Monday, October 28, 2013

"Staying Fit after Breast Cancer.... or the importance of exercising before, during and after treatment"

Dear Friend,

It's October, the NFL goes pink and we know it's Breast Cancer Awareness Month. No better time to take a closer look at the relationship between Breast Cancer and Fitness Training/Physical Therapy.

Before exploring the effect a Breast Cancer diagnosis  has on your ability to pursue Fitness Training at the different stages of the treatment let's look at a few CDC (Center for Disease Control) numbers that help us understand why we need Breast Cancer Awareness Month.


Breast Cancer is the number one cancer amongst women no matter there ethnic and racial backgrounds (except a couple of skin cancer types). It is the number one reason for Hispanic women to die of Cancer and the number two cause for all other women living in this country when dead is caused by cancer. In 2009 roughly 200,000 women and about 2000 men in the USA were diagnosed with breast cancer, in the same year approximately 40,000 women and 400 men died of the disease.


There are many different types of breast cancer, that vary depending:
  • on the origin, location of tumor at onset of the disease
  • on whether it is invasive or non-invasive, tumor growth stays confined within the tissue of it's origin or infiltrates other neighboring tissue types.
  • on whether it metastasized through the lymphatic system
  • on the microscopic appearance and the degree of difference from healthy cells (cancer grade)
  • on the degree of hormone involvement, some types are driven by high levels of estrogen and progesterone (female hormones)
  • on their genetic make up.
The most common  non-invasive breast cancer is ductal carcinoma in situ, being diagnosed about 60,000 times per year in the USA. The type of cancer you are diagnosed with determines your treatment and prognosis.


  • Lumpectomy, is surgery to remove cancer or other abnormal tissue from your breast. Lumpectomy is also called breast-conserving surgery.
  • Mastectomy, is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer. 
  • Lymph node dissection is part of diagnosis as well as treatment. When treated either a regional lymph node dissection , (some of the lymph nodes in the tumor area are removed); or a radical lymph node dissection (most or all of the lymph nodes in the tumor area are removed, also called lymphadenectomy) will be performed.
Non surgical:
  • Radiation Therapy uses targeted, high-energy X-rays to kill cancer cells. The goal of radiation therapy is to kill any cancer that might be left in or around the breast.
  • Chemotherapy uses drugs that kill or disable cancer cells. Chemotherapy is an option for most types of breast cancer. The decision to use chemotherapy is based on the tumor stage and certain tumor characteristics, as well as your age, overall health and personal preferences.
  • Hormone Therapy addresses the types of breast cancer that are driven by estrogen and progesterone are considered hormone receptor-positive. When the hormones attach to special proteins called hormone receptors, the cancer cells with these receptors grow. Hormone therapies slow or stop by depriving the cancer cells of the hormones that feed them.
  • Targeted or Immuno-Therapy targets specific tumor cell characteristics such as a specific protein that feeds the cancer cell. Targeted or Immuno-Therapies are less likely to attack healthy cells as chemo therapy will and therefore create less unpleasant side effects.
  • I believe Exercise and Physical Therapy should be included in the catalog of treatments as they not only help easing side effects caused by other forms of treatment, but reestablish bodily function and quality of life, provide a sense of normalcy, and help preventing recurrence.

Exercise and Physical Therapy:

If we accept Exercise and Physical Therapy as a form of treatment we need to answer the questions as to
  • why and when it is appropriate to introduce Exercise and PT to the patient, and
  • how Exercise and PT may be influenced and/or has to be modified by and because of other forms of treatments used.

Most risk factors that increase the chances of getting breast cancer are non-modifiable such as age, sex, genetics etc. with one exception, body composition. The greater the percentage of adipose tissue the greater the amount of Estrogen produced in the female body. Breast Cancer driven by female hormones (Estrogen and Progesteron) are the most commonly diagnosed forms of breast cancer. Body Composition is modifiable through Nutrition and  Exercise. In other words Exercise plays an important role in the prevention of hormonally driven breast cancers.

After having been diagnosed with breast cancer and introduced to a treatment plan many patients opt to use a moderate exercise program including aerobic activities and strength and resistance training to prepare for the upcoming surgical and non-surgical treatment regimen. Studies show that this type of preparation leads to an increased level of energy throughout the treatment phase, as well as a shortened recovery especially from surgery, and a better tolerance of the very much dreaded side effects stemming from chemo and radiation therapy.

Surgical procedures such as lumpectomy, mastectomy and lymph node dissection lead frequently to a loss of strength and mobility in the shoulder and arm of the affected side. These negative consequences are often further exacerbated by the possibly following radiation treatment. Physical Therapy and exercises prescribed by a Physical Therapist help to restore movement, function, strength and enable the patient to return to his or her regular activities of daily living. Exercising as part of the rehabilitation process needs to be closely monitored by the patient, the therapist, trainer and health care provider to prevent negative side effects such as Lymphedema. If the patient is undergoing radiation and/or chemo therapy immune responses are often reduced and lead to a greater risk for infections. During these times patients are better advised to train in privacy and avoid public places such as gyms and parks. Another common side affect of chemo and radiation treatment is extreme fatigue. Individuals presenting with extreme fatigue should exercise at significantly reduced intensities or even temporarily suspend all exercises.

Lymphedema is a non curable side effect of removal or damage to lymph nodes as part of cancer treatment. It commonly effects one arm or leg but may lead to swelling in both extremities on occasion.The swelling is caused by a blockage of the lymphatic drainage system. Some patients and doctors fear that exercise especially weight lifting might contribute to the development of lymphedema. Many others belief that the benefits of exercise outweigh the risk of Lymphedema by far. No matter what side you come down on, it is important to be alert and aware to the risk and notify your doctor as soon as you notice any type of unusual sensations or swelling. To reduce the risk of lymphedema discuss your exercise program with your physician and Lymphedema specialist prior to starting. In many cases it is advised to seek help from a Physical Therapist or Fitness Trainer before starting a home based fitness regimen.

Though the issue is complex it seems that those exercising regularly after finishing treatment have a greater survival rate than those who become less active or inactive. The reason why exercise plays a major roll in preventing recurrences is most likely the same as in primary prevention, the control of body weight and body composition.

The following is a proposed model for prescribing exercise to breast cancer survivors:


Staying physically active and taking advantage of Physical Therapy and customized fitness training has advantages at any stage, as prevention, as preparation for treatment, during rehabilitation and treatment and to prevent recurrence.
When starting a strength training program after finishing your cancer treatments I would advise you to hire the services of an expert Fitness Trainer or Physical Therapist that has experience in working with breast cancer survivors. These specialists can get you started slowly and teach you to be cautious and patient getting you on the road to recovery.
As always I hope I was able to provide some useful information to you and welcome your questions and comments.
A Sante,

Info Sources:


Sunday, August 25, 2013

Osteoarthritis of the shoulder

Dear Reader,

Like my mother many people suffer from chronic severe shoulder pain caused by degenerative joint disease also known as osteoarthritis.

Osteoarthritis occurs when the bone protective- or articular cartilage wears down and causes swelling, inflammation, and pain. In some cases bone spur (osteophytes) growth might occur, as bone rubs against bone. The shoulder is made up of two joints, the acromioclavicular (AC) joint and the glenohumeral joint. The AC joint is located where the clavicle (collarbone) meets the acromion at the tip of the shoulder blade. The glenohumeral joint is the meeting point between the arm bone (humerus) and the scapular (shoulder blade).

In the majority of cases osteoarthritis of the shoulder or any other joint for that matter is found in people age 50 or older. In the earlier years osteoarthritis is typically caused by a traumatic injury to the joint. A very small percentage of young osteoarthritis patients have a genetic predisposition to the joint disease that causes an early onset.

When seeing an orthopedic specialist, he/she will most commonly start the diagnostic process by establishing a medical history and perform a physical exam looking for swelling, pain and tenderness. Often muscular weaknesses surrounding the joint is found due to pain induced inactivity. In addition x-ray and MRI can produce imagery that details the degree of degeneration of the joint more accurately.

Osteoarthritis of the shoulder can be treated conventionally, through medication, and surgically. The first step of treatment is to rest the shoulder and modify activities involving the shoulder. The application of ice or heat packs to reduce swelling, inflammation and pain and improve mobility are typically temporarily and do not eliminate the cause. Your physician might prescribe a physical therapy program focused on  stretching and strengthening muscles to improve joint range of motion.

Should these conventional methods fail to bring relief medications such as Non-Steroidal-Anti Inflammatory-Drugs (NSAID's: Ibuprofen, Naproxen, Aspirin) or Cox2 Inhibitors (Celebrex) can  be used to further reduce inflammation, swelling and pain. Advanced stages and severe shoulder pain is often treated with corticosteroid or hyaluronic acid injections. Steroid injections reduce swelling and thereby alleviate pain and decrease joint stiffness. Hyaluronic acid injections are known as "viscosupplementation" and help lubricate the joint similar to the way W40 works on mechanic joints.

If all non-surgical options are exhausted your physician will suggest either a total shoulder replacement (arthroplasty) or a partial replacement in which only the head of the humerus is replaced (hemiarthroplasty). Both these surgeries are performed to treat osteoarthritis of the Glenohumeral joint. The removal of a small section of the end of the collarbone known as resection arthroplasty is the common surgical choice to treat osteoarthritis of the AC joint.

In recent years stem cell research has created new hope for osteoarthritis patients. In the last years stem cells who help heal and regrow cartilage were used in the repair of small cartilage defects. Currently studies are ongoing to explore whether the same treatment can help grow whole joint surfaces such as knees and hips in a lab to resurface the degenerated joint. For now this is still science fiction but there is a great deal of optimism and reason to be hopeful.

Many of my arthritic clients ask whether exercising is beneficial and whether I would recommend exercising while in pain. My answer to both questions is YES.

Our joints need movement! Movement nourishes and promotes joint health. Maintaining strong muscles will help support the weakened joint structure and reduce joint stress as you move. Stretching muscles and utilizing gentle mobilization exercises will help maintain good functional range of motion allowing for optimal use of the joint. Cardio-vascular exercises help in the prevention of diseases commonly known to be associated with inactivity and manage body weight therefore reducing impact on spine and joints. In addition learning meditation and relaxation techniques have shown to reduce stress and pain.
The exercise choices and the workloads when exercising with osteoarthritis depend on the severity of the disease as well a the timing. Workloads and work-out intensities have to be reduced when training an arthritic joint. Certain exercises might require modifications or need to be avoided all together in order to reduce the risk of causing aggravation. During an acute phase of inflammation one should further reduce or even eliminate the workload and focus instead on flexibility and mobility exercises working around the pain rather than through the pain.

Exercise suggestions for Shoulder OA:

Overhead Shoulder Stretch:
Stand with feet shoulder wide apart, arms hanging in front of body. Interlock fingers with palms facing down. Stretch arms straight overhead with fingers interlocked and palms facing ceiling.

Hold stretch for 20-30 seconds
2-3 Repetitions

Crossover Shoulder Stretch:
Stand with feet shoulder wide apart. Reach with one arm across opposite shoulder bending elbow. Gently push elbow further towards opposite shoulder.

Hold stretch for 20-30 seconds
Repeat 2-3 times each side

Towel Shoulder Stretch
Feet shoulder wide apart. Hold towel in one hand, drop it down the spine, Grab low end with other hand and gently pull top hand down behind head.

Hold stretch 20-30 seconds
Repeat 2-3 times each side

Shoulder Blade Pinch:

Stand with feet shoulder wide apart. Draw shoulders down and back until you feel your shoulder blades pinch in the back.

Hold for 5-10 seconds
Repeat 5-10 times

Rotator Cuff Strengthening
External Rotation

Stand with feet shoulder wide apart. Arms bend by your side at 90 degree angle. Grab elastic band with one hand and rotate outward. .

Repeat 10-20 times each side

Internal Rotation

Same position as before but this time arm rotates inward

Repeat 10-20 times each side.

These exercise are only a small selection and might not be suitable for everyone. Please talk to your physician and/or physical therapist before starting any exercise program.

I hope this short article is helping you understand your own condition or that of someone close to you. If you have any comments or questions please don't hesitate to email me.



Web Md:
American Academy of Family Physicians:
Arthritis Health:
Science Daily:
Chicago Tribune:
Arthritis Foundation:

Saturday, June 29, 2013

Living and exercising with Prostate Cancer

Dear Friend,

a few days after the 12th anniversary of my father's passing, he had prostate cancer, and after a very close friend was recently diagnosed with the same disease I decided to dedicate this blog to all those who are or have been living with prostate cancer.

The prostate is a walnut sized gland between the bladder and the penis surrounding the urethra. It produces the seminal fluid that transports and nourishes the sperm.

Cancer of the prostate gland is one of the most common cancers in men. Even though the causes of the disease are still largely unknown we do know about risk factors that increase your chance to develop prostate cancer:

  • Age: Prostate Cancer is most common in men over the age of 65 and cancer cells are found in nearly 80% of men by age 80.
  • Ethnicity: Black male have an increased risk overall for developing prostate cancer and more aggressive forms of the disease in particular. Reasons unknown.
  • Family history: Any man like myself who has a family history of prostate cancer is at a higher risk than those without family history.
  • Obesity: Significantly overweight men who are diagnosed with prostate cancer show more often advanced disease which is much more difficult to treat.
Prostate cancer can in nature be slow growing or aggressive and be assigned one of four different stages. Stage 1: The Cancer is confined to a very small area in the prostate itself. Stage 2: The cancer is still small but maybe effecting both sides of the gland and/or deemed aggressive. Stage 3: The cancer has invaded other non prostate tissues surrounding the gland. Stage 4. prostate cancer cells are spreading throughout body by way of lymphatic system and blood stream and/or have grown into nearby organs.

The symptoms of prostate cancer often don't appear until the later stages:
  • Difficulty urinating (initiation and reduced force)
  • Blood traces in urin and/or semen
  • Swollen legs
  • Pelvic pain
  • Bone pain
Should you experience any symptoms that concern you please see your doctor for a detailed diagnosis. The initial screening test is typically  a digital rectal exam (DRE) in which the doctor inserts a lubricated, gloved finger into the rectum to determine if your gland shows any abnormalities in texture, shape or size. In case of a positive DRE a prostate-specific antigen test (PSA) may be needed. This test analyzes your blood for a higher than normal level of PSA which could indicate an infection, enlargement, inflammation or cancer of the prostate gland.

The next step often includes ultrasound to produce a better visual diagnosis and a  needle biopsy to collect a tissue sample that can be checked for cancer cells. If it is determined that the cancer has spread, further diagnostics are used to define the exact situation and decide the treatment options.

The treatment of prostate cancer depends greatly on the speed with which the cancer is growing, the extend to which it has spread as well as your doctor weighing benefits versus side effects.

Treatment options include:

Radiation Therapy either via high powered energy beams applied from the outside or a low long-term dose of radiation treatment by inserting small radioactive seeds into the prostate gland near the tumor. Side effects are rare but in very few cases can lead to other forms of cancer associated with radiation.

Hormone Therapy targets the male hormone testosterone which helps cancer cells grow. Testosterone production can be stopped or limited through medications which prevent signals to the testicles to produce testosterone or through medications that prevent testosterone from reaching the cancer cells. A more radical and often faster way to reduce testosterone levels is the surgical removal of the testicles called orchiectomy. Side effects can include erectile dysfunction, loss of bone mass, weight gain, reduced sex drive and increased risk for heart attacks.

Prostatectomy is the surgical removal of the prostate gland, some of the surrounding tissues as well as nearby lymph-nodes. Side effects may include urinary incontinence and erectile dysfunction.

Freezing and thawing cancer cells via the use of gases that freeze and reheat the cancerous tissues and finally kill the cancer cells This form of therapy is still in developmental stages but complications have been significantly reduced over past years and presents a possible treatment option for those who did not respond to Radiation Therapy.

Chemotherapy is a very aggressive form of treatment most commonly used for  advanced stage prostate cancer (spread to other parts of body) or in patients that did not respond to Hormone Therapy. The medication that kills cancer cells is commonly taken either via pills or given intravenously. Unfortunately chemo therapy despite great progress still presents a lot of unwanted side effects in most patients.

As always it is better to prevent disease rather than having to treat it. The risk of developing prostate cancer can be reduced through a diet that is rich in fruits and vegetables and favors real healthy food choices over supplements. Nutrients and vitamins that have been linked to the prevention of prostate cancer are lycopene (found in tomatoes) as well as vitamin E and selenium. However supplements including these vitamins/minerals don't show the same success as foods naturally rich in vitamin E and selenium. In addition to a healthful diet regular exercising on most days of the week seems to cut the risk of prostate cancer even more. Screening healthy men for prostate cancer, who are not showing any symptoms of the disease, is somewhat controversial amongst the different medical organizations. To decide whether or not screening is appropriate for you please discuss your particular situation with your physician.

Exercise and prostate cancer
 As a Physio-Therapist and Personal Fitness Trainer I am of course especially interested in how far exercising can help reduce the risk of developing prostate cancer and how those with prostate cancer respond to exercise as an additional form of treatment other than the ones discussed previously.

It seems that the majority of studies performed between 1989 and today show a probable connection between increased physical activity and decreased prostate cancer risk. This reduced risk is explained by way of hormone level regulation, the prevention of obesity, improved immune functions, and the reduction of oxidative stress that are all positively influenced through regular exercising. Exercising also has a positive effect on those undergoing treatment for prostate cancer. One study suggests that men can reduce their risk of prostate cancer progression and increase their chance of survival by adding physical activity to their daily routine. These benefits can even be attained  with moderate levels of physical activity (15 minutes per day); however exercising vigorously for three or more hours per week seems to be of greater value and reduce all-cause mortality by 49% and prostate-cancer-specific mortality by 61%. Scientist are starting to understand why vigorous activities are more beneficial quoting it's positive effects on DNA repair and cell-cycle pathways as well as gene expression changes. They found upregulated genes that included well known tumor-suppressor-genes such as BRCA1 and BARCA2 in men with prostate cancer who participated in a vigorous exercise protocol for more than three hours per week.

I think it is safe to conclude that exercise does not only help in the prevention of prostate cancer, but can also positively change the outcome of the disease. More studies and research are needed to explain the correlation between exercise and prostate cancer in detail.

I hope this blog has been able to provide you with some interesting and helpful information. Please feel free to share my blog with anyone you might think would be interested, and as always your question and comments are greatly appreciated.

Wishing you and your loved ones good health,

Program in Human Biology, Stanford University California
Medscape Medical News
American Society of Clinical Oncology

Sunday, April 28, 2013

Exercising with AFib

Dear Friend,

as so many of my blogs this one too was inspired by the work with one of my current clients. He has experienced an increasing number of episodes of AFib during and outside of our training meetings. Rather than going into the details of his situation I would rather address the general issue of exercising when suffering from AFib.

Atrial Fibrillation (AFib) or paroxysmal atrial fibrillation (PAF) are characterized as irregular and often rapid heartbeats that cause a reduced blood flow to the body. Atrial fibrillation effects the upper two chambers of the heart where the blood is pooled that is returning from the body's periphery and moved on into the two lower chambers called ventricles, that pump blood back into the body's circulation. When you experience AFib the Atriums are beating out of sync with the Ventricles causing heart palpitations, weakness and shortness of breath.

The causes of Afib aren't exactly known and understood but we do know that hypertension, heart failure, coronary artery disease and pulmonary disease are major contributors in the development of this condition. A natural cause of AFib can be the hearts age. An aging heart does not respond the same way as a young heart and that can lead to PAF.

Frequent episodes of AFib can significantly increase ones risk of stroke and heart failure. Due to the chaotic atrial contractions blood remains longer in these chambers increasing the chance of blood clotting also known as thrombosis. As these clots start moving through the body they can cause blockage of blood vessels supporting vital organs (i.e. brain) with oxygen resulting in a stroke. Heart failure is caused by the increased work load on the ventricles, which have to work much harder when trying to keep up with irate and rapid atrial contractions and cause the heart over years to wear out.

AFib is most commonly found in people over the age of 65 and as our senior population grows, so does the number of people dealing on an ongoing basis with AFib. Initially AFib may occur infrequently, but over time most commonly episodes appear more and more often and in some cases becoming a permanent state. Patients are commonly treated with medications that regulate the frequency of heart beats and anti-coagulants (blood thinners) to reduce the risk of thrombosis.

Just like any other heart condition or cardio-vascular disease AFib too benefits from exercising regularly as long as the training intensity meets the state the client is in. Mild to moderate intensities when participating in aerobic activities and weight lifting can help with body weight control, enhance mental outlook, help prevent other health problems and maintain strength and mobility necessary to perform activities of daily living.

  • If you are suffering from AFib, please have your Cardiologist determine your maximum heart rate while exercising and after cool down. I personally like the use of heart rate monitors when training clients with AFib as it provides constant work-out intensity feedback.
  • Be aware and recognize symptoms of AFib. If your work-out causes chest pain, extreme shortage of breath or extreme exhaustion stop immediately and reconsult with your doctor.
  • If you are a novice to fitness training make sure you ease in to it gradually starting with 15-20 minutes sessions rather than going straight for a full hour. As Atrial fibrillation is intermittent adjust your work-out intensity and duration in accordance with the situation at time of training.
  • If you are dealing with other problems i.e. ischemic heart disease, chronic heart failure or valvular heart disease the exercise considerations of these diseases take precedence over those for AFib.
Regular exercising  can be beneficial for individuals living with AFib as it positively effects the contributing factors to heart disease and improves the overall quality of live. The key to maximizing the benefits of exercising is to follow a well designed and supervised program that the individual can follow long term.

Hopefully this article is helping you to understand better the risks and benefits of exercising with AFib. Should you have any questions or comments please let me know.

A Sante,

Sources:,, Medscape, Mayo Clinic, American College of Sports Medicine.

Wednesday, January 16, 2013

Warm-Up and Cool -Down: Why and How

Dear Friend,

I wish you and your family a Healthy and Happy 2013.

Yesterday I watched my son's High School soccer game. As so often, my observations triggered a new blog. During the middle of the game one of my son's teammates, who just a few minutes earlier had entered the game as a sub, went down on to the pitch in a great deal of pain. No one knew exactly why. I thought it was the lack of proper warm-up before he entered the game that caused the injury. Turns out I was wrong. Upon further examination the boy showed all classical symptoms of Sciatica. However having observed his warm-up prior to coming into the game made me want to write a blog discussing the changes that have taken place over the past 4-5 years with respect to warm-up and cool-down and the scientific reasoning behind these changes.

The right warm-up and a proper cool-down need to be essential parts of every work-out and athletic competition. Correctly done they help minimize the risk for injury, increase physical performance and help with recovery after the competition or work-out.

The preferred warm-up of the past and that of my son's teammate included some form of gradually increased cardio vascular activity ( in his case way too little) like running, cycling, swimming etc. to increase the body's core temperature and blood circulation within the muscles. This phase was followed by static stretches to increase flexibility and range of motion (prolonged stretches that are used to increase the length of soft tissue and flexibility of the muscle). This warm-up procedure is flawed in at least two ways.
  1. Static stretching is a very inactive warm-up method which leads to a decrease in muscle and body-core temperature that had just been elevated during the first phase of the warm-up. Therefore rendering the cardio-vascular warm-up part worthless. Reducing muscle temperature and core-temperature reduces physical performance ability (reduced oxygen supply, reduced neurological activation level) and increases risk of soft tissue injury as a colder muscle is less pliable/flexible and tears easier.
  2. Besides that, several recent studies have shown that static stretches reduce the muscles ability to contract forcefully leaving that stretched out muscle weakened for up to an hour. This muscle weakness leads to an increased risk for injury and a muscle performance reduction.
Does this mean static stretches should be avoided all together? The answer is no. Static stretches are still a vital part of an athletes overall training. They do increase flexibility and improve joint biomechanics thereby reducing risk for injury to soft tissue and joints. Static stretches should based on today's knowledge be performed as part of a cool-down procedure and/or be done on off days.

Lately we are leaning more and more towards sports specific dynamic warm-up programs. These dynamic warm-ups focus more on the neuromuscular systems of the muscle. Dynamic warm-ups help with short term flexibility gains and lead to more adequate protective reflex responses from the Golgi Tendon Organs without compromising the strength of the muscle. Golgi Tendon Organs are lying deep within the muscles and protect the muscles from being overstretched. If not properly prepared and activated during warm-up these organs often over react during sports activities leading to muscle strains. Dynamic warm-up protocols help dampen the reaction of the Golgi Tendon Organs leading to improved muscle performance.

To properly warm-up I suggest you continue to start the same way you used to. Brisk walking, jogging or cycling etc. will help increase core and muscle temperature, improve oxygenation of muscle, and get your metabolic and nervous systems ready for action. After that skip the static stretches and move into dynamic sports specific exercises such as high knee jogging, butt kickers, multi directional lunges, bear walks, leg swings, arm circles etc.

After completing your work-out or competition slowly turn the system back down by gradually decreasing the intensity. Slow jogging and static stretches are a good way of returning physically and mentally to a real life activity level.

I hope I was able to shed some light on the recent changes to Warm-Up and Performance Readiness. As always, if you have any questions or comments please feel free to contact me.

A Sante,

Mayo Clinic:
Journal of Strength and Conditioning Research. ” 2008: