DEAR MAYO CLINIC: I've always been active, but after being diagnosed with breast cancer and starting my treatment, I'm a little worried about getting back into my routine. Is it OK to exercise during cancer treatment?

ANSWER: Exercise decreases the risk of developing cancer. Studies have shown there is a 30%- 35% reduction in the risk of breast cancer among the most physically active women compared with those who are least active. Exercise also plays a protective role in many other cancers, including lung, endometrial, colon, kidney, bladder and esophageal.

However, exercise can also be helpful during and after cancer treatment. According to the American Cancer Society, research shows that exercise during cancer treatment can improve physical functioning and quality of life.

Moderate exercise can:

• Increase strength and endurance.
• Strengthen the cardiovascular system.
• Reduce depression.
• Decrease anxiety.
• Diminish fatigue.
• Improve mood.
• Raise self-esteem.
• Lessen pain.
• Improve sleep.

Of course, there may be certain issues that prevent or affect a person's ability to exercise due to disease or type of treatment, including:

• Anemia — having a low number of red blood cells or quantity of hemoglobin or protein.
• Weak immune system.
• Some forms of radiation treatment.
• Some surgeries limit certain exercises.

Some people should use extra care to reduce the risk of injury, including older people and those with bone disease, arthritis, or nerve damage, also called peripheral neuropathy.

Exciting studies show that regular physical activity is linked to increased life expectancy after a cancer diagnosis. In many cases, it also decreases the risk of cancer recurrence. Multiple studies in cancer survivors, with the strongest evidence in breast and colon cancer survivors, have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive.

The American Cancer Society, the American Institute for Cancer Research, the American College of Sports Medicine, and the U.S. Department of Health and Human Services all advocate physical activity for cancer patients and survivors.

The American Cancer Society recommends cancer survivors take these actions:

• Participate in regular physical activity.
• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.
• Exercise at least 150 minutes per week.
• Include strength training exercises at least two days per week.

Not everyone is ready to head to the gym during or after cancer therapy. However, reconnecting with an activity you like to do can increase your enjoyment and ability to stick with an exercise program. Exercise may include a bike ride with friends or chasing your dog around the park.

Walking is a great activity for almost everyone, and swimming can be a wonderful alternative for those with joint issues. Yoga is fantastic for strengthening, flexibility and balance concerns.

Kaye Sturz, D.N.P., Hematology/Oncology, Mayo Clinic Health System, Eau Claire, Wisconsin

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DEAR MAYO CLINIC: For my kids, the best part of back-to-school shopping is picking out a new backpack. While I want them to have backpacks they like, I also want to make sure they have features that support their backs. What should I look for?

ANSWER: The backpack is as much a part of school life as homework, pencils and recess. Kids use backpacks to carry everything they need during the day and make a fashion statement. Unfortunately, the excess weight of supplies stuffed into an improperly worn backpack may lead to sore joints and muscles.

As a new school year begins, follow these tips to help kids take a load off to keep their backs healthy:

Limit the weight.

Students of all ages seem to carry heavier loads in their backpacks. They often tote a day's worth of textbooks, a change of clothing for after-school activities, school projects and lunch. As a result, many parents have heard their school-age children complaining of back pain.

Overall, adults and children shouldn't carry more than 15% of their body weight in a backpack. For a 60-pound child, that means a pack weighing less than 9 pounds.

Even when worn properly, your student may need to lean forward to compensate for extra backpack weight. This can affect the natural curve in the lower back. Extra weight also can cause a rounding of the shoulders and an increased curve of the upper back. As a result, children may experience back, shoulder and neck pain.

Adjust them properly.

When worn properly, backpacks are the best way to carry things, especially for long periods of time.

Backpacks should be worn using both straps. Slinging a backpack over one shoulder can cause a person to lean to one side to compensate for the uneven weight, causing a curve in the spine. Over time, this can lead to lower and upper back pain, strained shoulders and neck, and even functional scoliosis (curvature of the spine). Teenage girls are especially susceptible to scoliosis.

Tighten the straps so the pack sits high on your child's back with the top of the pack about even with the shoulder blades. It also should be snug, so it doesn't sway side to side while walking.

When properly worn, the back and abdominal muscles support a backpack. These are the strongest muscles in the body, stabilizing the trunk and holding the body in proper postural alignment. Improper backpack use presents some dangers to young, still-growing joints and muscles.

Look for key pack features.

Urge your children to look past the color or design when selecting a backpack. These features can make a significant difference in how they feel while wearing the pack at school:

• Wide straps
  Wide, padded straps won't dig into the shoulders, and they're more comfortable. Narrow straps can hinder circulation, causing numbness or tingling in the arms, which may lead to weakness in the hands over time.
• Multiple sections
  Select a backpack with many pockets and sections to keep children organized. This also helps distribute the weight more evenly across the pack.
• Waist belt
  Tightening the waist belt helps to evenly distribute the weight of the backpack and support children's abdominal muscles.
• Lightweight when empty
  Consider the weight of the backpack when it's empty so your children don't have additional weight beyond books and supplies. For example, a canvas backpack will be lighter than leather.
• Reflective material
  If your children walk or bike to school, look for a backpack with reflective strips that make them more noticeable to drivers. You also can add strips of reflective tape at home.

Encourage your children to wear their backpacks properly. To help keep them light, they should make frequent stops at their lockers throughout the day to avoid carrying all their books at once. And leave nonessentials at home.

If they're in pain or have discomfort, talk with their primary care clinicians before a problem becomes serious.

Michelle Rein, M.D., Family Medicine, Mayo Clinic Health System, Caledonia, Minnesota

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DEAR MAYO CLINIC: I received a notice from my health system that I'm due for a colorectal cancer screening. I'm 45. Do I really need to have this done now? 

ANSWER: It's easy to be confused or overwhelmed by screening recommendations for common types of cancer. Your healthcare team is a trusted resource for keeping you up to date on screenings, including screening for colorectal cancer. 

Why, when and how should you be screened for this cancer? Test your knowledge of colon cancer screening with these myths and facts.   

Colorectal cancer is rare. 

Myth: Colorectal cancer is the second-leading cause of cancer-related death in men and women combined. Roughly 1 in 26 women will have colorectal cancer, and about 1 in 24 men will have colorectal cancer. To put that in perspective, when watching a football game, of all the players on the field, about one player would be diagnosed with colorectal cancer in their lifetime. 

Colorectal cancer can happen when you're young. 

Fact: The rate of colorectal cancer is increasing in people under 50. Rates of colorectal cancer in people under 50 have doubled since 1990. In people over 65, the diagnosis rates have been decreasing, most likely because of colorectal cancer screening.

Many younger adults don't consider themselves at risk. That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

Screening for colorectal cancer starts at age 45.  

Fact: In 2021, the recommendation for colorectal cancer was updated to begin screening at age 45. This is because the rate of diagnosis is increasing at younger ages.  

Colorectal cancer can be prevented with screening. 

Fact: The goal of colorectal cancer screening is to prevent cancer, not just find it when it has already developed. Most colorectal cancer develops from a polyp, a small, precancerous growth. The presence of polyps can easily be identified using colonoscopy screening tests. Polyps can be removed during a colonoscopy to prevent them from developing into cancer.

You can also help keep your colon healthy by:

• Add bulk to your diet with lots of veggies and whole grains.
• Eat healthy fats found in olive oil, salmon, avocados and nuts.
• Strive for 30 minutes of exercise most days of the week.
• Watch your weight. Carrying extra pounds has been shown to increase your risk for colon cancer.
• Drink alcohol in moderation, and don't smoke.

Family history is the only risk factor for colorectal cancer.  

Myth: While a family history of colorectal cancer influences your risk of developing cancer, other important risk factors increase the risk of developing colorectal cancer. Medical conditions including obesity and inflammatory bowel disease (IBD), and lifestyle choices, such as a diet high in red meats, smoking and alcohol use, increase risk. Because colorectal cancer is common, all adults over 45 should be screened regardless of family history.  

African Americans have a higher risk of developing colorectal cancer, and American Indian/Alaska Native people have the highest risk of colorectal cancer.   

A positive stool-based screening for colorectal cancer is the same as a cancer diagnosis.  

Myth: A stool-based test looks for more than cancer, and it can identify precancerous lesions or polyps. These tests don't address the polyp if a polyp is present in the colon. A follow-up colonoscopy is needed to identify the polyp and potentially remove it.  

If you have more questions, talk with your healthcare team about screening options for colorectal cancer at age 45.  

Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota  

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DEAR MAYO CLINIC: I have two sons, ages 5 and 11. My eldest is always excited to start school and have new adventures. My younger son will begin kindergarten this year. Although he went to child care part-time, my younger son has begun to express concern about being away from me all day and is showing increased anxiety as we talk about school. How can I help him be less anxious?

ANSWER: Getting ready for a new school year can be exciting for children, parents and caregivers. It may also be a major cause of anxiety or stress. 

Most people get nervous when they face change. Whether kids are heading off to elementary, middle or high school, or even college, leaving the safety and familiarity of home can prompt feelings of fear. 

One of the most helpful things you can do is reassure your son that what he's feeling is normal. Separation anxiety happens to many people of all ages. Then, as much as possible, help him gradually gain exposure to, and get comfortable with, going to school. 

Talking through fears

Try to gain a sense of what it is about school that makes your son nervous. Is he concerned about making new friends? Is he concerned about the teachers? Is he worried about the classwork? Is there something new that may be causing anxiety, like riding a bus? Sometimes, just being able to talk about those details and put the nervousness into words can help a child who is feeling anxious. 

Continuing to show love, support and warmth can go a long way. Share with your son an experience you had when you were anxious about facing something new. Talk to him about how you handled the situation. Ask your older child to share some experiences and how he overcame his fears. Doing this will let your younger child know that he is not alone in the situation, that it is OK to be nervous, and he can get through it. 

Preparing ahead of time

To help your son prepare for school, talk to him about what his school day might be like. You could also visit the school to meet his teachers, take a tour of his classroom, see the playground, or even locate the bus stop. If your son is nervous about getting on the school bus, call the transportation department to see if he can meet the bus driver early. 

Another idea is to find social opportunities with other incoming kindergarten students. Reach out to parents of children in your neighborhood who will be going to school for the first time. Then, plan a social gathering at a local playground. 

A week or two before school starts, develop a routine. Begin to wake up early and get ready on time. Also, consider practicing some schoolwork. You can get your older child involved in sharing his thoughts about what was the best part of school when he was that age. 

Spending time apart

Begin by spending some time away from your son. Maybe it's having your child go to a friend's home for an hour. Then, slowly increase the time away from your son so that he has an opportunity to feel comfortable being with others for longer periods of time. 

All of these steps will help him know what to expect, prepare him gradually for what school will be like, and ease the transition. This approach is based on one of the core principles of treating anxiety. That is, when you are frightened of something that is not dangerous, you need to have practice dealing with the source of your fear until it becomes routine or boring. You cannot be talked out of anxiety. You need exposure to, and experience in, dealing with the situation. 

If your child is resistant to the attempts you are making, or if his anxiety doesn't decrease even after you've taken these steps, talk with your pediatrician or primary care clinician about seeing a healthcare professional who can help. Books on coaching for anxiety can also be a resource. Anxiety is a normal part of life that can't be completely eliminated, but many successful strategies can reduce anxiety and how often it causes problems.

Stephen Whiteside, Ph.D., Psychology, Mayo Clinic, Rochester, Minnesota 

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DEAR MAYO CLINIC: We just moved to an area with a lot of opportunities for water recreation and are so excited about our first summer on the water. But we want to make sure everyone stays safe. Can you give us some pointers for water safety?

ANSWER: Nothing beats a day at the lake, river, beach or pool for fun, fitness, fishing and relaxation. While spending time on and around the water this summer, these tips can ensure that everyone is safe, has fun and enjoys the time together.

Learn to swim

Every year in the U.S., about 4,000 people die by drowning. Children, men and nonwhite people are at the highest risk. 

Learning to swim is one of the most important ways to stay safe on the water. The American Academy of Pediatrics supports swimming lessons for most children ages 4 and older. Lessons for children ages 1 to 4 could be appropriate, depending on how often they're exposed to water. Even infants can be introduced to the water. Check to see what classes are available in your area.

Swimmers of all ages may be more familiar with pools than rivers and may not know what to do if caught in a current. Stay calm, float on your back, and when you come to a calmer area, flip over and swim diagonally toward shore with the flow of the current.

Keep these safety tips in mind too:

• Don't swim alone.
• Supervise children when they're swimming, and stay close enough to reach out to a child at any time.
• Before diving into a body of water, know the water depth and if there are any underwater obstacles.
• Keep pool gates closed at all times, and consider an alarm to alert you if the gate is opened.

Wear a personal floatation device

Even expert swimmers can get into trouble during an emergency. It's important to be sure everyone in a watercraft wears a U.S. Coast Guard-approved personal flotation device. While boating or swimming, remember that arm floaties and inflatable toys aren't a substitute and tend to give kids and families a false sense of security. 

Excellent, comfortable, easy-to-put-on models of personal flotation devices are available, so there's really no excuse not to wear one.

Stay safe while boating, no matter your craft

One of the most popular and fun activities of summer is spending time on the water. Boating creates lifelong memories and gives us the opportunity to unplug, spend time together, learn new skills and explore new areas. 

Whether your craft is a power boat, fishing boat, pontoon, personal watercraft, canoe or kayak, you should remember these basic safety rules as you head out for a day on the water:

• Be a weather watcher. Summer weather can change quickly. Check the forecast before heading out and check again frequently while on the water. If you do get caught in a storm, navigate to the shore as quickly as possible.
• Tell someone the details of your trip. Tell your trip plan to a friend who's staying ashore. Share details about who's on the boat, where you'll be and how long you'll be gone.
• Always operate your boat at a safe speed. Waterways can become crowded during the summer. Slow down, stay alert and steer clear of larger vessels. Be sure to follow speed limits in "no wake" areas.
• Respect buoys and other navigational aids. They've been put in place to ensure your safety and the safety of other boaters and swimmers. If you're not familiar with them, the U.S. Coast Guard has a handy water navigation system guide.
• Leave alcohol on shore. The risk of drowning or injury significantly increases when alcohol or drugs are involved. More than 70% of water recreation deaths are related to alcohol use.

Be sun savvy

The sun's rays can be intense on the open water. Protect everyone with hats, sunglasses and sunscreen. Look for water-resistant, broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. Apply sunscreen generously and reapply every two hours, or more often if you're swimming or sweating.

Drink plenty of water

Even when surrounded by water, it's possible to become dehydrated. Sitting in the sun can increase your body's temperature. Pack plenty of water for each person, and drink some water every 15 to 20 minutes to remain properly hydrated.

Jason Wray-Raabolle, M.D., Family Medicine, Mayo Clinic Health System, Owatonna, Minnesota

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DEAR MAYO CLINIC: I've taken up running again and decided to enter a half-marathon. I know I have to push myself to get ready for the race, but I don't want to overdo it. What should I watch out for as I train?

ANSWER: We're surrounded by warning signs — on the roads, at work, and on packaging and equipment. Your body sends warning signs, too. As your race date nears, it's tempting to pull out all the stops. But that makes this a prime time to watch for warning signs of overtraining.

Overtraining or overuse injuries are any muscle, joint or bony injuries, such as tendinitis or a stress fracture, that result from repetitive trauma. Overuse injuries typically occur because of training or technique errors.

Runners are tenacious athletes. Pulling back and slowing down may be tough, but while some overtraining issues can be resolved with simple rest, others may evolve into more significant problems.

How overtraining and overuse injuries occur

Going too fast, exercising for too long or simply doing too much of one type of activity can strain your muscles and lead to an overuse injury. Improper technique also takes a toll on your body. For example, if you use poor form while running or doing strength-training exercises, you may overload certain areas of the body, which can cause an overuse injury.

Thankfully, most overuse injuries are avoidable. Try these suggestions to prevent them:

• Use proper form and gear.
  Whether you're starting a new activity or have been playing a sport for a long time, taking lessons can help ensure you're using the correct technique. Talk with an expert about proper form, equipment and gear fit to help ensure success.
• Pace yourself.
  Rely on your training program, which should spread your aerobic activity throughout the week. Take time to warm up before physical activity and cool down afterward.
• Gradually increase your activity level.
  When changing the intensity or duration of physical activity, do so gradually. Try not to increase anything by more than about 10% per week. Your body needs time to adapt to the new stress.
• Mix up your routine.
  Instead of focusing on one type of exercise, build variety into your training program. Doing a variety of low-impact activities prevents overuse injuries and allows your body to use different muscle groups.

Overtraining signs and what to do 

It can be hard to know when you’re pushing through your training for continuous improvement and when you’re moving into overtraining. Your feet and legs take a pounding as you run mile after mile, so watch for these issues: 

• Callous blistering and broken toenails are common overtraining problems. 
• Early morning pain on the sole of your foot can be a sign of plantar fasciitis. 
• Tendinitis can leave you with pain in the back of your ankle or in the front of your shins, also called shin splints.

Typically, these can be treated with rest and medication to relieve pain and inflammation. Slow down your training. Return to the level you were at before the problem or consider cross-training with low- or no-impact exercise, such as a stationary bike, elliptical or swimming. Take an extra day off. These symptoms can be short-term if you treat them early and appropriately.

If pain continues despite rest or gets worse, it could indicate a bone issue, which is potentially serious. Stress reactions or stress fractures are common in the mid-foot, mid-shin or, most concerning, high up in your leg by your hip. Pain that doesn't go away is a symptom, so consult your healthcare team.

What to do if you suspect an overuse injury

Tell your healthcare practitioner if you've recently changed your workout technique, intensity, duration, frequency or types of exercises. Identifying the cause of your overuse injury will help you correct the problem and avoid repeating it. You can seek further guidance by talking with specialists such as sports medicine physicians, athletic trainers and physical therapists.

Once your injury has healed, ask a specialist to check that you've completely regained strength, motion, flexibility and balance before beginning the activity again. Pay special attention to proper technique to avoid future injuries.

Staying strong

Don't allow an overuse injury to prevent you from being physically active. By working with a specialist, listening to your body and pacing yourself, you can avoid this common setback and safely increase your activity level.

Knowing you worked hard to prepare will add to your feeling of accomplishment on race day, but don’t overdo it. You’re almost there. Take care of yourself so you can keep going strong all the way to the finish line.

Corey Wencl, Sports Medicine, Mayo Clinic Health System, La Crosse, Wisconsin

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DEAR MAYO CLINIC: Recently, I was diagnosed with BPH. This is all new to me, and I hope you can help me better understand the condition and how it's treated. 

ANSWER: Now that you've been diagnosed with benign prostatic hyperplasia (BPH) — noncancerous tissue growth within the prostate — it's time for you and your healthcare team to talk about treatment options. 

These options depend on the severity of your symptoms, which can range from having a weak urine stream to not being able to urinate at all. Most treatments are done in the outpatient setting, including your clinician's office, while others may require a hospital stay. Wherever you are on the range of symptoms, there are treatment options that can relieve them, including:   

Behavior modifications

If you're experiencing bothersome, but not severe, symptoms, such as having a weak urine stream or frequently getting up at night to urinate, your treatment may start with:

• Changes to your diet
  Some foods, such as chocolate, citrus, carbonated beverages and caffeine, can irritate your bladder, which can increase your urge to urinate. Cutting back on these foods may ease your symptoms.
• Fluid intake
  Reducing the amount of fluid you drink before bedtime can decrease your need to urinate during the night.
• Timed urination (voiding)
  Holding your urine can also irritate your bladder, so making a point to urinate every hour and a half to two hours can reduce the urge to go "now."

Medications for BPH

If these behavior modifications are no longer effective, your clinician may prescribe a medication, which you'll need to take every day. These include:

• Alpha blockers
  These drugs relax muscles in the bladder and prostate, and they open up the urinary channel to reduce blockage. Side effects include a decrease in blood pressure, dizziness and lightheadedness. They also can cause semen to go back into the bladder instead of the penis, which may be startling, but is harmless.
• 5-alpha reductase inhibitors
  These medications work to shrink the prostate by lowering the production of a specific hormone. There are more side effects, and it may take six to nine months to see any results. Men may have a lower sex drive, and some will experience erectile dysfunction.

Surgical procedures

You and your healthcare team may decide that in-office therapies or surgery to shrink or remove overgrown prostate tissue would be the best treatment option for you. Some treatments work better than others, depending on your symptoms, treatment goals and the size of your prostate. Most preserve sexual function and have little or no effect on erectile or ejaculatory function. 

These treatments include:

• Temporarily implanted nitinol device
  This procedure reshapes the tissue of the prostatic urethra and the bladder neck to create a wider channel through which urine can flow. A narrow, folded nickel titanium device is inserted into the prostatic urethra. As the device expands, gentle pressure reshapes the urethra and bladder opening. After five to seven days, the device is removed.
• Prostatic urethral lift (PUL)
  This procedure reshapes the prostate using a small, permanent implant to compress and lift the side of the enlarged prostate to increase the urethra opening.
• Steam therapy
  During the treatment, a tiny needle is inserted into the urethra and positioned in the prostate gland. In nine seconds, the needle produces a 2-centimeter-wide steam ball that shrinks the surrounding prostate tissue.
• Transurethral resection of the prostate (TURP) and photo-selective vaporization (PVP)
  During a TURP, a lighted scope is inserted into the urethra and the surgeon uses an electric loop to remove all but the outer part of the prostate. TURP generally relieves symptoms quickly, and most men have a stronger urine flow soon after the procedure. 

PVP is laser therapy performed in an operating room under anesthesia. A surgeon inserts a thin, tube-like instrument into the urethra. This instrument has a lens, light and tool that sends out an electrical current to destroy prostate tissue. Heat from the current seals small blood vessels, reducing the risk of bleeding. This procedure destroys or removes overgrown prostate tissue and is a good choice if you need to stay on blood thinners.

• Prostate enucleation (BipoLEP or HoLEP)
  This procedure removes nearly the entire prostate without an incision. It is often a good option for patients with especially large prostates, the inability to stop blood thinners or in significant urinary retention. A thin instrument is inserted into the urethra. Then, a laser cuts the prostate tissue into small, removable pieces. 
• Simple prostatectomy
  This minimally invasive surgery removes tissue blocking the flow of urine. It usually requires a one-night stay in the hospital and is done laparoscopically through a small incision in your side, most often using a surgical robot.

Ross Avant, M.D., Urology, Mayo Clinic Health System, Austin and Red Wing, Minnesota; Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: When I go for a walk or to the gym, people always seem to be checking their pulse, whether by hand or with a wearable. Why is heart rate so important?

ANSWER: Your heart rate, or pulse, is the number of times your heart beats per minute. Your resting heart rate is when the heart is pumping the lowest amount of blood you need because you're not exercising. If you're sitting or lying down ― and you're calm, relaxed and aren't sick ― your heart rate is typically between 60 and 100 beats per minute. 

Other factors that can affect your heart rate include: 

• Air temperature 
  When temperatures or humidity increases, the heart pumps more blood, so your pulse or heart rate may increase. 
• Body position 
  Sometimes, when going from sitting to standing, your pulse may go up a little. After a few minutes, it should return to a typical rate. 
• Emotions 
  If you're stressed, anxious or incredibly happy, your emotions can raise your heart rate. 
• Body size 
  Body size usually doesn’t increase your heart rate. However, if you're obese, you may have a higher resting heart rate. 
• Medication use 
  Medications that block adrenaline tend to slow your heart rate. Thyroid medication may raise it. 

Why your heart rate matters 

Cardiovascular exercise, also called cardio or aerobic exercise, keeps you and your heart healthy. This specific type of exercise gets your heart rate up and your heart beating faster for several minutes. Cardiovascular exercise helps strengthen your heart, allowing it to pump blood more efficiently and improving blood flow to all parts of your body. It also boosts your high-density lipoprotein (HDL), or "good" cholesterol, and lowers your low-density lipoprotein (LDL), or "bad" cholesterol. This may result in less buildup of plaque in your arteries.

Abnormal heart rate 

If you experience irregular heartbeats, including a racing heartbeat, slow heartbeat or a feeling of fluttering in your chest, you may be experiencing a heart arrhythmia. Heart rhythm or heartbeat problems can occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, slow or irregularly. Talk with your healthcare team if you have heart rhythm concerns.  

Know your numbers 

Many wearable activity trackers can monitor your heart rate when you exercise and periodically throughout the day. If you don't have an activity tracker, you can use the radial artery in your wrist or the carotid artery in your neck. If you have heart disease or long-standing diabetes, it's best to use the artery on your wrist. 

To find your heart rate manually: 

• Locate the artery you will use to find your heart rate. 
• Using the tips of your first two fingers, press lightly over the artery. 
• Count your heartbeats for 30 seconds and multiply by 2 to find your total beats per minute.  

What's your target heart rate? 

Your target heart rate is the rate you need to maintain over a set amount of time to reach the energy level necessary to give your heart a good workout. The first step in finding the target heart rate that will maximize your cardiovascular exercise is determining your maximum heart rate. 

Your maximum heart rate is 220 minus your age. Your target heart rate for moderate to vigorous exercise is about 50%–85% of your maximum heart rate. 

A general guide for averages by age is: 

• 20: 100–170 beats per minute 
• 30: 95–162 beats per minute 
• 35: 93–157 beats per minute 
• 40: 90–153 beats per minute 
• 45: 88–149 beats per minute 
• 50: 85–145 beats per minute 
• 55: 83–140 beats per minute 
• 60: 80–136 beats per minute 
• 65: 78–132 beats per minute 
• 70: 75–128 beats per minute 

How to give your heart a good workout

Start slowly. 
If you’re beginning an exercise program, aim for the lower end of your target heart rate zone, and then gradually build up intensity. If your heart rate is too high, take it easier. If it's too low, add some intensity and push yourself to get your heart rate closer to your target.

Try interval training. 
Interval training, which includes short bursts of 15–60 seconds of higher-intensity exercise, alternated with longer, less strenuous exercise, effectively increases cardiovascular fitness. Talk with your healthcare team before trying interval training, but it’s typically safe for those with existing heart disease and type 2 diabetes. 

Take the "talk test." 
If you can carry on a conversation in brief sentences while exercising, you're probably in the moderate intensity range. You'll be breathing faster, developing a light sweat and feeling some muscle strain. If you're working at a vigorous intensity, you won't be able to say more than a few words without catching your breath. If you can sing while working out, you're probably in the low-intensity range, so step it up.

Xiaoke (Ken) Liu, M.D., Ph.D., Cardiovascular Medicine, Mayo Clinic Health System, La Crosse, Wisconsin

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DEAR MAYO CLINIC: We live in a rural area about 40 minutes from our health system's nearest clinic. However, they do offer the option to meet virtually with our healthcare team members. We'd like to try virtual care. Could you tell us more about it? 

ANSWER: Whether you live in a rural or urban community, virtual care can be a great choice for connecting with healthcare. You can save drive time, avoid bad weather and stay home when it's best not to be in a clinic where you could infect others. 

But even better, if your primary care clinic offers video visits (most do), you maintain continuity of care with your healthcare team, whether you're at home or traveling. Any information and care recommendations are entered into your electronic health record.   

Choose your virtual option

There are typically three main types of virtual care (also called telemedicine or telehealth): messaging, video visits to your home, and video visits at a clinic. 

Messaging. You and your healthcare professional exchange information via a secure messaging platform. This can include questions about a condition, medications or follow-up from a previous appointment. Your clinician usually responds within 24 hours or less. Messaging may lead to a video visit or an in-person appointment.

Video visit to your home. Through your health system's patient portal, you can set up a video appointment with a member of your healthcare team, just as you would an in-person appointment. Just as with an office visit, hearing your story about how something happened, symptoms you're experiencing, medication side effects and more, can help your clinician make an informed diagnosis. 

During a video visit, you can discuss your issue with your clinician, upload photos to give your healthcare team a close-up look at something, like a rash or lump. For example, if your child has an ear infection, there's an inexpensive device you can purchase online that takes a video of the ear canal. With this information, your clinician can recommend care.

Your clinician also may order other services or arrange to have a specialist connect with your visit. You can even invite a family member or friend to join the visit to provide an extra set of ears.

In addition, if you need translation services, they can be arranged when you make your appointment. During the video visit, your clinician, interpreter and you will all be online.

Video visit at the clinic. Another variation of video visit is making an in-office appointment but then connecting with a specialist online. This is particularly helpful for patients who may not have stable internet connections.

On-demand care. Your health system may offer other forms of virtual care, such as on-demand care via a mobile app. This service is typically available 24/7 every day, including weekends and holidays. On-demand care can focus on an urgent problem, but you can also schedule an appointment and arrange to receive helpful reminders about prescriptions, lab work, follow-up appointments and more. 

Your in-person and virtual providers collaborate on your care through a shared medical record. However, the level of integration varies widely across healthcare organizations.

When to consider virtual care

The list of conditions that can be addressed virtually is a long one, including:

• Upper respiratory Infections, including colds, influenza and COVID-19 (especially now with home diagnostic kits)
• Sinusitis
• Rashes
• Insect bites
• Constipation
• Mental health conditions
• Urinary tract infections (often coupled with a lab test)
• Monitoring and adjusting medications for chronic conditions
• Follow-up for many chronic conditions, including:
  • Diabetes
  • Weight-loss medications
  • High blood pressure (if you have a home blood pressure cuff)
  • Cholesterol
  • Low thyroid

However, if you're having difficulty breathing or chest pains, you should go to the emergency department. If you suspect something is broken or infected, you should also seek in-person care because these conditions tend to require a "hands-on" exam and assessment or direct treatment.

Before, during and after your video visit

Here are a few tips for a successful video visit:

• When you make your appointment, upload any photos or videos that could give your clinician a close-up view of the problem.
• Be sure you have a reliable internet connection.
• Arrange for a quiet space for the visit, especially since you'll be sharing protected health information. Having a video visit at a coffee shop or on a public computer may not be a good choice.
• Dress comfortably but appropriately. 
• Make a few notes about what you want to cover with your clinician.
• Be sure to ask questions. If someone is joining the visit, let them know they can ask questions, too.
• Following your visit, you'll receive an after-visit summary just as you do with an in-person visit. It's typically delivered to your patient portal.

David Blair, M.D., Family Medicine, Medical Director, Primary Care on Demand, Mayo Clinic Health System, Bloomer, Wisconsin  

The post Mayo Clinic Q&A: When to consider virtual care appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I am thrilled to say I am a breast cancer survivor. It has been almost six months since I finished treatment. But I can't shake the fatigue. I was never a napper, but I find myself feeling desperate to close my eyes in the middle of the workday. I don't feel sharp in my thinking, and I fall asleep in front of the TV at night. I'm worried. How can I get past this stage? I want my life back.

ANSWER: Cancer-related fatigue can be distressing. It is a persistent, subjective sense of physical, emotional and cognitive tiredness and/or exhaustion related to cancer or cancer treatment that is not proportional to recent activity. It interferes with daily function and quality of life. Cancer-related fatigue is different from the usual tiredness we all experience. It's more intense, it's not temporary and it's not relieved by rest alone.

Several factors can contribute to cancer-related fatigue. The cancer itself can lead to fatigue. 

Some cancers weaken muscles, damage organs or alter hormones, which can cause fatigue.

Sometimes treatment damages healthy cells in addition to cancer cells. Treatments such as chemotherapy, molecular targeted therapy, hormonal therapies and radiation all may cause fatigue. 

Side effects of treatment may result in a blood problem called anemia, pain or stress, all of which can add to your fatigue. 

If you're not feeling well, your activity level may lower, which causes the body to decondition, causing fatigue. Preexisting conditions, such as anxiety and depression, also may worsen with cancer and play a role in fatigue.

Cancer-related fatigue can happen at any stage. It might start before treatment, become more pronounced during treatment, and sometimes linger even after treatment has ended. Everyone experiences this differently. 

The duration of cancer-related fatigue can be variable. For some people, it might improve a few weeks after finishing treatment. For others, it can last for months or even longer. It affects a lot of cancer patients but doesn't always get proper attention from healthcare professionals. It's important to communicate with your healthcare team about any ongoing fatigue. 

Treatments can include physical therapy and exercise guidance to help increase activity levels, medications, complementary and integrative medicine approaches such as yoga and tai chi, and psychological and mindfulness-based strategies to manage emotional stress and monitor fatigue levels. As every patient is different, a combination of these approaches typically works best.

While there's no way to prevent cancer-related fatigue, several self-care strategies can help boost energy levels, including: 

• Staying as active as possible, even if it's just light exercise. Start slow and find a routine.
• Eating a balanced diet and staying hydrated. When you have cancer, you may need more protein and nutrients than ever. Drink plenty of fluids, and limit caffeine.
• Setting a regular sleep schedule, taking short naps if needed, and finding time to relax and reduce stress. 

If you need guidance or you are experiencing fatigue that is not responding to these modalities, ask your primary care team for help. You may need help from family and friends to help with household tasks too. — Touré Barksdale, M.D., Physical Medicine & Rehabilitation, Rochester, Minnesota

The post Mayo Clinic Q and A: Beyond tired with cancer-related fatigue appeared first on Mayo Clinic News Network.