Slow, low-intensity exercises can benefit both sexes

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Today we'll explore the benefit of mind-body exercises, which are relatively low intensity and slow in pace, with a physical therapist who has a lot of experience with mind-body exercise. Rebecca Carey is a doctor of physical therapy at Upstate and the lead physical therapist for the oncology program, and she also has an interest in integrative medicine and pelvic health. Welcome to "The Informed Patient," Dr. Carey.

[00:00:39] Rebecca Carey, DPT: Thank you so much for having me, Amber.

[00:00:41] Host Amber Smith: I know that yoga is considered a mind-body exercise, but there are others. Can you tell us how mind-body exercise is defined, and then what are some of the other exercises besides yoga?

[00:00:55] Rebecca Carey, DPT: Yeah, so mind-body exercises are typically movement sequences that involve breathing, control, attention regulation on the breath, which is a little bit different than typical physical exercises. Tai chi, meditation, mindfulness, even Pilates and qigong are all considered types of mind-body exercises.

[00:01:14] Host Amber Smith: When you think about yoga, there's all of these different styles of yoga. Do they all count as mind-body?

[00:01:22] Rebecca Carey, DPT: Yes. So, whether it's chair yoga that someone's practicing, or a high intensity, sometimes referred to as a power vinyasa class, the focus is always going to be on breath regulation through different movements. So there's lots of layers of benefits here.

[00:01:38] Host Amber Smith: OK, so exercises like running and swimming, those are meant to keep your heart and lungs healthy. Strength training with weights is meant to keep your muscles and bones healthy. What is the benefit of yoga or tai chi or meditation? What is that working on?

[00:01:56] Rebecca Carey, DPT: Yeah, so really the entire body.

So there's a lot of research showing us that it can help improve mental health, so particularly stress, anxiety, depression. There's also benefits to our memory and cognitive function, and it goes without saying that there's also improvements that have been demonstrated in some research studies on our physical health.

So things like balance, flexibility, strength. And I think flexibility is probably the No. 1 that I often hear from both patients and students that I want to improve my flexibility. I'm going to start practicing yoga or start practicing some type of Pilates or tai chi. But I think that really the experience of practicing something like this is that we are able to shift our attention from our physical status to our breathing. And so by doing that, it's like working a muscle where you, you're strengthening your attention, your ability to concentrate on something other than a physical sensation.

[00:02:57] Host Amber Smith: You mentioned the mental health benefits. How quickly would someone, maybe, notice an effect?

[00:03:04] Rebecca Carey, DPT: The research for this, it really depends on the study. I've seen it vary anywhere between four weeks to 12 weeks. So it just depends on the individual and what's going on. But the good news is that for most of the studies, looking through all of the literature for any population is that as little as once a week can be beneficial.

[00:03:26] Host Amber Smith: And you said balance, flexibility, strength, I mean, those are sort of the physical benefits of this. Is that something that people would notice right away, that they, their balance is, they're getting better with that or they're more flexible, they can reach further or bend deeper?

[00:03:46] Rebecca Carey, DPT: Yes. I mean, I do think that after about four weeks, folks can start to notice some changes in that. Now, we know from a physical and physiological standpoint that muscle tissue does not actually change until about six weeks of strength training. So you won't actually see changes if they looked at someone's muscle under a microscope. However, you will physically feel some differences. And that's because what the brain is telling the body to do. So the brain is sending a signal to those muscles that it needs to use them in a stronger way, to meet the resistance and to meet the demands that the practice is calling for.

[00:04:26] Host Amber Smith: Well, I know a lot of these mind-body movements are sort of lower intensity, slower movement types of things. Can they also, can they give you a workout? Do you ever see people doing yoga who are sweating, for instance?

[00:04:41] Rebecca Carey, DPT: Absolutely. So, it really depends on the type of practice that you're looking for.

There are some practices in yoga where it's entirely movement and very fast paced movement. So those would be types of yoga like Iyengar or Ashtanga, for anyone who's listening and is familiar with that. There's also a very common term at most studios, Vinyasa, which is also known to be a very fast-paced practice.

Now, for anyone listening who is thinking they might want to try a practice like this, something like tai chi is very slow paced. And even the YMCA, I believe, has tai chi classes. The Syracuse Parks Department has chair yoga, for seniors especially. There's lots of different options, and the practice doesn't always have to be slow. That's where some of the cardiovascular benefit can also play a role.

So it's not only in just our ability to regulate our blood pressure and heart rate, which are also demonstrated benefits of practicing any type of mind-body exercise, but there's also a benefit in actually physically challenging our system so that we can have that improved reduction in long-term high blood pressure and those different types of things that we typically would see as a benefit from any type of e exercise.

[00:05:59] Host Amber Smith: Now, what age do you recommend people begin with mind-body exercise? Is this more for seniors?

[00:06:06] Rebecca Carey, DPT: Anyone can begin at any time. It's very commonly practiced in Central New York in schools right now. And the benefits are huge to kids learning stress management tools that can be used at school or at the home, in their home environments. The Syracuse Parks department, as I mentioned, they do have chair yoga and regular yoga classes for all ages. And there's lots of other studios that include yoga and meditation, really for anyone.

I've gone to many different fitness classes in the Central New York area, and I can honestly say that you just need to kind of find your niche, find your group. There's lots of individuals who are practicing and doing different things, and if you're looking for a group that's maybe in your similar age demographic, then there's definitely something for you.

[00:06:55] Host Amber Smith: Do people need to do anything to prepare themselves or bring any equipment or certain clothing?

[00:07:02] Rebecca Carey, DPT: I would say, if you are going to be attending a class, take a look at the class that you're going to attend and the description. Especially with regard to yoga, unless it's chair yoga, plan on getting up and down from the floor.

You always want to wear typically loose, comfortable clothing. And just make sure that you can keep an open mind, and follow the instructor. So the instructors will typically also give different guidance in terms of making modifications and giving some different ideas, especially if you are a beginner. And sometimes I share with patients and even myself when I was a beginner, know that it can be helpful to let the instructor know that you're a beginner so that they can keep a special eye on you, to give you some additional information if it's necessary, and to kind of keep an eye in case you have any questions.

[00:07:56] Host Amber Smith: Now, are there any common mistakes that you can help us avoid?

[00:08:01] Rebecca Carey, DPT: So in general, I think that sometimes when we think of certain poses or certain movements, some individuals will wonder, you know, am I stretching in the right way? Am I moving in the right way? Am I doing this correctly?

Again, I would really defer to, if you're working with an in instructor, take their guidance, take their lead, and that's so much of what any type of mind body practice is, is really focusing on a little bit of that letting go aspect. The tuning inward gets easier the longer that you practice. But at first it feels kind of clunky, and that's pretty normal. So it won't necessarily feel natural unless you've done something like this before. It may feel a little bit extra physical, so you may feel it in your body a lot. Wow, this is a big stretch. Wow, we're really holding this position for a long time. Or what am I really getting out of this? But again, the benefits, you have to stick with it, and then you see the changes that happen. And they've all very frequently, so there's many studies where they've looked at MRI (magnetic resonance imaging scans) and brain changes that have happened over a period of time in individuals practicing yoga, practicing meditation, tai chi. And there's changes in the brain that happen in terms of memory, cognitive function, and even how we regulate our emotions.

[00:09:21] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with physical therapist Rebecca Carey, and we've been talking about the benefit of mind-body exercise.

One of your other research interests is pelvic health, so I'd like to ask you, what's important about pelvic health?

[00:09:40] Rebecca Carey, DPT: Yeah, so pelvic health applies to everyone. Everyone has a pelvic floor. It's comprised of muscles. And there's three layers of skeletal muscles, which means that we have the ability to control these muscles, and we have voluntary say over what they do.

So the reason why it's so applicable, especially if someone has, let's say, had a child, is that it's similar to a postoperative state, right? And if someone has had a C-section, it really is a postoperative state. The muscles in the pelvic floor often need different types of rehabilitation to return and maintain good function. Every population benefits. It just depends on what symptoms someone is experiencing.

[00:10:24] Host Amber Smith: So particularly women who've had children may know the term "Kegel" exercises, that sometimes they're told to do Kegels during their pregnancy.

[00:10:33] Rebecca Carey, DPT: Mm-Hmm. Yes.

[00:10:34] Host Amber Smith: Can you describe that, and is that the same thing as pelvic exercises?

[00:10:40] Rebecca Carey, DPT: Really that's a very interesting question because Kegels are a contraction of the walls of the vagina. And so oftentimes we think of squeezing the pelvic floor muscles and that that's an exercise. The thing is, that is not the only exercise that exists for the pelvic floor.

So one of the benefits of seeing a pelvic floor physical therapist, for example, is that we can assess the muscles to see, is it something that you do need to do? So if an individual is performing a Kegel, and let's say they're actually doing it the wrong way, then that gives us information about what we might need to work on.

Now, other times if an individual's going to squeeze the muscles in this way, and nothing happens, so they think that they're sending the signal, right? Then there's a connection or coordination piece that's missing. And again, we would know where to start in terms of giving you instruction on how to do this.

But oftentimes I've found that there's often more flexibility that's actually needed at the pelvic floor muscles rather than toning or strength training. So that's a very common one that I hear from lots of patients in our community as well.

[00:11:55] Host Amber Smith: So what happens naturally to the pelvic area as we age? Do we become less flexible? What else happens?

[00:12:05] Rebecca Carey, DPT: As we age, very normally, our hormones change. So the tissues that are in our pelvic area also change. So these skeletal muscles are relied upon by a couple of different organs to function, and organ systems, right? So all our bladder function, our bowel function, sexual function, occurs within this region and is reliant upon these muscles.

So the other part that comes into play, right? Hormones, and so there's genitalia in the pelvic area as well. In terms of aging, there's a term called sarcopenia, which is the slow loss of muscle tissue. And that happens, again, very naturally. It's normal to happen as we age. So what can happen then is we may see a bit of atrophy or a change occur to the muscles that are in the pelvic floor. So it may be that there's more weakness there, or there's more difficulty to access the muscles. And so individuals might experience different things, like a whole slew of different symptoms.

I can go through some of those -- urgency, frequency, urinary or bowel incontinence, constipation, IBS ( Irritable Bowel Syndrome), difficulty starting the urine stream, pelvic pain. You know, anyone who has a history of abdominal surgery, abdominal pain, any type of cancer of the colon, bladder, rectum, ovaries, cervix, uterus, prostate, anything in that area will typically benefit from pelvic floor rehabilitation. And that's to give someone an idea of a program that's tailored specifically to them in particular exercises so they know what to do and when to do and why.

[00:13:48] Host Amber Smith: So do people come for the pelvic exercises only as rehab, or do you recommend people start doing these moves before there's ever anything, any problem that they have in that region?

[00:14:03] Rebecca Carey, DPT: That's a really great question. I'm often asked that. So, everyone owns their own body, right? So we can always take note of what control do we have over these muscles, right? So you can assess yourself and see.

One of the most common ones that I like to use with patients is taking a little washcloth, rolling it up and just sitting on it, like as if it were a bike seat. And then you can squeeze the muscles and then see, do I feel less pressure? Do I feel more pressure? Does anything change? Does nothing change. When you have that feedback, then the brain gets a little bit more information about, OK, the muscles are squeezing, I'm sending the signal. I did that correctly. Right?

You may notice that nothing changes. So then if you notice nothing changes, you can try again. And so that's the way that our brain learns, and then our bodies can transform that way.

[00:14:57] Host Amber Smith: At what age would you recommend men and women beginning exercises, or becoming aware of perhaps the need for exercises for their pelvic floor?

[00:15:07] Rebecca Carey, DPT: I do think that it really is for every age.

Here at Upstate, our pelvic floor team consists of six doctors of physical therapy with additional training in pelvic floor muscle function. And we treat all populations, including all genders, all ages. We see children who are having recurrent bedwetting, some other symptoms as well, sometimes constipation, other things going on.

But the more that we are in touch with this area of the body, it can really only help us. Then, if we notice that we're having symptoms, we can oftentimes try to address that on our own. And with a little bit of that biofeedback or proprioception tool with using the washcloth, which just means that we're training our brain and the nerves to send the signal to the muscles.

We can try something like that. Or we can seek out care and assessment. So if we don't have an idea of what our baseline is to know how we typically function and how we feel, then it's hard to know, then, when we need help, right? And that's really what any type of rehabilitation is, is we're helping and guiding people along to restore their function, help them get back on their feet, always seeking to empower them to focus on taking control of their own symptoms.

[00:16:29] Host Amber Smith: And can these pelvic floor exercises be incorporated into the mind-body exercises that we talked about earlier?

[00:16:38] Rebecca Carey, DPT: Yes, absolutely. So there is a wide body of research in particular related to pelvic floor dysfunction and pain, urinary incontinence as well, and yoga, the benefits of practicing yoga, so in particular the type of yoga that's been used in these studies is what we call hatha yoga, H-A-T-H-A, but that's a very umbrella term for yoga, as much of the yoga that is practiced in our country is some form of hatha yoga.

So, practicing these pelvic floor exercises can be incorporated and blended into the mind-body exercise. It just depends on how you want to do it. So much of the benefit of yoga is on hip openers, and openers for the low back, and all of these areas we know are correlated with pelvic floor health. So if we're doing a stretch, like a child's pose or a stretch, like a pigeon pose, or happy baby -- if anyone wants to look these ones up -- those are all beneficial for the pelvic floor.

And so, many times when we think of exercise we might think of as strengthening, oftentimes flexibility training, mobility is usually where we need to start when it comes to the pelvic floor. And yoga really meets the bill for that.

[00:18:01] Host Amber Smith: And again, that would be for men and women, is that right?

[00:18:05] Rebecca Carey, DPT: Yes, absolutely.

[00:18:07] Host Amber Smith: Well, thank you so much for making time for this interview, Dr. Carey. I appreciate it.

[00:18:11] Rebecca Carey, DPT: Thank you so much for having me, Amber.

[00:18:13] Host Amber Smith: My guest has been Rebecca Carey. She's a doctor of phYsical therapy at Upstate and the lead physical therapist in the oncology program. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at uc1112.com/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.