Meeting Nutritional Needs as Part of Healthy Aging

What older adult is not interested in healthy aging? We want to be able to avoid disease and disability, maintain good cognitive function, have an active social life, and be engaged in meaningful pursuits. Healthy aging does not just happen; it requires effort.

As we grow older, our nutritional needs are affected by physical changes. Our metabolism slows, we lose muscle mass and bone density, and our organs have to work harder to keep us alive and healthy. In general, older adults require fewer calories on a daily basis, but need more nutrients. Our energy intake declines from the age of 50 and hits its lowest point after 80. At the same time, we may find that our bodies are lacking Vitamin D, Vitamin B12, Calcium, and Sodium. If we can sustain proper levels, we have a better chance at achieving healthy aging.

Vitamin D prevents disease and promotes bone health; a lack of Vitamin D can lead to high blood pressure, cancer, fractures, and falls. Aside from taking supplements, older adults need to be out in the sun more (with sunscreen!), which can be difficult in places where the sun is absent for much of the year.

Vitamin B12 (as well as B9 or Folate) deficiencies can be caused by a number of things including an unhealthy diet. Shortages can result in tiredness, muscle weakness, vision problems, and psychological problems–among other issues. Higher levels protect against cognitive decline and anemia.

For older adults, it is more difficult to absorb calcium. This contributes to lower bone density which can lead to osteoporosis and other health issues.

As for Sodium, we usually think of this as a bad thing (causing hypertension), but too little can be dangerous too. Symptoms can include vomiting, loss of energy, and confusion. In severe cases, seizures, coma, and death can result. 1500 mg/day is recommended–about a third of a teaspoon. To combat the risk of hypertension, proper levels of potassium should be maintained (4.7 g/day).

In addition to these four, it is important to take in proper amounts of fiber, hydration, and other nutrients such as Zinc, Vitamin C, and Vitamin E. Although this all sounds somewhat complicated, most blood tests ordered by physicians before a check-up will ascertain whether you are at the right levels for these vitamins and minerals. If you doctor tells you that there is a deficiency, there are always ways to address them–most of which are easy and painless.

We all want to be healthy agers. Exercise, proper rest, and nutrition are important throughout our lives, but even more so as we get older. Keep tabs on your nutrients to help provide the best life going forward!

Bending Over Backwards for Better Health

We have all heard the expression “to bend over backwards,” which means to put in an extra effort or to be extra flexible on a matter. In the fitness world, there is an exercise called a Back Extension that is the literal physical manifestation of this expression–and it has many benefits for the human body!

The Back Extension is an exercise in which the spine above the waist is extended or leans posteriorly (backwards). Back Extensions can be done many ways. There are machines at most gyms; some move and allow you to add weights, while others are immobile and rely on your body weight as resistance. Without equipment, they can be done lying prone (face-down) on a mat while lifting the head, shoulder, and chest up off the mat; you can lift your legs at the same time for added effect, which is often called a “Superman” or “Superhero.” They can be done in a standing position; some people find it helpful to place their hands on their hips or in the small of the back for stability. For those with balance concerns, it can be done with the buttocks up against a table, counter, or other non-movable object; once in position, lean backwards with arms at the side or crossed across the chest.

What are the benefits of the Back Extension?

Improved posture by strengthening stabilizer muscles – erector spinae, in particular.
Prevention of back pain by lengthening the spine.
Stronger back due to improved flexibility, increased muscle strength, and wider range of motion.
Stronger glutes, hamstrings, upper back and shoulders, and abdominal muscles, which together add up to a stronger core.
The exercise is low-impact, can be done without equipment, and helps to prevent injury.

How often should you do Back Extensions? If you are using weights, recommendations are 3-4 sets of 10-15 reps, twice to four times per week. If you are using just body weight, they can be done in the same quantity every day.

Many times we bend over backwards for others whom we care about. The Back Extension exercise is something that we can do for ourselves to show care for our bodies.

Fitness Myths that Drive Me Crazy?

There are a lot of things in this world that drive me crazy. Injustice is probably at the top. This is followed by rudeness, disrespect, and belligerence. Apparently, however, according to a recent New York Times article, there are “8 Fitness Myths that Drive Experts Crazy;” and I guess I consider myself (after all these years) a fitness expert.

Of course, the title of the article engages in a bit of hyperbole to catch the potential readers attention, but the points made in the article are true and provide some good fitness advice.

Here are the myths:

“You should stretch before you work out.” Actually, static stretches (holding a pose) are either ineffective or even harmful before exercise. Rather, one should do dynamic stretches that mimic the kinds of action you will be doing during the upcoming exercise. Static stretches are best for after the workout.
“You need to lift heavy weights to build muscle.” This is especially pertinent to older adults. If you are looking to compete in a bodybuilding contest, by all means go for heavy weights with fewer reps. To build muscle, however, it is possible to do so using lighter weights with more reps.
“Running destroys your knees.” Not true. In fact, it can even protect knees against osteoarthritis. As long as you do not run too fast or increase your distances too quickly, your knees should be okay.
“Walking is enough to keep you fit as you age.” I have blogged a lot about walking; it is a great activity, but for most people it is not sufficient to keep fit. Strength training should also be a part of the program for older adults to combact the loss of muscle mass.
“Modifications are for beginners.” A modification is changing the way an exercise is done to either make it easier or to protect an injury. Some people modify until their strength increases; one could start with a wall push-up then progress to a push-up off a counter and finally progress to a push-up on the floor. For many others, though, a floor push-up would cause injury (or they simply cannot get up from the floor) so modifications are the way to go on an on-going basis.
“Runners and cyclists don’t need to strength-train their lower body.” This does not make me crazy at all. While running and cycling do strengthen the lower body, they are not enough to create significant muscle growth; once again, resistance training as well as exercises like squats and lunges can increase bone density and make the lower body stronger.
“You need 10,000 steps a day to be healthy.” I debunked this one a long time ago. That number came from the company that produced a pedometer and they liked it because it was a nice round number. Research shows that benefits accrue up to 7500 steps/day and that as few as 4000/day reduce the risk of mortality.
“Taking an ice bath after a tough workout improves your recovery.” True or not, you will probably never find me doing this. The theory is that the ice bath will reduce inflammation. As I learned when I studied to become a personal trainer, not all inflammation is bad; inflammation can be useful in helping the body heal and build strength. Jumping in an ice bath can short circuit the natural path. Every once in a while, an ice bath may be okay after a tough workout; saunas, on the other hand, seem to be safer and more effective!

There are many other myths in the fitness world–many with regard to older adults. Here are a few: Older adults should not do power exercises. Older adults should only do seated exercises. Older adults do not need to do exercises with weights. And the list goes on. Before making decisions about your own fitness, do some research or check with a fitness professional near you!

New Year’s Resolution? Grab a Partner

It is that time of the year again. Hanukkah and Christmas are behind us, and in just a few days it will be 2024. I have blogged in the past about New Year’s Resolutions. You can read those posts here, here, here, and here. If you do not want to read all of those posts again, let me give you a summary.

A resolution without a plan is just a resolution. If the goal is: ”I am going to get in shape,” what is the plan? A better resolution is: ”I am going to go to the gym 3 times each week.” The more specific you are the better the chances you will achieve your goal.
Keep it simple. I know some friends who have a whole bunch of resolutions; it is like a grocery shopping list. In Hebrew there is an expression: Tafasta m’rubeh, lo tafasta, which translates as “if you try to grab too much, you grab nothing.” I like the Rule of 3. Choose three things and concentrate on them.
Be realistic. Many of the resolutions that we make we have made before. Are they actually achievable? Can we identify the reasons why we failed? Socrates said, “Know Thyself;” be honest with yourself about what you can and will do and make the plan accordingly. It is better to have small successes that help to build a pattern.

What is the secret sauce to all of these? Grab a partner. Find someone who is willing to be with you on your fitness journey. It can be a spouse/partner, colleague from work, a friend at the gym, etc. Work together to plan goals and how to meet them. Once that is done, hold each other accountable.

Several years ago when I work at a gym, I was in charge of a fitness challenge. We divided into three teams. Not only did individuals win prizes, but the entire team could win if they met certain criteria. We had a very low drop-our rate for the challenge simply because team members looked out for each other, encouraged each other, and did not want to disappoint others in the group. The same dynamic can work one partner or even a small group. Have each other’s backs and watch the results.

The next week is a great opportunity to think about what went well and not-so-well in the past year. A New Year can be a new beginning. To make the most of it, have a plan (keep it simple and realistic), and grab a partner!

Wishing everyone the best in HEALTH and happiness in 2024!

Why all the Talk about RSV?

My wife and I just returned from a one-week cruise in the Caribbean where I served as the cruise ship rabbi for Hanukkah. It was very relaxing and a lot of fun as well. Great weather too!

One of the things that I noticed on the cruise was a heightened sense of hygiene on the ship. When we sailed in Alaska in 2019 (pre-pandemic), there was an emphasis on washing hands to prevent RSV (Respiratory Syncytial Virus) which had become common on cruise ships. On this vessel, we were reminded to wash hands before every meal (“washy-washy!”) and there were hand sanitizer dispensers all over the ship. Very few people wore masks, except for those handling food.

So, did I bring back any souvenirs from our trip? Well, yes. RSV. Despite my washing, I managed to pick up the virus. A few days into the trip I started to feel a little sniffly, but I attributed it to the change in climate from the cold weather of Cleveland to the heat of the tropics. By the day we came home, I had a runny nose. On the flights home my ears popped and, five days later, they are still plugged up; do not worry, as I see an ENT later today.

What are some of the symptoms of RSV? They include fever, severe cough, wheezing, rapid breathing or difficulty breathing, and even a bluish color of the skin due to lack of oxygen (cyanosis). I experienced a sore throat as well but mostly displayed the runny nose and cough. I saw a doctor on Tuesday to see about my ears, and she recommended a COVID test (negative) and a RSV test (positive). I have been isolating at home–training clients via Zoom–and wearing a mask when I need to go out.

There is a new vaccine out for RSV for those over 60. According to the CDC, RSV sends as many as 160,000 people over the age of 65 to the hospital each year and results in about 10,000 deaths. For a virus that was most common in young children, the last 20 years has seen an impact equal to that of the flu in older adults according to Dr. William Shaffner of Vanderbilt University’s School of Medicine. Should all older adults get the RSV vaccine? Dr. Chad Nielsen of University of Florida Health in Jacksonville suggests that most healthy adults who are not immunocompromised and do not have other comorbities should be able to fight off RSV without a vaccine. Others should definitely talk with their physicians about whether the vaccine would be a good idea.

In the meantime, I will keep hydrated, get plenty of rest, and avoid cold, dry air; these are thought to help minimize the effects of the virus. Pain relievers and other over-the-counter symptom relievers are also on hand.

It was a great cruise; perhaps on my next one I will just bring back a t-shirt instead!

Walking and Type II Diabetes

Readers of this blog know that I have written quite a bit about walking as exercise for older adults. The benefits are many and go beyond simple cardio activity; walking is associated with better health outcomes and disease prevention. Still, older adults wonder if walking is good enough; this was the topic of a post nearly 3 years ago. It is good, but the more intense it is, the greater impact it has on our health.

NBC News recently reported on a study that came out earlier this week in British Journal of Sports Medicine about walking and diabetes. In particular, it dealt with Type II Diabetes; according to the Mayo Clinic, Type II Diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. The National Institutes of Health notes that a person is more likely to develop Type II Diabetes if they are not physically active and are overweight or have obesity. Extra weight sometimes causes insulin resistance and is common in people with Type II Diabetes.

The upshot of the new study is that it is now possible to quantify what kind of walking (slower vs faster) can prevent the development of Type II Diabetes. Walking at a pace of 2.5 mph can lower the risk by 15%. The faster the pace, the bigger impact it will have: 3-4 mph lowers the risk by 24% and over 4 mph reduces the risk by 39%. Obviously, the more vigorous the activity, the more it influences our overall health in addition to our chances of getting Type II Diabetes–but speed isn’t everything. Guidelines recommend that adults exercise for 150 minutes per week; so if a person walks vigorously, but only for 30 minutes a week, they are much less likely to make a dent in their chances of developing the disease.

As always, before beginning an exercise regimen, it is important to talk with your physician. Most doctors recommend walking because it requires no equipment (except for supportive shoes) and no instruction. Now there is another reason to like walking: we can help prevent Type II Diabetes.

Do You Know Squat?

One of the main concerns that older adults have from a physical standpoint is their ability to walk well and climb stairs. These are both activities that are a part of daily living and lead to greater independence.

There are many exercises that can help with walking and stair-climbing. Of course, there are treadmills and stair-climbing machines, but most people use these more for cardio exercise than for building lower body strength. If you are looking to maintain or strengthen the muscles for these activities, arguably the best exercise is the Squat. I blogged about this a couple of months ago, but it bears some repetition and further expansion.

When I ask my new clients to show me a squat, nine times out of ten what I get is a deep knee bend (an exercise that is not particularly good for the knees and that I do not recommend for older adults). When doing a deep knee bend, the knees bend and go forward–usually in front of the toes; this puts a good deal of stress on the tendons and ligaments.

As a trainer, one of my primary goals is to teach my clients various exercises and the correct way to do them. When a squat is done properly, feet are a little bit wider than shoulder-width, the rear-end goes back and down, and the knees stay behind the toes; ideally, the knees should stay directly above the ankles/heels. As I noted in the blog referenced above, this is not easy for most people, let alone older adults. It takes practice because there is almost always a fear of falling backwards, but eventually my clients are able to do a half-squat correctly (only lowering the rear-end down halfway) and then move on to a full squat; Sit and Stands are also a great way to practice the form. Those who master a full squat can begin to add different elements such as a wide-stance, side-to-side squat, squat with a lateral leg raise, squat jumps, and adding dumbbells or barbells.

Why is the squat so effective? It works nearly every muscle in the lower body: glutes, quads, hamstrings, adductors, hip flexors, and calves–the very muscles that are recruited in walking and stair-climbing as well as other activities. How many squats should you do? This varies from person to person, but I usually start my clients with 2 sets of 10-12 reps. Once those have been mastered and there is no feeling of pain or soreness, we add the elements mentioned above to increase the level of resistance and/or add another set.

A personal trainer or other fitness professional can help you on your squat journey. It is quite important to get the form correct–to avoid injury and to make sure to reap the benefits of this simple but effective exercise.

Exercise before Surgery

Early last week, one of the regular participants in an on-line class that I teach had hip replacement surgery. I teach the class 3 times/week and she is almost always there unless she is traveling. Even in the weeks leading up to the surgery, she has been participating fully with a few modifications.

I checked in with her a few days after surgery to see how she was doing. She told me that the surgery went well–no surprises–and that the recovery had thus far been better than expected. She further explained to me that she had no doubt that all the workouts had prepared her body for a speedier and easier post-surgical experience. I have a friend who had a benign brain tumor removed over 20 years ago; he had a couple of months before the surgery date and he did his best to get in as much exercise as possible. He wanted to give himself the best chance for a successful recovery; there were unrelated complications after surgery and his strength helped keep him alive. He made a full recovery and continues to work out regularly.

These two anecdotal stories illustrate something that medical research has backed up. Study after study shows that the better shape you are in before surgery, the more likely you are to have an easier recovery with positive results. For those who exercise on a regular basis, there is no need to pile on more workouts; those who engage in physical activity regularly are likely to have greater strength and improved cardiovascular capacity to begin with. There is an indication, however, that those approaching surgery may want to shift to more HIIT workouts. HIIT stands for High Intensity Interval Training; it is exactly what it sounds like: periods of intense exercise interspersed with periods of moderate or light exercise. For more info on HIIT workouts you can look at my post from July 2019 and a follow-up from August 2021.

Followers of my blog know that I have undergone a few surgeries over the past years. I have been fortunate to recover to 100% with each one. It is not because of luck alone, but rather because I have prepared my body to be strong and resilient. It goes without saying that if you have been scheduled for surgery, you should talk with your doctor to see what they recommend or discourage before going under the knife (or laser). Hopefully a regular regime of exercise, proper rest, and good nutrition will–like an apple a day–keep the doctor away…but when surgery is called for, the better we go into it, the better we are likely to come out of it.

You Are Free to Roam About the Cabin

With November right around the corner, we enter into a heavy travel season: Thanksgiving, Hanukkah, Christmas and New Year’s. Travel will be brisk this year as the pandemic has been (mostly) tamed and folks are feeling more confident about taking longer trips to see loved ones.

Many of my clients do quite a bit of air travel–some of it long-haul–and they have asked me about the best exercises to do while on a long flight to prevent problems. The number one issue of concern is DVT (deep vein thrombosis); this is when a blood clot forms deep inside the body (very often in the legs) and it is more likely to occur when we sit for long periods of time. The clot can move throughout the body and cause serious health issues.

In-flight exercises–in addition to plenty of water–can help prevent DVT. What are the recommendations–especially given how tight space is on most airliners?

If you are able to get up and walk around (after the “fasten seat belt” sign has been turned off!) that is a great idea. This is more difficult in narrow-body planes, but you can carefully stand in place and look to see if the aisles are crowded or if in-flight service is in progresss. If the coast is clear, take a stroll. On wide-body jets with two aisle, it may be possible to do a big lap around the plane. Do this as often as feasible.
Exercises that can be done while seated include: ankle rotations (lift your foot of the floor and rotate your ankle); “quick feet” (running in place tapping either heels or toes quickly on the floor–alternating sides); calf raises (lifting heels up and then lowering them); leg extensions (straighten alternating legs so the foot comes off the floor); knee-ins (bring both knees or one at a time up to the chest and hold with hands); glute squeezes (clench those butt cheeks together); forward bends (lean forward as far as you can bringing your head down). Upper body exercises include shoulder rolls, elbow flexes (like a bicep curl without weights), and punches (don’t hit the back of the seat in front of you).
There are also many stretches that can be done while seated–both dynamic (active) and isometric (holding a stretch still).

A simple internet search will turn up lots of exercises to keep moving during the flight. Just make sure that whatever you do is in compliance with crew member instructions–and be aware of those seated around you who might be affected (ie, poked in the eye) if you are not careful.

Finally, these exercises work on long car, bus, and train rides as well. If you are the driver, make sure to stop with regularity in order to walk around and do some of these exercises as well. It goes without saying (I hope) that you should find a safe place to do this like a parking lot in a gas or EV charging station, or a rest area. The side of the road is more dangerous than a DVT.

I hope these tips help. Bon voyage!

Deep Sleep and Alzheimer’s Disease

One of the issues that older adults face is getting enough quality rest and sleep. Older mens’ sleep is often interrupted in the middle of the night by the need to urinate if they have prostate issues. Many post-menopausal women suffer from insomnia and night-time breathing disorders. Others just have a hard time “shutting off” all the activities of the day. It turns out that lack of quality sleep can affect more than just our level of energy the next day; it can also influence the progression of Alzheimer’s Disease.

ScienceAlert just reported on a study conducted at UC-Berkeley published in BMC Medicine (an on-line journal of medicine) in May. The research showed that subjects in the study who got more deep sleep (defined as non-rapid eye movement slow wave sleep) did better on memory tests the next day than those who did not. The article notes that there is a bit of a chicken-egg issue here; one of the symptoms of Alzheimer’s is sleep problems…and sleep problems may worsen the disease progression. Even so, this appears to be another piece in the puzzle.

Researchers believe that the study and scores of others like it point to this kind of sleep as necessary for allowing the body to get rid of waste products in the brain that accumulate during the day. It remains to be seen what improved sleep over the long-term might do, but in the short-term it appears that more of this kind of sleep can slow the progression of the disease. If, in fact, there is a cause-effect relationship there will be more effective ways to prevent this kind of dementia.

The article also mentions the role of sleep aids (that might actually do more harm than good in this respect). In order to get a better night’s sleep quality, lay off of caffeine later in the day, exercise, limit screen time at night, and take a hot shower. Most of us would like to get on board with that…and now we know it may have the added benefit of preventing dementia.