Exercise is important to all aspects of our health. Daily exercise helps slim the waistline, keeps us fit, reduces the chances of heart disease and high blood pressure, helps us sleep better, and gives us more energy. Thirty minutes of exercise daily will rev up the metabolism and improve moods.

Exercise is also important for our mental health. Moving our bodies releases neurotransmitters and endorphins which are known as “feel good” chemicals. It also reduces chemicals that can cause depression to worsen. Working out improves our appearance, which helps boost confidence.

Stress has been known to cause depression in people and animals. Mice were put to the test in a study done in Stockholm. After 5 weeks of putting the mice in some mild stressful situations, they showed signs of depression. Doctors know that exercise before stress occurs reduces depression due to an enzyme produced known as PCG-1alpha1, so they bred mice that contained high levels of that enzyme. They then exposed these mice to 5 weeks of stress, and while they showed signs of worry, they did not become fully depressed. Continuing the study on people, those put through 3 weeks of endurance training showed high levels of the enzyme in their muscles, proving the theory that exercise reduces depression.

While that is great news, those who struggle with long-term depression, chronic pain, arthritis, and high amounts of stress, have a difficult time just finding the motivation to begin to exercise. Fibromyalgia sufferers have pain in all parts of the body, making basic movement difficult, let alone jogging, or riding a bike.  Those with fibromyalgia are three times more likely to have depression, much of it having to do with the length of time it takes to diagnose.  Fibromyalgia is not well understood and hard to treat. Compounded with chronic pain and fatigue sufferers tend to withdraw from friends, have more anxiety, and exercise less.

Frozen shoulder is another issue that has not been studied in depth and is misunderstood. It often occurs for no reason, and causes capsules surrounding the joint in the shoulder to shrink and form scar tissue. This causes lowered range of motion and pain. There are three stages to frozen shoulder: freezing, frozen, and thawing.  The freezing stage causes pain and limited range of motion, pain and motion decreases during the frozen stage, and the shoulder begins to improve during the thawing stage. Each stage can last up to 6 months, so this is around 18 months of pain and limited range of motion, which causes depression and inactivity.

Exercise does not have to be painful, grueling, boring, or cringe-worthy. Finding an activity you enjoy is the first step. Start small, do little things like walking around the block, taking the stairs instead of the elevator, parking farther from the door in a parking lot, washing the car, or pulling weeds. Anything that gets you moving around will greatly improve your mood, and help you feel better in and out.


Like Santa, bones know when you’ve been sleeping, and they know when you’re awake.  They know when you’ve behaved or misbehaved.  They know when you’ve been exercising–so go out and walk!  In all seriousness, bones are aware of what is happening in your body (not Skynet aware, but more like The Sixth Sense aware).  What’s truly amazing is that the bones adjust accordingly, based on your exercise routine.   When you exercise, your bones help retain minerals and will be there like a good friend supporting you through your activities into maturity. If you do not exercise, your bones stop caring about minerals and will hang out on the couch with you eating potato chips. Your bones do as you do, not as you say.

What Exercises Help the Bones?

Impact activities are the most successful at strengthening the bones. Sports like soccer, track, volleyball and other sports that require a significant amount of running and jumping will give the best results. Weight-lifting is also useful when used in conjunction with other impact activities. All of the fun stuff you used to do around the neighborhood as a kid: tag, football, racing, jump rope, and toilet papering the neighbor’s house at night (after all, one must jump to get the proper paper placement in the tree) are great for strengthening the bones.

“I’m Too Old to Play Those Games!”

No, you’re not. It is never too late to get your body up and moving. It may sound counterproductive, but even if you have problems such as osteoporosis or weak bones, it is better for your body to stay mobile rather than stay at rest. Luckily, the older you are, the less impact you need to do to strengthen your bones.  In fact, a brisk walk a few times a week can be all you need to start getting stronger. You can become stronger still by throwing in a hip shake and a side step while you’re walking. This type of movement can also help prevent falls in the elderly.

Shake It Up

If walking briskly while thrusting out the glutei seems daunting, there are other ways to help strengthen bones.  While not for everyone, there are vibrating platforms one can use to build bone. According to Dr. Keith DeOrio, your entire skeletal structure is affected by vibration platforms and “Your muscle spindles fire secondary to the mechanical stimulation produced by the vibrating plate, and this rapid firing of the muscle spindle causes a neuromuscular response that leads to physiological changes in your brain as well as your entire body.”

The studies on the vibration platforms are few for now, but there have been no downsides to using it. People 65 and older seem to benefit from just 12 minutes a day a few times a week. It is even suggested that doing squats while standing on the platform can increase speed and agility. While helpful, be mindful that it isn’t such a significant amount you will be begged to participate in the summer Olympics, but chances are your bones and body will feel better and stronger.



Knee injury while at rest.  Seemingly contradictory.   It has long been suspected that an active life and daily movement represent good ways to reduce your likelihood of getting arthritis. Now some researchers have finally looked at the numbers to see if this popular notion withstood statistical scrutiny. Their conclusion?

When they analyzed the step data from the pedometers, they found a strong link between participants’ activity level and knee health. Their results suggest 6,000 steps marks an important threshold: 70% of participants who developed knee impairments walked less than this amount while 70% of those who remained healthy walked more.

Using nothing more advanced than off-the-shelf fitness trackers, these researchers were able to study and control for a variety of factors in a population of about 2,000 people. Sure enough, the more active participants seemed considerably less likely to develop knee pain and other symptoms associated with this progressive disorder.  From a scientific standpoint, this makes sense.  Cartilage and the locomotion machine (i.e., body) function better when the ‘engine’ is kept warm.  Not turned off and allowed to collect dust; and not when the engine is ‘revved’ too high, wherein the parts fall into disrepair.  For example, the fascinating thing about cartilage is that cartilage requires, as a part of its normal maintenance, it’s use (such as with walking) to deliver the nutrients from the joint fluid into the cartilage structure.  It’s use actually prolongs it’s longevity!

Of course a cohort study like this cannot officially separate causation from correlation; it is possible, for instance, that people who walk fewer steps do so because they already have bad knees. Yet this study remains a tantalizing clue in support of the idea that sedentary lives can be injurious lives, and that we would all do better to move around more during our active years.


Frozen shoulder, otherwise known as adhesive capsulitis, is a painful and paralyzing shoulder condition. Although it can take weeks or even months to fully develop, most people find the initial symptoms concerning enough to seek help.

The simple truth is that this is a terrible ailment that can take upwards of a year to resolve.  Patients with diabetes and/or hypothyroidism, especially women, are particularly vulnerable to this problem.  It may start as a result of a simple slip and fall or other seemingly insignificant shoulder injury.  The pain is extraordinarily high and profoundly limits life style.  Often times the patients find that they cannot sleep through the night, they have pain reaching behind them for hygiene or dressing, and they have pain reaching overhead.

But what kind of help is considered the most effective course of treatment? I have written before about the vast benefits of shoulder exercises for orthopedic pain, and about the growing consensus that pain relief can be covered at home nearly as well as it can at the hospital or clinic. Now researchers have found good evidence that simple exercise can be a “drug” all its own.  In this study exercise was used as a treatment measure in various settings.  After dividing patients with frozen shoulder into three groups – some patients were placed in an exercise class; a second group were to perform individual physical therapy; a third group were to perform individual home exercises.  Researchers found the most dramatic improvement among the group exercisers:

They discovered improvement in the exercise class group from a mean Constant Score of 39.8 at baseline to 71.4 at 6 weeks and 88.1 at 1 year, as well as a significant improvement in shoulder symptoms in the Oxford and Constant scores compared to the individual physiotherapy or home exercises alone groups.

This is a good sign that getting out of the house and remaining active can help to “thaw” a frozen shoulder, and may also prevent further recurrence of the problem. If you’d like to learn more about the latest advances in shoulder pain management, please contact my San Diego orthopedic shoulder surgery offices today.


Most of us who grew up in the 20th century were continually reminded about the importance of “cooling down” after vigorous exercise.  When we exercise, a biochemical reactions takes place that builds up lactic acid in the muscles.  The prevailing theory at that time was that an abrupt stoppage of activity could lead to muscle pain, cramping and soreness, possibly as a result of lactic acid that hasn’t had a chance to disperse.  The muscle soreness is referred to as delayed onset muscle soreness (DOMS).  The idea is that the gentle muscle motion during the cooling down period allows the blood to continue to be pumped through the muscles to wash away and prevent the lactic acid from building up, and thus prevent DOMS.

Now it turns out that advice may have been inaccurate.  As a recent article pointed out, cool downs are not as helpful as we once thought:

The available scientific evidence shows, in fact, little benefit from cooling down as most of us do it, with a prolonged, slow easing of physical effort.

So should we abandon the gradually slowing treadmill altogether? Not necessarily.  There are some smaller benefits to cooling off, especially given the fact that blood vessels can expand in the legs to shunt more oxygen to busy muscles. Halting exercise abruptly can lead to pooling of blood in the extremities (thigh and leg muscle), causing  a sudden drop in blood pressure.  Basically, a gentle cool down can keep you from fainting or getting light headed.

Spending five or ten minutes slowing down is probably no longer a necessary step in your daily routine and probably a waste of valuable exercise time.  A simple two to three minutes should suffice. To learn more about exercise and orthopedic care, contact my San Diego offices today.


It is a question that has bedeviled physicians, nutritionists and trainers for generations: Why do some people hit the gym every day without fail, while others can barely find the motivation to hit the restroom in the morning?

Now scientists may have found a clue. A new study in the Journal of Physiology suggests genetic loading may influence the level of activity in which most of us engage on a daily basis. A rat study suggested that identical twins have a tendency to exercise a similar amount no matter what environment with which they are faced. Researchers then bred rats that were inclined to be highly active, and a separate group inclined to be more sedentary. Once again, the rats did as their genes predicted:

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

The silver lining in this particular study, however, is that rats who spent more time sedentary soon began to mimic their active counterparts; studies indicated that their brains actually began to look more like their motivated cousins across the lab. It seems possible that you, too, can raise your energy level just by, well, raising your energy level.  Just say to yourself “I will do it!”  Get out there and move!

We have plenty of hard data that tells us exercise can prevent knee pain and back pain, and prevent costly orthopedic knee surgeries. This study should be a strong reminder that exercise is a choice we can all make when necessary.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow