How Do I Know if I’m Working Out Hard Enough?

My last post tackled the question of how we know if we are making progress in our exercise program. That discussion took more of a long view of things, but how do we know if we are working hard enough in any given workout? This is a topic that I have blogged about in the past as well: once on 9/6/2020 and then a few days later on 9/10/2020.

To recap, when it comes to cardio exercise there is a formula that is often used to determine if the workout is effective. It is not exact, but the equation is 220 minus your age; that number gives you the maximum heart rate, but the goal is to be at 65-85% of that number. For instance, a person who is 70 should not exceed 150 beats/minute; the “sweet spot” is between 97 and 127. When it comes to resistance training (weights), it is a little more complicated as it will depend on what the goal is. Rather than going into detail here, consult your favorite fitness professional; recommendations will vary in relation to a number of factors such as age, current level of fitness, injuries, etc.

Still, in any given workout, is there an easy way to get a sense of things? For cardio, there is something called the “talk test.” If a person is able to talk while doing the exercise (running, biking, etc.) it would be considered moderate; if a person can talk with difficulty but not sing, that is a more vigorous level. If the person is unable to speak at all (like during a sprint), that is the highest level of exertion–one that can only be carried out for a limited amount of time. What level is appropriate? It will depend on a number of factors (are you just trying to stay fit, or are you training for a marathon?), but going back to the formula above will help.

For resistance training, I usually recommend a weight that allows the client to do 12 reps with the last few being difficult. If all 12 reps are easy, it is time to either add weight or reps, or in some other way increase the level of difficulty. Those looking to bulk up, will follow a different set of standards–generally, heavier weight with less reps. I also use the RPE or Rated Perceived Exertion; this is fairly subjective, but it asks the exerciser to rate how difficult an exercise is. I use a 1-10 scale with 10 being the most difficult; most clients are honest (although we all know the adage “never tell a personal trainer something is too easy!”) This is a relatively simple way to gauge the level of work for both resistance and cardio training.

The key is not to rest on one’s laurels. When an exercise becomes to easy, it will not help to accomplish the fitness goal. Progression to a more challenging level is what is called for.

Although it can seem confusing at times, we are usually our own best judges of how hard we are working. We need to be honest with ourselves, though, so as not to overwork or underwork. Being honest with ourselves is a good rule in every aspect of our lives.

How Do I Know If I’m Making Progress?

A client recently asked me how it is possible to know if progress is being made while engaged in an exercise program. There are a number of ways to answer this.

Progression (from the word progress) is an important concept in fitness. It refers to ways that exercises are made more challenging. For instance, the amount of weight being lifted can be increased. The number of reps can be increased. An element of difficulty can be introduced like doing an exercise on one foot. In general, an exercise program needs to take into account progression so that “progress” can be made. If the same exercises are done over and over with the same intensity, duration, and resistance, there is little reason to expect that there will be increased muscle mass or endurance…or whatever the particular goal might be.

How can it be tracked? There are apps on phones and devices like Fitbits that can monitor and record workouts. Even without such technology there are ways to follow this. For example, if it took 15 minutes to walk a mile at the beginning of April and at the beginning of May it took 12, that is progress. If a person is running and they are able to go further each time (by adding a block or lap), that is also progress. These kinds of progressions are most effective when they are recorded in some way–even if on a piece of note paper.

By the way,progress may not always appear in the mirror as bigger muscles or greater definition or a smaller waistline–although those can be signs of progress. Sometimes the best indicator is a sense of feeling healthier, more fit, or energetic.

Progress does not just happen. It needs to be figured into the equation. A fitness professional is trained how to introduce this into a workout in a safe, effective way. This is particularly important for older adults. On the one hand, older adults may be more prone to injury by overtraining or training the wrong way. On the other hand, older adults may go to easy on themselves and not really effect change. A trainer–especially one who has certification to work with older adults–will know how to strike that balance.

Most importantly, know what your goals are. Once those are established it is easier to set a course that includes progressions so that you do not go from 0-60 in 10 seconds…and then hit a brick wall. Put those progressions in place, monitor results, and re-evaluate as necessary. And always remember, if it does not challenge you, it will not change you!

A *Foot*note to the Last Post

In my last blog post, I discussed the importance of taking care of one’s feet. To be honest, my post was motivated by some pain I had been experiencing in my left foot that was to be addressed at an upcoming appointment with my podiatrist. After an x-ray, I was diagnosed with a stress fracture and now have to wear a boot for four weeks. Stylish, no?

What is a stress fracture? According to the Mayo Clinic’s website: “Stress fractures are tiny cracks in a bone — most commonly, in the weight-bearing bones of the lower leg and foot. Stress fractures are tiny cracks in a bone. They’re caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances.” The first time I had a stress fracture, my podiatrist showed me how they happen. He took a regular #2 pencil and tapped it repeatedly on top of my quad muscles; under my quads is the femur–which is the strongest bone in the human body. The doctor told me that if he just kept tapping, eventually he would fracture the femur; it is like erosion that does its job slowly but continually.

I looked at the x-ray this week, and could not really see anything; it is not like a regular fracture where it is pretty obvious that the bone is broken. A podiatrist, however, is trained to identify these tiny cracks. The most common treatment is to immobilize the foot to allow the bone to grow back and heal the fracture. That is why a boot is most often prescribed.

Are stress fractures preventable? Yes, and no. According to the Mayo Clinic, ways to prevent stress fractures are: 1) start new exercise programs gradually so as to allow the bones to strengthen as new demands are put on them; 2) use proper footwear–I discussed that in the previous post linked above; 3) cross train–in other words, exercise different parts of the body in different ways rather than repeating one singular exercise over and over; and 4) maintain proper nutrition to ensure the proper vitamins, minerals, and other nutrients that keep bones strong. The “no” is that even when you do all these things (as I do), it is still conceivable that this can happen. I was on a hike in Arizona recently with a very uneven trail; I rolled my ankle at least a dozen times and I think this may have contributed to the stress fracture.

I will heal. This has happened before and, after some inconvenience, things will go back to normal. In the meantime, I will immobilize my foot as best I can. I will also continue to follow the recommendations about exercise, footwear, and nutrition. No 100% guarantees, but injuries will occur now and again–and they are small price to pay to avoid the negative health consequences of a sedentary lifestyle.

Don’t Forget those Feet

About fifteen years ago, when I was working full-time as a congregational rabbi, I faced a dilemma that I needed to resolve. I was the associate rabbi but would in a few years become the senior rabbi; that is not the problem. The issue was that I knew that being “in charge” would require me to do a lot more standing–especially when conducting services, and even more so at the important high holidays. How would I be able to do it when after only an hour or so my feet would start aching? Some days, after work I would take off my shoes and my feet would be throbbing.

I decided to visit a podiatrist (a medical doctor that specializes in the feet and lower legs) to see if there was something wrong. It turns out that I was pronating when I walked or stood and this was causing the discomfort; the good news was that it could be corrected with custom orthotics. It took about a week or so to get used to them, but afterwards I could feel a huge difference. My feet did not ache and I could stand, walk, and even run much longer than before.

Over the years, I have had the orthotics adjusted and even gotten new ones. I have ones that I use in my “regular” shoes and others that I put in my athletic footwear. The results are remarkable.

Of course, not everyone needs orthotics or the special care that a podiatrist can provide. Even so, at any age it is important to have proper footwear, in particular when engaging in athletic activities. Some of you may recall a related blog from a few years ago. It is noteworthy as well that, like tires on a car, athletic shoes have will wear out and need to be replaced. Having the proper footwear will not only protect the feet (from falling dumbbells!) but also provide proper support and alignment for the rest of the body.

How do you know if you have the right shoes? I recommend to all my clients that they go to a store that specializes in athletic footwear and has staff that is well-trained. I love DSW, but that is not the place to get properly fitted. There are some chains, but most metro areas have a locally-owned store that can provide shoes especially for cross-training, tennis, running, etc. There are others as well that are geared toward older adults and their unique requirements. Local stores have a vested interested in treating you right to keep you as a customer and rely on your referrals.

Most of us do not really give a great deal of thought to our feet….that is, until there is a problem. When they are unable to do their job the impact is huge. Do not wait until there is an issue; have the proper shoes and see a medical professional when something is not right. God gave us two feet; “Oh, the places you will go” with them–but only if you care for them!

Dementia and Physical Fitness

I recently had a discussion with a loved one about doing personal training with individuals who have irreversible medical conditions and/or cognitive decline. The focus was on whether it is ethical to accept payment to work with someone when there is little chance that the work we are doing will improve the situation.

I wrote about this tangentially in a blog post a couple of years ago in which I talked about the statement “All Lives Matter,” concluding that many people who say that really do not act in way that truly reflects it. I shared a story about an incarcerated individual with whom I have corresponded and visited for over twenty years. He is currently serving a life sentence. In 2002, he was diagnosed with a terrible cancer and called on me to counsel him on what he should do. Ultimately, he decided to undergo treatment and beat the odds by becoming cancer-free (he did the same again with a later diagnosis). One might wonder what the point is of curing one’s cancer if when it is all over s/he will still be still be incarcerated for the rest of one’s life. Is the life of an incarcerated person somehow not worth living? I learned that it is, and I have seen it played out over and over again since 2002.

In a similar vein, one could ask whether there is any point to training someone with Alzheimer’s or another end-stage disease. I addressed this in a more recent post, remembering a client who was on hospice care when I began training him. He had been athletic his whole life and his family knew that he loved to work out; in the last several months of his life, that is what we did together. Did it hold off the disease? Did it cure him? No. Did it add quality to his life on the days we were together? I would like to think so.

I do work with clients who experience cognitive decline. There are all kinds of considerations that go into carrying out this kind of training and my certifying organiation, The American Council on Exercise, has even written about it. There is research that indicates that aerobic exercise can actually help maintain (and perhaps even improve) cognitive function, but even if there was not, the quality time spent together is worth it. As with all my clients, I meet them where they are–physically, emotionally, spiritually, and mentally. I consider it a special honor to work with older adults; I believe that I make a difference in the lives of these clients (and in their families), and I know it has made a difference in mine.

Redemption

This coming weekend is an important one for each of the three Abrahamic faiths (Judaism, Christianity, and Islam). Jews begin the celebration of the eight-day Festival of Passover on Friday at sundown; most Christians mark Easter on Sunday, April 17; Muslims are in the middle of the holy month of Ramadan.

Although each of these religious traditions is distinct and these holidays are unique, there is a common theme among them: redemption. Redemption is generally described as the action of saving from sin, error, evil, or danger. In Judaism, Passover is the case of redemption par excellence. The Hebrews were saved from slavery in Egypt and brought out into freedom; once they had escaped they received the Torah and were able to worship God properly. In Christianity, Easter celebrates Jesus’ resurrection three days after his death; this represents Jesus’ victory over death and hints at the possibility of eternal life through acceptance of him as Messiah. Jesus is seen as a redeemer oforthose who believe in him. Ramadan is a month of fasting that honors the month in which Islamic scripture, Quran, was first revealed to the prophet, Muhammed. This revelation serves as a proper guide for Muslims of how to live their lives and avoid sin and evil. Redemption is a central theme in each holiday–all being observed at the same time this year!

How is this related to fitness? Many people despair of being able to stay or become physically fit–at any age, but more keenly as we grow older. This is where redemption comes in. The concept means that where we are today (physically, emotionally, spiritually) is not where we need to be forever; we are capable of overcoming obstacles and hardship and rising to a higher level. This is true in fitness at any age. For example, just because a person has problem with balance or walking does not mean that it will always be like that; of course, if no changes are made in behavior the problem will persist, but exercise, proper diet, and sufficient rest can make a huge impact. Focusing on our physical fitness can affect other areas as well. Working out releases hormones that elevate our mood. Additionally, if we are working out with a trainer or in a group setting, we are building relationship. The benefits of keeping physically active are numerous and have been mentioned throughout my blog. Exercise can truly grant us a kind of redemption. Not only that, keeping ourselves fit and healthy better allows us to do what it is that we were put on earth to do. We cannot serve God and humanity if we are too weak, frail, or sick to do so.

Best wishes to everyone for a redemptive season of the year. Chag Peseach Sameach! Happy Easter! Ramadan Kareem!

Passover’s Almost Here; What’s the Plan?

Everyone has a time of the year that is most challenging in terms of keeping up with their fitness routine and good nutrition. For me, it is my favorite holiday on the Jewish calendar: Passover! This holiday presents a double-whammy (if not triple-whammy) in this regard. First, out of the 8 days that the holidays is observed, half of them (days 1, 2, 7, and 8) are festival days when certain kinds of activities are prohibited; many people who observe the holiday include exercise in that category. Second, the entire food scheme is turned upside-down; many foods we are used to eating are forbidden for the 8 days, and many that are permitted are heavy in carbohydrates–like Matzoh.

Passover (and Easter, which is also right around the corner) is filled with pitfalls and many months of hard work can be erased in week. How do prevent that from happening? Planning.

For my family this means setting the menu for the entire holiday in advance. By planning out each of the meals, we know that we have balanced, healthy food options for the week. This actually presents a great opportunity since fruits and vegetables are exempted from the Passover prohibitions (consult your rabbi regarding legumes) and can be increased in quantity during the week; this also helps to regulate the digestive system.

The other key is ensuring that on the non-festival days, time is set aside for exercise; set those times in advance and it will be even easier to stay on track. On the festival days, we are permitted to walk. If the weather is nice, use this as an opportunity to get outside and keep moving; along the way, visit friends and family.

This is really not that difficult. The problem is that many of us have convinced ourselves that because the first two nights of Seder feasts are just that–feasts!–the entire holiday is a lost cause in terms of healthy eating. Two “challenging” meals are followed by 6 days during which we can eat more carefully with the intention to keep portions smaller and include fruits and vegetables. We should not beat ourselves up because we “fell off the diet wagon” for two days, but rather we should get right back on the path of good nutrition. This is also true after a day of heavy eating, chocolate eggs, etc., for those who celebrate Easter.

Holidays need not be a reason for anxiety–at least around food. There are times when it is natural to overindulge. The main thing is not to stress over it; accept it, get over it, and move forward.

Wishing everyone who observes a happy and healthy holiday!

Protecting those Knees

As we age, we hear more and more about people requiring knee surgery or even knee replacement. While the knee is not the most complicated joint, it is one that gets a lot of use and bears a lot of weight. It is important to be cognizant of the proper form while exercising to avoid injury; in particular, doing lunges or squats the wrong way can put a great deal of pressure and stress on the knee.

When we talk about the knee, we cannot just talk about the bones (the femur, tibia, patella, etc.) but also about the tendons, ligaments, and cartilage. All of these are susceptible to strain and injury. Working with a fitness professional is one way to help ensure that knees stay healthier–or at least avoid serious damage.

A new study referenced in the most recent issue of IDEA Fitness Journal reaches some enlightening conclusions about the connection between exercise and the risk of physical harm to the knees. As a runner (although I run less now than I used to), I always worried about the risk to this all-important joint; I assumed that our knees were like tires: they last for certain amount of miles and then they need to be replaced! Researchers at the University of Southampton and University of Oxford (both in England) found that the benefits of exercise–even for the frail and elderly–outweights the risks with regard to our knees. The study focused on the likelihood of developing knee osteoarthritis from physical activity. 5000 participants were followed for 5-12 years and the data suggests that neither the amount of energy spent in physical activity or the length of time were associated with a risk of developing arthritis.

This is good news; my last blog post focused on a related idea. Many people are afraid to work out for a variety of reasons–including injury. Studies show that the more information that can be shared with those beginning an exercise regimen, the greater the chances of success; that information should include debunking myths and stressing the benefits of exercise (versus the risk of not) as well as setting proper expectations of what the process will be like.

My knees have not worn out (yet), but it is good to know that it does not appear that years of running and physical activity might lead to knee arthritis in the future. One more reason to go boldly ahead keeping myself fit for whatever the future brings.

Overcoming Fear of Exercise

On an intellectual level, most people understand that exercising is good for us. On an emotional level, it is a little more complicated. Many of us are afraid to begin a program of exercise because we may think that it is too late, that we will get injured, that it will be too difficult, that it will not make a difference, etc. This becomes even more challenging for older individuals and/or those with long-term health conditions (LTCs).

I was diagnosed with Crohn’s Disease when I was 12 years old. This auto-immune digestive disease has all kinds of “embarassing” symptoms, but one of the main problems for me was that it was difficult to maintain a healthy weight (I was underweight), and my energy levels were lower than normal. As a result, in high school, I was excused from Physical Education classes; this did not set me on a path of healthy habits and fitness. It took over 25 years for me to realize the importance of taking care of my whole body and actually do something about it. Thank goodness, I have been in remission for a long time and am in great physical condition.

A recent statement in the British Journal of Sports Medicine, addresses this issue. The Physical Activity Risk Consensus group at University of Edinburgh in Scotland advises that while the benefits of physical activity for those with LTCs outweigh the risks, work needs to be done to properly prepare these individuals for what they will face when they begin exercising. It is all about setting proper expectations and readying them for how their bodies may react. The statement addresses 8 specific concerns: 1. neuromuscular pain, 2. fatigue, 3. shortness of breath, 4. cardiac chest pain, 5. palpitations, 6. elevated blood sugar levels, 7. cognitive impairment, and 8. falls and frailty. This all sounds kind of scary, right? The researchers say that those with LTCs can be helped to overcome their fears and reticence by having informed conversations with healthcare providers about the risks; this is why we always say, “Talk with a healthcare professional before beginning any exercise program.” Each case is different, so concerns will vary, conditions will not be the same, and point of entry will be unique. Looking at some of the 8 concerns above, it can be explained that some muscle pain is normal and that it will lessen as the body acclimates to the new routine. Fatigue and shortness of breath are normal when exercising. This should be accompanied with a clear description of the benefits of physical activity and how it can lead to reducing the occurrences of these 8 concerns.

Working with older adults, I am constantly reminding my clients of why we are doing what we are doing. I will say things like: “this exercise is strengthening the muscles that will help you walk better,” or “the more you practice doing this activity, the better your balance will be and the less likely you will be to experience a fall.” Fear is real. It stopped me when I was younger–when more physical activity was actually what I needed; I wish that there would have been a doctor who would have prepared me to leave my comfort zone. Thankfully, I eventually did…but it took a quarter of a century.

Manage expectations–both in terms of results and challenges–and most individuals, including those with LTCs, will have a greater chance of better health outcomes. The research backs it up.

Cover All Your (Muscle) Bases

In youth, there are certain “rules” that many follow when engaging in resistance training. The reasoning goes that for men to be more attractive they need to concentrate on their arms and chest. Women may feel the need to focus on abdominals and glutes. These rules do not apply in the same ways as we enter older adulthood.

Do not take this to mean that older adults are not concerned about their appearance; rather, as we age we need to take a more holistic approach to the muscles we exercise. It is important to pay attention to the muscle groups that help us to perform the activities of daily living (ADL) such as walking, climbing stairs, carrying groceries, bending down to pick up something we have dropped on the floor, etc., not just the ones that get us noticed when we wear tight clothes! After all, what good is having gigantic biceps and a huge chest if we cannot make our way across the room?

A recent article on AARP’s website by Michele Wojciechowski highlights some of the often-ignored muscle groups that deserve our attention and exercise. The author highlights the following areas: 1) The hip area (the glutes and hip flexors); these are key to walking and getting up from a seated position. 2) The core; this part of the body is from the shoulders through just below the hips and serves as support for the entire upper body. Often, older adults with poor posture have weakened core muscles. 3) The knees–which are not a muscle, but a joint; they are supported by the quads and the hamstrings; keeping those strong and limber is key to walking, climbing stairs, standing, and maintaining balance. 4) Ankles and feet; again, vital to walking but also important in maintaining balance and stability; ask anyone who has had feet or ankle problems and they will tell you that it seriously inhibits mobility. 5) The neck; not keeping the supporting muscles strong and limber will literally cause “a pain in the neck.” It is not uncommon at all to see older adults whose heads are perched out well in front of the chests; this causes problems beyond appearance, possibly affecting sleep, posture, and the ability to drive a car. 6) Hands and wrists; while many are hit by arthritis in this area, others simply allow the lower arm muscles to weaken, which limits the ability to perform fine motor skills like writing, eating, typing.

As I age, I am concerned about my appearance. I always want to put the best version of myself forward. For me this means not only working on the “sexy” muscles, but also on the ones that will keep me active and independent. Do not overlook these muscle groups or they will have a way of calling your attention to them in a way you might not enjoy.