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.

Well, That’s a Stretch…

Those involved in fitness as professional and as consumers know that an important–but often overlooked–part of exercising is stretching. Everybody agrees that it is a good thing but, unfortunately, many of us are inconsistent in our stretching; even worse, some people do it improperly causing more harm than good.

A recent trend in a field allied to fitness is Assisted Stretching. Assisted stretching usually involves a practitioner and is done in-person. It can, however, also be done remotely or as part of a group setting. The “stretcher” helps the “stretchee” (is that a word?) release tension from muscles, tendons, ligaments, and joints. A recent article on CNN.com highlights the ways in which assisted stretching is being used to relieve chronic aches and pains. This technique is being used in people of all ages, and it is not just for athletes. In fact, many people who spend a great deal of time sitting or otherwise inactive can develop tightness that can cause discomfort.

Recent studies are not exactly conclusive about how effective assisted stretching is. Can it be better than stretching on one’s own? We can look at this the same way that we look at personal training. Yes, a person can perform the same exercises suggested by a personal trainer on their own, but will they? A personal trainer helps to keep clients accountable, progresses them at an appropriate pace, and helps to prevent injuries. That is why trainers are popular and effective. Likewise, a person can stretch on their own, but will they do it correctly and consistently?

This trend, according to the article is growing rapidly. While more research is likely needed to ascertain the true effectiveness and possible drawbacks, assisted stretching looks like it can help keep our muscles, tendons, ligaments, and joints in better shape. That can only be a good thing.

In the meantime, remember to stretch before and after your workout. Questions about how to best do that? Ask a fitness professional who will be happy to help you develop a routine.

The Keys to Happiness as We Age

A recent article in The Atlantic by Arthur C. Brooks highlights ways that we can help to ensure happiness as we get older. Brooks is an American musician, social scientist, and professor at Harvard University. He has written many articles and a book on this topic.

In the article, he cites an ongoing study (over 80 years) that traces the attitudes, conditions, and well-being of the subjects over the course of their lives. Here are some fascinating conclusions: 1) Happiness declines through young adulthood into middle-age and bottoms out at about age 50. 2) After that it starts to go up again until about the mid-60s. 3) After that, it can go one of two ways; there are those who get much happier and those who get much more unhappy.

The study makes clear something that should be clear to begin with. The decisions that we make earlier in our lives have an impact on how we will feel later in life. The investments (not just financial) of our earlier years pay dividends–or if we have not invested wisely, we suffer. This is a pretty stark reality, but it is also not 100% accurate. There are those who are born into wealth, who inherit good genes, have tragic accidents, etc., whose lot is determined in large portion by events beyond their control.

There are, however, factors that we can control according to Brooks. All things being equal (which they are not), making the right choices in these realms will yield better results (happiness) in later years. In short, here is the list.

  1. Don’t smoke, and if you do, quit.
  2. Drink in moderation.
  3. Maintain a healthy body weight.
  4. Keep active every day.
  5. Develop coping skills for when life gets challenging.
  6. Never stop learning.
  7. Invest in interpersonal relationships.

Nothing earth-shattering, right? How many of these 7 are we doing right now? Is there time to make a change? Of course! All the research on fitness, shows that it is never too late to make a change, and it will have positive outcomes.

I am the happiest I have ever been. I do what I love with people I love. I put effort into all 7 categories above. I have a few years until I hit my mid-60s, but I am hopeful that I will fall into the “getting much happier” category. I hope you will join me there!

Osteoporosis and Weight Training

It has been a long-held perception that as we age we need to be more careful and not “overdo it.” While it is true that older adults should take appropriate caution with physical activities, research overhwelmingly shows that being active–including weight training–is associated with better health outcomes. Sometimes it happens in unexpected and surprising ways.

Osteoporosis is a condition in which bones bones become weak and brittle; this condition is especially prevalent in older women. Under normal circumstances the cells in our bodies are constantly dying and being regenerated; this includes our bones. Osteoporosis occurs when bone tissue is reabsorbed into our bodies at a faster rate than it is replaced. The bones (osteo) become porous (porosis) as shown in the picture above. They become especially susceptible to fracture.

How can it be treated? Proper diet and medications are effective, but so is weight training. Wait! What? We are going to ask people with brittle bones to lift dumbbells?!?! As a matter of fact, this is a great way to strengthen bones. Our bodies respond to stimuli according to the SAID principle. SAID stands for Specific Adaptation to Imposed Demands. What this means is that when we make our bodies act in a certain way, it will change physiologically to accomodate those new requirements. As an example, postal workers who have a walking route (as opposed to sitting in the mail truck) often have stronger legs and amazing calves. Likewise, folks whose work requires them to do heavy lifting of packages will develop larger arm, shoulder, and back muscles. Their bodies have adapted specifically to the demands opposed on them.

How does this work with Osteoporosis? When we train with weights, our bones get the message that they need to work harder and get stronger; the bones respond by creating new tissue at a faster rate. Lower body bones can also be strengthened by weight-bearing exercises like walking.

Is this dangerous? Like any physical activity, there are always risks. Those with Osteoporosis should be aware of their surroundings to avoid injuries and falls which can result in broken bones. They should also avoid high impact activities like jumping or those that require jerky or sudden movements. Otherwise, there are few restrictions with regard to just how heavy those weights can be.

It seems somewhat counterintuitive to put stress on brittle bones but, in fact, it is one of the best things to do for Osteoporosis. As always, consult a healthcare professional before embarking on any new fitness regimen, and let your fitness professional know of any conditions that might impact your health and safety. Otherwise, do not be afraid to pick up those weights; your bones will thank you!

“Stop Loading, Start Exploding”

I just returned from the IDEA Personal Training Institute in Alexandria, VA. IDEA is an organization that provides educational opportunities for Personal Trainers. The title of this blog is the title of one of the courses I took, taught by Cody Sipe of the Functional Aging Institute.

The central topic of the course was Power Training. I have blogged about this in the past; once in 2019 and once in 2020, but it is worth reviewing what it is all about. Power=force x velocity. Power training focuses on increasing the rate at which work (ie, lifting weight, pulling a cable, throwing a ball) is performed. Power training has been a part of the fitness world for a long time, but it was thought that this kind of exercise was not appropriate for older adults.

Research shows that as we age muscle strength declines, but power drops even more quickly; the reason is that velocity decreases. Older adults may not be able to move as quickly as they had when they were younger. Why does this matter? As we age, our interest generally changes from having a beach body to have a body that functions the way we need it to; we need to be able to walk, climb stairs, lift and carry objects, etc. Power training–not strength training–is most effective at improving function. If you think about it, it makes perfect sense. Unless we are participating in a weightlifting competetion, there is a limit as to how strong we need to be; if the heaviest thing we lift is a 50 lb. bag of mulch, do we need to be able to bench press 200 pounds? On the other hand, being able to move quickly and effectively is necessary to prevent falls and other injuries. We need to train our bodies to react without a lag time. This would all indicate that it is preferable to work with lower weights (stop loading) with reps that are performed with greater speed (start exploding).

The conference was valuable, but this course in particular will help me to better train my clients. For years, people have thought that we cannot push older adults to perform resistance exercises (or even cardio) too quickly. Now we know that increasing the speed has tangible benefits.

I look forward to seeing the results as I continue to integrate power training into the work that I do.