Researchers from UChicago Medicine have discovered an association between vitamin D deficiency and COVID-19.
In a retrospective study of patients tested for COVID-19, researchers at the University of Chicago Medicine found an association between vitamin D deficiency and the likelihood of becoming infected with the coronavirus.
“Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections,” said David Meltzer, Chief of Hospital Medicine at UChicago Medicine and lead author of the study. “Our statistical analysis suggests this may be true for the COVID-19 infection.”
It’s important to note that the study only found the two conditions were frequently seen together; it does not prove causation. Meltzer and colleagues are currently planning further clinical trials.
Half of Americans are thought to be deficient in vitamin D, with much higher rates seen in African Americans, Hispanics and individuals living in areas like Chicago where it is difficult to get enough sun exposure in winter. (However, research has also shown that some kinds of vitamin D tests don’t detect the form of vitamin D that is present in a majority of African Americans—which means those tests might falsely diagnose vitamin D deficiencies in those individuals. This particular study accepted either kind of test as criteria.)
COVID-19 is also more prevalent among African American individuals, older adults, nursing home residents and health care workers—populations who all have increased risk of vitamin D deficiency.
“Understanding whether treating vitamin D deficiency changes COVID-19 risk could be of great importance locally, nationally and globally,” said Meltzer, the Fanny L. Pritzker Professor of Medicine. “Vitamin D is inexpensive, generally very safe to take, and can be widely scaled.”
Meltzer and his team emphasize the importance of experimental studies to determine whether vitamin D supplementation can reduce the risk, and potentially severity, of COVID-19. They also highlight the need for studies of what strategies for vitamin D supplementation may be most appropriate in specific populations. They have initiated several clinical trials at UChicago Medicine and with partners locally.
NOTE: Patients should contact a physician to have their vitamin D levels tested. Only take the dose recommended by your doctor.
Citation: “Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results,” Meltzer et al., JAMA Network Open, Sept. 3, 2020. DOI: 10.1001/jamanetworkopen.2020.19722
Findings were previously reported on medRxiv, a preprint server for the health sciences.
Funding: University of Chicago/Rush University Institute for Translational Medicine (ITM) Clinical and Translational Science Award, African American Cardiovascular Pharmacogenetic Consortium.
Exercise may help change exercisers’ brains in surprising ways, according to a new study of physical activity and brain health. The study, which included both mice and people, found that exercise prompts the liver to pump out a little-known protein, and that chemically upping the levels of that protein in out-of-shape, elderly animals rejuvenates their brains and memories. The findings raise provocative questions about whether the brain benefits of exercise might someday be available in a capsule or syringe form — essentially “exercise in a pill.”
We already have considerable evidence, of course, that physical activity protects brains and minds from some of the declines that otherwise accompany aging. In past rodent studies, animals that ran on wheels or treadmills produced more new neurons and learned and remembered better than sedentary mice or rats. Similarly, older people who took up walking for the sake of science added tissue volume in portions of their brains associated with memory. Even among younger people, those who were more fit than their peers tended to perform better on cognitive tests.
But many questions remain unanswered about how, at a cellular level, exercise remodels the brain and alters its function. Most researchers suspect that the process involves the release of a cascade of substances inside the brain and elsewhere in the body during and after exercise. These substances interact and ignite other biochemical reactions that ultimately change how the brain looks and works. But what the substances are, where they originate and how they meet and mingle has remained unclear.
So, for the new study, which was published this month in Science, researchers at the University of California, San Francisco, decided to look inside the minds and bloodstreams of mice. In past research from the same lab, the scientists had infused blood from young mice into older ones and seen improvements in the aging animals’ thinking. It was like “transferring a memory of youth through blood,” says Saul Villeda, a professor at U.C.S.F., who conducted the study with his colleagues Alana Horowitz, Xuelai Fan and others.
Those benefits were a result of the donor animals’ young age, though, not their exercise habits. The scientists suspected that exercise would spark additional changes in the bloodstream that might be transferable, whatever an animal’s years.
So, as a first step in the new study, they had both young and elderly mice run for six weeks, then transfused blood from both groups into elderly, sedentary animals. Afterward, those aged mice performed better on cognitive tests than equally elderly controls, whether their transfusions had come from young runners or old. They also showed spikes in the creation of new neurons in their brains’ memory centers. It was the donors’ activity that had mattered, not their age.
Intrigued, the scientists next set out to find what differed in the exercisers’ blood. Using sophisticated mass spectrometry and other techniques, they separated out and enumerated various proteins in the running animals’ blood that were not seen in similar profusion in blood from inactive mice. They then zeroed in on one little-studied protein known as GPLD1 (its scientific name is long and unpronounceable). The slightly mysterious protein is known to be produced mostly in the liver, an organ not usually thought to have much interplay with the brain. But levels of the protein were elevated enough after exercise to justify more investigation.
So, the researchers now employed genetic engineering to amplify the release of GPLD1 from the livers of old, inactive mice. Afterward, those animals performed almost like young mice on tests of learning and memory, and their brains teemed with far more newborn neurons than in other old mice. In effect, they gained the brain benefits of exercise without the effort of actually exercising.
To ensure that this reaction was not purely rodent-based, the scientists also checked blood drawn from elderly people. The older men and women who habitually walked for exercise showed higher levels of GPLD1 in their bloodstreams than those who did not.
The combined upshot of these findings seems to be that exercise improves brain health in part by prompting the liver to pump out extra amounts of GPLD1, Dr. Villeda says, although it is not yet clear how the protein then changes the brain. Subsequent experiments by the scientists showed that the protein probably does not breach the blood-brain barrier and act directly on the brain, Dr. Villeda says. Instead, it is likely to incite alterations in other tissues and cells elsewhere in the body. These tissues, in turn, produce yet more proteins that have effects on other tissues that eventually lead to direct changes to the neurotransmitters, genes and cells in the brain itself that undergird cognitive improvements.
Dr. Villeda believes that if further experiments show that GPLD1, in isolation, helps to initiate this molecular chain reaction, then it is at least conceivable that infusions of the substance might offer the brain benefits of exercise to people who are too frail or disabled for regular physical activity.
This experiment principally involved mice, though, not people, and does not tell us anything about the systemic effects of extra GPLD1, which in high amounts might be undesirable. More fundamentally, the findings highlight the pervasive, intricate, whole-body effects of exercise, with the liver, in this case, somehow changing minds and brains after workouts. At the moment, it is impossible to know if the same synchronized, interwoven processes all would occur in response to a GPLD1 exercise pill and, if not, whether it could be considered an exercise pill at all.
Dr. Villeda is quick to agree that pharmaceutical GPLD1, even if effective for brain health, “would not recapitulate the benefits of exercise.” There would be none of the usual fat burning, muscle building or cardiovascular improvements, he points out. But he hopes that, if future experiments in his lab with animals and people show consistent results, the substance might eventually help people who find moving difficult to think better.
A version of this article appears in print on July 21, 2020, Section D, Page 6 of the New York edition with the headline: Give Your Brain a Boost.
Here is food for thought: an average person takes 16 breaths per minute. Therefore, a person who lives to the age of 80 years, will end up taking 672,768,000 breaths in their lifetime! Let that number sink in and understand why this is so important.
As our bodies, environments and health undergo changes, so do our breathing patterns. Somewhere during our life’s journey, we end up turning into shallow breathers, using accessory muscles from our neck, back, shoulders or holding tension in our body when breathing. Our diaphragm, which is located below our rib cage and center of our belly, is the primary breathing muscle along with external intercostals, which helps us breathe.
Taking deep breaths throughout the day can establish a sense of grounding, and help us reduce unchecked tension in our body. It can act as a stress reliever and modulate the reaction to the day to day strains in life. After all, it is difficult for the body to maintain the same level of stress with extra oxygen in our blood when we breathe from the diaphragm.
A Breathing Exercise
Let’s try this exercise…Take a deep breath right now, let your shoulders relax and allow your abdomen to puff out as you take a deep breath in through the nose… hold…now slowly breath out through your mouth. Repeat this 5 times. The relaxing feeling that you are experiencing is your parasympathetic nervous system responding.
We tend to spend the majority of our time and days running on sympathetic overdrive aka the flight or flight response. This response can cause elevated heart rate, sweating, tensing of muscles and quickening of breathing (sympathetic response) all of which can take a long term toll on the body contributing to high blood pressure, anxiety, depression and addiction. Think of both of the above systems as the accelerator (sympathetic system) and brakes on your car (parasympathetic system). Learning how to use the brakes can help decrease cortisol levels (primary stress hormone)and relax the mind and body.
Proper Breathing Technique
Some studies have also suggested a link between improper breathing technique and chronic low back and neck pain. One such study demonstrated a strong association between increased forward head posture and decreased respiratory muscle strength in neck patients.
Adopting a practice of diaphragmatic breathing has a lot of advantages: it can help you manage your pain, relieve stress, reduce tension, improve quality of sleep, decrease blood pressure, and more. All you need is your lungs, a place to stand, sit or lie down and the intention to breathe.
Priyanka Jariwala, is Clinical Director at Performance Rehabilitation in Yonkers. She specializes in orthopedic and sports related injuries and is an expert in human kinesiology. Using an approach called Selective Functional Movement Analysis (SFMA), Priyanka is able discern subtle abnormalities in a individual’s movement and target the tissues that are causing the abnormalities. She frequently utilizes specialized instrumentation to effectively loosen these tissues and employs a wide variety of creative exercises that help restore mobility, strength and function. Priyanka is very motivating and while she develops a caring relationship with her patients, she will push her patients to maximize their potential.
The World Health Organization released guidance on June 16, 2020, that people shouldn’t wear face masks while exercising because it could reduce the ability to breathe comfortably, noting that the most important factor in preventing disease spread is distancing yourself from others. Still, it’s everyone’s own choice to decide if they want to wear a mask while exercising.
Either way, because the thought of exercising with a face mask on sounds, uh, miserable, CNET talked to a few experts who discuss everything there is to know about exercising while wearing a face mask.
Generally, yes, it’s safe for most people to exercise while wearing a face mask, Grayson Wickham, a physical therapist and certified strength and conditioning specialist at Movement Vault, tells CNET.
“Most people can perform every and all exercises with a face mask on,” Wickham says. “You will want to monitor how you’re feeling while exercising and watch out for specific symptoms such as lightheadedness, dizziness, numbness or tingling and shortness of breath.”
Wickham says people who have underlying cardiovascular or respiratory conditions should take caution when exercising with a face mask on. The severity of their condition will dictate whether or not it’s appropriate for them to exercise with a face mask on, Wickham says.
“Someone that has an underlying respiratory condition that is on the more severe side will want to exercise indoors without a face mask,” he says, to ensure safety for themselves and others.
Examples of such conditions include asthma, chronic obstructive pulmonary disorder (COPD), bronchitis, cystic fibrosis, pulmonary fibrosis and any other conditions that affect the heart or lungs. If you have a cardiovascular or respiratory condition, it’s a good idea to ask your doctor about exercising with a face mask before attempting to do it. If you can’t go see your doctor right now, try calling or scheduling a telemedicine visit.
Also, people who are new to exercising or haven’t exercised in a long time should pay extra attention if exercising while wearing a face mask. Monitor the intensity of your workout and keep it on the low-to-moderate side to avoid symptoms like dizziness and fainting, Wickham says.
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What happens when you exercise with a face mask on?
Compared with normal breathing, wearing any kind of protective mask decreases the flow of air into your lungs, Scott McAfee, physical therapist and orthopedic specialist at MovementX, tells CNET.Less oxygen in your lungs means less oxygen in your bloodstream and your working muscles, which is what makes training more difficult.
“Different masks have varying levels of airflow restriction, depending on the thickness of the material,” McAfee says. “With less air, your body has less available oxygen to utilize during exercise to convert glucose [sugar] into energy.”
McAfee says that anyone, even those who have a relatively high level of fitness, should expect to fatigue faster when exercising with a face mask, comparing this scenario to altitude training or wearing an oxygen deprivation mask to elicit greater respiratory fitness (this is something that elite athletes do).
“Over a few weeks, your body will certainly adapt by becoming more efficient at metabolizing oxygen, but this takes time,” McAfee says. “If you start to feel dizzy, imbalanced, or overly fatigued, stop. Be smart [and] don’t over do it.”
What to expect while exercising with a face mask on
“Due to the increase in breathing resistance, it’s normal to get out of breath quicker than you typically would in your workout when not wearing the face mask,” Wickham says. “You may not be able to perform at the same level that you would when not wearing the face mask,” he says, adding that you can expect a decrease in your workout performance while wearing a face mask.
Someone who has a higher fitness level may not feel the effects of a face mask as harshly as someone who is just starting to exercise, Wickham says, but even very fit people will most likely not be able to perform at their typical level.
If you do feel lightheaded, dizzy or extremely short of breath, you should sit down and take a break. If the symptoms don’t go away relatively soon, you should take your mask off to allow yourself to breathe normally, Wickham says. If you do need to take your mask off, always follow your state’s public health rules and try to maintain at least six feet of distance between you and other people.
How to not feel restricted while exercising with a face mask on
Sorry — you’re not really going to get around this one.
“Unfortunately, it is hard to get around feeling constricted while wearing the mask,” Wickham says. “The good news is, your lungs and cardiovascular system are getting an extra workout while you are wearing your face mask because it is providing extra breathing resistance.”
A silver lining: The more you exercise with a face mask on, the more accustomed your body will become to the reduced flow of oxygen, and theoretically, you should feel like a beast when you can finally work out without a face mask on.
As long as you don’t have an underlying respiratory or cardiovascular condition, and are listening to your body, you will most likely be getting enough oxygen while exercising with a face mask on, Wickham says.
The most accurate way to determine if you’re getting enough oxygen is to use a pulse oximeter, Wickham says, which tells you exactly the oxygen saturation of your blood.
“The next best thing is to simply listen to your body,” he says. “If you experience lightheadedness, dizziness, extreme shortness of breath or numbness and tingling, you need to stop exercising and sit down and take a break.”
Wickham warns against pushing through these sensations: “If you feel any of these symptoms, this is your body telling you that something is not right, and that something is that you are not getting enough oxygen into your lungs and to the rest of your body,” he says.
So to all you folks who’ll be sprinting to the squat rack when gyms reopen (see you there!), yes, you can safely exercise with a face mask on, provided you heed your body’s warning signs. And because hitting the gym with a face mask on is likely to be a post-coronavirus norm, you can at least take solace that your lungs will just be that much stronger when you can exercise freely again.
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First published on April 28, 2020 at 1:35 p.m. PT.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.
Marie Geraghty, PT, MS – Senior Physical Therapist
Have you heard of camogie, hurling or Gaelic football? If not, Marie Geraghty, our newest physical therapist, can explain them to you. Marie has a strong interest and depth of knowledge in sports physical therapy. On top of that, she is currently the team physical therapist for multiple teams playing in the Gaelic Athletic Association in the Bronx. We know our patients with sports injuries, as well as other problems, will benefit greatly from her care and expertise.
Marie Geraghty graduated from the University of Limerick in 2012 with her Physical Therapy degree and subsequently received a Master of Science degree in Preventive Cardiology from the National University of Ireland, Galway. The combination of her physical therapy degree and in-depth study of wellness, cardiovascular disease and disease prevention has allowed her to implement a holistic approach to her delivery of care. She has been active in research studying the effectiveness of rehabilitation protocols for patients undergoing total hip and total knee replacements. She also participated in research evaluating anterior cruciate ligament surgery outcomes.
From the Mayo Clinic News Network, By Deborah Balzer
The COVID-19 pandemic has resulted in another type of patient coming to the emergency departments.
Dr. Sanjeev Kakar, a Mayo Clinic orthopedic surgeon, says as a result of stay-at-home guidelines that have kept many adults and children home, there’s been an increase of patients with injuries from household accidents, including more kitchen knife cuts and lacerations, table saw accidents, lawn mower and tool mishaps, and gun injuries that are typical for this time of year.
While not all of these injuries are specific to the hands and fingers, hand injuries can be devastating and take a very long time to heal.
The hand is an intricate organ,” says Dr. Kakar. “The issue there is when you have a hand injury, not only do you injure the skin, but we worry about critical structures such as nerves and blood vessels, and the bones and tendons. And they all work in a perfect orchestra, and when they’re injured, it can lead to devastating injuries not only in terms of the surgery but also the recovery. You’re looking at months and months of hand therapy.”
Journalists: Sound bites with Dr. Kakar are in the downloads at the end of the post. Please courtesy “Sanjeev Kakar, M.D. / Orthopedic Surgery / Mayo Clinic.”
The goal is to get you back to normal function as much as possible, but sometimes that isn’t the case — and especially as we’re trying now as physicians to decrease patients coming into the hospital because we want to protect our patients,” he says.
Dr. Kakar says coming to an emergency department may potentially expose patients to someone with COVID-19. “It may be that a patient comes in who doesn’t have any signs or symptoms or any contact with coronavirus, now they’re subjecting themselves to that increased risk.”
“We really want to get the message to our patients in terms of think what you’re doing,” says Dr. Kakar. “Am I doing anything that’s putting me at extra risk, my family at extra risk, and also the health care providers that are taking care of me?”
Practicing good safety measures at home:
Keep knives and sharp instruments safely away from children
Don’t use dull knives – a dull knife can slip
Use lawn mowers, power tools away from children
Follow manufacturer’s safety instructions when using power tools and machinery
“Sometimes patients have already seen twenty doctors. They’ve had their scars, lungs, and eyeballs examined, but no one has asked, ‘How are you doing with all this?’ ” Patients, she learned, feel frustrated by their dependence on others. They can’t return to work; they’re forced to take taxis because they can’t climb the subway stairs. Others have trouble paying bills and keeping track of medical appointments. “Often, what these patients need is not a doctor,” Lief said. “They need physical therapy, occupational therapy, social interaction, case managers, financial planners. They need people to help them get their lives back.”
I’ve compiled some links to helpful and healthful articles and recipes which may make meal-prep easier and tastier during these challenging times. Since our partners and kids are suddenly in the house 24/7 we are tasked with cooking much of the day, often having to please picky palates. New recipes can spice up the cooking process (no pun intended) and offer ideas for healthier eating in general. Bon apetit!
Continue to heal with physical therapy while practicing social distancing.
“With You Every Step of the Way” is not only our motto, it’s our mission!
During these challenging times we recognize that you may not be able to visit our clinic for your physical therapy sessions. But even missing one or two sessions can have unintended consequences, requiring a longer recovery period.
That’s why we are now offering Telehealth services! You will be able to continue connecting and working with your physical therapists from the comfort of your home.
Telehealth uses electronic communication to remotely provide health care information and services. We offer this to our patients. There is a combination of clinical, technical, and financial considerations that determine if telehealth is right for you.
If you are interested in Telehealth, the best thing to do is to call our clinic and we can determine if it is a fit for you.
Medically Reviewed by Jody Braverman, CPT, FNS, RYT
If numbness, tingling and pain in your feet as a result of nerve damage is disrupting your life, your doctor may recommend exercises for neuropathy. While treating the underlying problem that is causing neuropathy is the first step, exercise can help with strength, balance and range of motion.
Proper stretching can help with neuropathy of the feet.
Image Credit: fizkes/iStock/GettyImages
What Is Neuropathy?
Peripheral neuropathy, which affects the peripheral nervous system, causes damage to the peripheral nerves. It often originates in the hands and feet, causing pain, numbness and tingling, according to the Cleveland Clinic.
Joseph Palmer, DPT, OMPT, a physical therapist at the Greater Baltimore Center for Rehabilitation Medicine, tells LIVESTRONG.com that neuropathy happens for a wide variety of reasons. Some of the most common causes, he says, include chronic diabetes or unregulated blood glucose levels.
Additionally, medication-induced damage from chemotherapy drugs or mechanical nerve entrapment, which results in pressure on the nerve and corresponding damage, can also cause neuropathy, according to Palmer.
Steven Srebnik, PT, MSPT, a physical therapist and founder of Performance Rehabilitation, tells LIVESTRONG.com that as neuropathy progresses, larger nerves become damaged, impairing your position sense and balance. To help manage some of these issues, specific exercises are often recommended.
“Exercise is imperative to address weakness in the legs and balance impairment,” says Srebnik. “Working with a physical therapist who is an expert in program design can help with problems such as this.”
Focusing on exercises specific to strengthening the small muscles in the foot, such as picking up marbles with your toes or scrunching a towel with your toes can help, according to Srebnik.
While peripheral neuropathy remains an ongoing issue, Srebnik says by using a proactive approach, such as diet and exercise, you can do a lot to alleviate the problem and improve the severity of the symptoms.
An April 2014 review published in Frontiers in Cellular Neuroscience found that exercise training for people with peripheral neuropathy from diabetes helped improve nerve function, reduced neuropathic pain and numbness and improved both static and dynamic mobility. The authors concluded that exercise specific to neuropathy could be an effective intervention for reducing symptoms.
Exercises for neuropathy are often recommended by a physical therapist or your doctor as part of a treatment plan. “When participating in physical therapy, your therapist may challenge your vestibular system and work on your lower extremity strength, as these activities can help improve your ability to react to a loss of balance,” says Palmer.
In general, Palmer says some exercises for neuropathy in the feet include stretching exercises, aerobic exercise, balance exercises and strength training.
“Stretching can reduce muscle tension and relieve muscle pain, which can be associated with neuropathy,” he says. Some examples of common stretches include:
For aerobic exercise, Palmer recommends recumbent biking, which can improve blood flow and nerve health. When doing balance exercises, Palmer says you should have proper supervision or appropriate support from a chair or kitchen counter. Examples of balance exercises for neuropathy include:
While standing, place your feet together, close your eyes and balance. As you progress, you can try standing on one foot, but only if you can remain still.
Tandem stance, one foot in front of the other, with the eyes open or closed. In this position, challenge the vestibular system by turning your head while your eyes are open.
In addition to stretching, aerobic and balance exercises, Palmer also suggests strength training, since it can improve your ability to react to a loss of balance. “My recommendation is to start with gym equipment that allows you to train in a seated position,” he says. “Knee extension and knee flexion machines, as well as seated leg press, can be helpful to improve leg strength.”
Is This an Emergency?
To reduce the risk of spreading COVID-19 infections, it is best to call your doctor before leaving the house if you are experiencing a high fever, shortness of breath or another, more serious symptom.