, by doing strengthening and stretching exercises to augment your regular routine in preparation for any major surgery like Knee Replacement. WebMD offers facts on TKR preparation and the article states that performance of upper body strength training will certainly assist you in managing a cane, crutches or walker during your post-operative recovery. The key is to integrate the stretching and strengthening program into the cardiovascular workout you are currently performing in the pool.

This may not be the best time to alter your training and possibly risking further knee complication. Consider focusing on a lean, nutrient dense diet to reduce body fat and body mass and concentrate on the physical conditioning that will assist you in quickly recovering from surgery so that you can return to a lifestyle that will allow you to increase your efforts and progress toward your personal fitness and wellness goals in a timely manner.

Documentation by the Knee Society, founded in 1983, states that, Total knee replacement is a predictable and durable procedure. How you treat your new knee will influence its longevity. Therefore, it is important to know which activities are permissible and which are not following total knee replacement. The pain relief achieved by total knee replacement, combined with the correct regimen of exercise and sports, should improve the patient's overall health and quality of life.

The benefits of an active lifestyle have been well documented. Following total knee replacement, you should be instructed about limitations and have good self-control and self-awareness when returning to recreational sports. After surgery, most activities require some reflection and often some modification. Your level of expertise in your particular activity needs to be considered. Sports and fitness regimens must be individualized. Participation in sports and recreational activities should be discussed with your surgeon.

Recommended Activities: Cycling is an excellent aerobic workout. Calisthenics, swimming, low-resistance rowing, stationary skiing machines, walking, hiking, and low-resistance weight lifting all are excellent ways to maintain fitness without overstressing the implant. Suitable activities include bowling, croquet, golf, doubles tennis, table tennis, ballroom dancing and square dancing. Other activities that are suitable but slightly more risky include downhill skiing, scuba diving, in-line skating, ice skating, softball, volleyball, speed walking, horseback riding, hunting and low-impact aerobics.

Discouraged Activities: In general, patients who have undergone total knee replacement should avoid high-impact activities that cause high stress loads on the implant and therefore may increase the risk of early failure. Activities to avoid include baseball, basketball, football, hockey, soccer, high-impact aerobics, gymnastics, jogging, power lifting, rock climbing, hang gliding, and parachuting.

There is no exercise that can target a specific area of your body for fat loss. While there are many exercises that you can do to lose weight, your body is designed to slowly burn the fat from all areas of your body rather than just one spot. The key is to burn enough fat overall that your body reduces those extra stores in the belly or whatever area you are targeting. When working toward fat loss, look for exercises that challenge large muscle groups for extended periods of time. Cardiovascular exercise is one of the best ways to burn those extra calories. Cardio exercises include running, swimming, jogging, cycling, and even circuit training. When performed at a moderate to vigorous intensity level, these exercises will help you burn off extra fat and ultimately slim down that belly.

For more information on exercises that help with weight loss, check out Exercise to Lose Weight on WebMD.

This all depends on your goals, whether you are working on athletic performance or exercising for weight loss. For either case, with cardio, you don't want to consume more calories pre and post workout than what you will be burning. Pre workout, it is best to eat something small about an hour before. This should contain complex or slowly digested carbohydrates and some protein and/or fat. Examples could be a slice of whole grain toast with peanut butter or cheese, half a cup of Greek yogurt and half a banana, or half a cup of cottage cheese with some mixed fruit or grapes. With 45-60 minutes of continuous high intensity cardio training you should be burning about 500 calories - this is equivalent to running at about a 9-10 minute mile pace. Therefore a 200 calorie snack before and after would be sufficient to replenish energy; adjust that to less for weight loss or to account for larger meals throughout the day. Most non-competitive recreational athletes find that a smaller pre snack of about 100-150 calories works better.

Post workout, it is important to get a snack containing protein within an hour of exercise to replenish and repair muscles and refuel muscle glycogen (energy stores), which will prevent your body from breaking down and using its own muscle for energy. Chocolate milk is one of the ideal post workout snacks, with a 4:1 ratio of carbohydrates to protein. Other options are a Greek yogurt with some berries, an egg, a smoothie, or turkey sandwich. Meals can actually be the post workout snack - eating breakfast, lunch, or dinner can help to keep foods balanced as well as takes out some of the work of finding a perfect post workout snack.

An often misunderstood strategy is carb loading. In actuality our bodies have a limited amount of energy storage in the muscles, which lasts about 90 minutes during activity depending on the individual. Any more energy will either be burned immediately or stored as fat. Carb loading has been found beneficial for use in performance and high endurance activity, however for general recreational and/or training lasting less than 90 minutes, minimal effect is shown. If you are exercising longer, you may need a small carbohydrate snack to renew energy mid activity session. Pick foods that are minimally processed and contain high quality protein, some fiber, and an abundance of vitamins and minerals. If you are looking for a sports performance and competitive view on pre and post workout foods here are recommendations from the Sports, Cardiovascular, and Wellness Nutrition practice group.

Take time to experiment with different foods pre and post workout to find what works best for you and your goals. Along with foods for energy, hydration is incredibly important, check out this link for more information about proper hydration during exercise.

A grande (16 oz) chai tea latte with 2% milk (with steamed milk) is 240 calories and 45 g of carbohydrates, 42 of which are sugar. A chai tea with skim milk contains 210 calories and 43 g of sugar. A better option may be a tall (12 oz) with skim milk - that has 160 calories and 32 g sugar. This is still a lot, but a slightly better option and will still give you the taste you want. This nutrition information is from Starbucks; Satellite Coffee does not post their nutritional information, but the beverages are nearly identical between the two. Another option is ordering a black tea and adding in your own honey and splash of milk if you are trying to cut calories. For weight control, it is best to keep beverages (as well as snacks) to around 150 calories or less.

Water is the most important nutrient our bodies need to function. Every day we lose water through breathing, perspiration, and excretion. To remain healthy and keep our bodies working properly, the Institute of Medicine recommends about three liters (13 cups) of water for men and 2.2 liters (9 cups) of water for women. This is the total water suggested, however we get roughly 20% of needed water from the foods we eat, especially fruits and vegetables.

The "8 by 8" rule is often suggested as the standard amount of fluid you should drink in a day - 8 glasses of 8oz of fluid per day. Many factors affect hydration and how much water you need. These include exercise, environment, illness or health conditions, and pregnancy or breast feeding. Living in the hot arid climate of Albuquerque can also increase your water needs, especially during the summer months.

The key is to drink enough fluid so you rarely feel thirsty. Tips include: Drink a glass of water or other low-calorie beverage with and between meals. Also drink water before, during, and after exercise.

Check out these links for more information about the effects of caffeine and alcohol on hydration and Mayo Clinic recommendations.

On one hand some people say that it does not matter if you eat below your BMR. Eating at BMR would result in slower weight loss, eating below BMR produces quicker visible results.

On the other hand I have heard that eating below your BMR will result in slowing down your metabolism because your body goes into starvation mode. Starvation mode could slow down weight loss in the long run, and have long term negative effects on your metabolism. Should I take my BMR into consideration when counting calories for weight loss?

Basal metabolic rate (BMR) is the calculated number of calories a person would burn if he/she did absolutely nothing all day - lay in bed all day. When reducing calories for weight loss your BMR is important. There are numerous calculations available online as well as lab tests that measure BMR based on oxygen intake and carbon dioxide output. Depending on what your calculated BMR is, you can eat fewer calories and safely lose weight and keep it off. When calculating for weight loss, it is important to calculate based on your goal weight rather than current weight. For those looking to lose a significant amount of weight, it is best to start with a 500 calorie/day reduction from what they are currently eating and progress to that goal weight calculated BMR.

Severe calorie restriction (less than 1000 calories/day) is not recommended for any extended period of time to individuals with healthy activity levels. While severe calorie restriction may appear to do well in the beginning, over time your body will adapt and become very efficient at storing energy - aka the fat you wanted to lose. Once normal (1600-2000 calorie) healthy eating levels return, the person may experience weight regain. Typically less than 1200 calories per day is not advised sustainable weight loss. If you are eating above that 1200 calorie level the bodies starvation mode is much less likely to kick in to affect.

Taking your BMR into consideration is important in weight loss since it can give you a rough starting point; however you can eat below your BMR calorie level and still maintain a healthy rate of weight loss. It is important to not forget about physical activity as it is also key to weight loss and maintenance success. Use a calorie calculator that includes an activity level when planning your weight loss and targeted daily calorie level.

RMR (resting metabolic rate) is another similar measure of energy expenditure. UNM's Exercise Physiology Lab provides testing for individuals to find out their RMR. Contact the lab at 277-2658 for more information regarding pricing and scheduling an appointment.

For a generally healthy person, 4 cups of spinach a day is unlikely to cause any health problems. In fact, it is more likely that including the spinach will be a good thing.

Spinach is a very healthy food choice. It is low in calories, high in fiber, and a good source of many vitamins and minerals including magnesium, potassium, calcium, folate, and vitamin C. Spinach contains lutein and zeaxanthin, two carotenoids that have been shown to benefit eyesight by preventing macular degeneration due to aging.

That said, if you have calcium or iron intake concerns or are prone to kidney stones, you might want to be cautious with high volumes of spinach. Spinach does contain a compound called oxalate. Oxalates can impair the absorption of minerals like calcium and iron. In the body, oxalates can also form into kidney stones. If these are concerns for you, talk to your doctor to see if limiting oxalates is appropriate for your health status.

For some, the fiber in spinach may cause intestinal distress (typically gas, bloating, and/or diarrhea), especially when eaten raw. If you experience these symptoms soon after drinking the smoothie, you might try a smaller serving of spinach to see if that makes a difference.

Also, consider the other ingredients in your smoothie. While smoothies can be a convenient way to boost your intake of fruits and veggies, they sometimes deliver a huge sugar load that can cause blood sugar spikes. Try to limit added sugars and add a little healthy fat and protein (such as almond or peanut butter) to help slow the absorption of the sugars.

Ultimately, eating leafy vegetables is a good thing for most of us. Continue to include spinach in your diet, but also consider swapping in some other options for a little variety. Your green smoothies could also be made from ingredients like kale, Swiss chard, or even cucumbers or avocados.

For some more info on spinach, including discussion of eating too much, check out Eating a Bowl of Spinach Per Day. What Are the Effects of Too Much Spinach? also sheds light on the subject.

The best diet to use is the one you will stick to. The problem with most "fad" diets is that they focus on unsustainable habits - completely avoiding certain foods, following complicated rules, or severely restricting intake. Most of us cannot maintain this for more than a few weeks. So the key is to find a plan that meets your needs and lifestyle.

Ideally, we would limit calories through a healthy eating pattern rich in fruits, vegetables, lean protein, and healthy fats. However, some of us prefer a structured plan to provide direction. Research suggests that all plans that healthfully limit calories will work regardless of the focus (e.g. low-fat, low-carb, or low-calorie). So take some time to look over several diets and find one that fits your preferences and lifestyle.

US News & World Report regularly reviews diets, evaluating several factors including how easy they are to follow, nutritional completeness, and weight loss success. Check out the report to help you find a weight loss plan that is right for you.

To assist with osteoarthritis, emphasize foods that help reduce the body's inflammatory response. The basics of an anti-inflammatory diet are the same as a general healthy diet and include lots of fresh fruits and vegetables and lean proteins while at the same time reducing refined grains, sugars, and alcohol. From that starting point, consider these additions:

• Increase consumption of fish high in omega-3 fats, such as salmon, halibut, and cod.
• Eliminate all trans-fats.
• Eat more beans and lentils.
• Minimize your intake of red meats, processed meats, and full fat dairy.
• Choose 100% whole grains.
• Eat more cruciferous vegetables such as broccoli, cauliflower, kale, and cabbage. These veggies help your liver to eliminate toxins.
• Herbs have strong anti-inflammatory properties. Some especially potent ones are ginger, turmeric, cinnamon, thyme, rosemary, and garlic.
• Include some fermented foods in your diet. Common fermented foods include kimchi, miso, sauerkraut, yogurt, kefir, and kombucha. These promote a healthy gut that can reduce inflammation.

If you suspect you may have a food sensitivity, talk to a Registered Dietitian or your regular health care provider. Identifying and removing trigger foods can be helpful. Additionally, weight loss can dramatically improve knee osteoarthritis by reducing pressure on the joint.

For more information on anti-inflammatory foods and the potential benefits, check out Anti-inflammatory Diet: Road to Good Health? from WebMD.

The first step in managing hypothyroid is to talk with your health care provider and get a treatment plan. Unless caused by iodine deficiency (not common in the US), hypothyroid cannot be rectified by diet alone. It requires active adherence to your medical plan. That said, diet can be an important part of managing the disease.

Your food choices can impact the effect of your medication. Levothyroxine is the typical medical treatment. Talk to your provider about correctly taking the medication since combining it with food or supplements such as calcium, iron, and fiber pills can reduce the medication's effectiveness. Typically, you will take your medication first thing in the morning well before you eat any food.

The primary role diet plays in hypothyroidism is to help minimize symptoms. Two of the more common side effects are weight gain and constipation. Here are tips to manage these symptoms:

• Weight gain: balance caloric intake by emphasizing low calorie foods such as fruits and vegetables. There are numerous free web sites that can help you evaluate and adjust your intake; sparkpeople.com and fitday.com are two favorites.
• Constipation: ensure you are consuming sufficient fiber and water. Women should target at least 25 grams of fiber per day, while men should get 38 grams. WebMD has an article that offers some great fiber suggestions.

And don't forget physical activity. Having a regular exercise routine will help manage weight, improve circulation, fight constipation, and generally boost your metabolism.

For more information on hypothyroidism, check out Hypothyroidism (underactive thyroid) on the Mayo Clinic's website as well as their expert answer on diet and thyroid function.

Sitting at a desk for long periods can be especially problematic for those with low back problems. Properly used, a foot rest can be an important part of the ergonomic equation to help reduce your pain.

A foot rest serves two main purposes. Primarily, it "raises the floor". The ideal posture at your workstation is to have hips, knees, and elbows at a 90-degree angle. But limitations in desk adjustment or an individual's height may still leave your feet dangling. The foot rest gives you a firm base of support which helps take strain off your lower back.

Secondly, some foot rests hinge and can rock. This allows you to periodically move your feet, increasing blood flow and decrease the possibility of clots.

Be sure to adjust your foot rest so that it provides that firm base of support so you can achieve proper posture. Keep it positioned such that you can maintain those 90-degree angles and that your feet don't dangle. Then, once it is in the right position, if your foot rest can rock, periodically move your feet to keep the blood moving.

Remember, a foot rest is a tool to improve workstation ergonomics, but it cannot replace the importance of frequent rest breaks to stand up, stretch, and move around. Employee Wellness recommends the 30/30 rule - for every 30 minutes of work, stretch for at least 30 seconds. Install Workrave on your computer to prompt you for regular rest breaks.

Also, UNM's Safety & Risk Services offers ergonomic workplace evaluations to help you fine tune your setup and reduce the chance of injury. Visit the Safety amp; Risk Services website or call (505) 277-2753 for more information.