Recalculating…

This is the last installment of what I learned at the IDEA / ACSM Health & Fitness Summit in Denver. The last session that I took was about making modifications in exercises to avoid pain for clients and class participants with joint or muscle issues. Since I deal exclusively with older adults, almost all of my clients have at some time or other needed modifications to the exercises we do so I was looking forward to brushing up on my skills and knowledge.

There are lots of exercises. There are also lots of muscles and joints. There is rarely one single exercise that will benefit a certain part of the body. For instance, the triceps can be worked in a number of ways: bench triceps extensions, overhead triceps extensions, cable push-downs, triceps dips, push-ups, triceps kickbacks, etc. If doing one of them causes pain, that does not necessarily mean that it is impossible to train the triceps; on the contrary, there are almost always other forms of the exercise that do not create discomfort. Additionally, there are ways to adjust the amount of weight, the speed of the exercise, or the number of sets to achieve the same goal without pain.

I have to be honest that I out of the four courses I took, this was the one that I found least helpful to me. There was more technical jargon than necessary (presenters do not need to call it the glenohumeral joint; among professionals there is no need to show off–just call it the shoulder) and, frankly, my work over the past 7 years has required me to come up with all kinds of adjustments to the exercises we do one-on-one and in a group setting. One of the things I enjoy the most in my on-line group fitness class is seeing the variations of movement on the screen among the participants based on their abilities; they have learned how to achieve the same goal in a different way. It is a win-win.

Even so, I did pick up a few new “tricks.” I also think it is important for trainers who do not necessarily work with special populations to understand that not everyone comes to a personal trainer to become an elite athlete. Many are looking to maintain strength, agility, balance, and independence; the path for older adults and those with disabilities looks very different from the one followed by a 19-year-old basketball player.

The human body is a wonder. We all have certain assets and liabilities in our physical fitness. It is reassuring to know that in almost any condition there are ways to build better fitness. We just need to be flexible and recalculate how to keep it pain-free.

Training People with Parkinson’s Disease

In my next installment of “What I Learned at the IDEA / ACSM Health & Fitness Summit in Denver,” let’s talk about Parkinson’s Disease (PD). This is an issue that is near and dear to me. My father (of blessed memory) had Parkinson’s Disease and I have a client living with it as well. Most of us know someone who lived or lives with it–most notably, the actor Michael J. Fox.

While at the conference, I signed up for a session aimed at trainers who might be working or interested in working with someone living with PD. The session had three speakers: one from the Parkinson’s Foundation, one who is a researcher on PD, and a third who trains people with PD. A young woman with early onset PD was also there to talk about her own experience and to serve as a “client” for the demonstrations. It was an excellent program giving us a mix of information about the disease, how to work with it, and how to find more resources. The most important thing I learned, though, was just how effective exercise can be in delaying the progress of the disease; it is truly remarkable.

One of the ideas that what was stressed to us was to get in touch with local resources for more guidance and education. There are on-line resources and certification programs that are available too. I am accustomed to training with what are called “special populations” in my work with older adults; I have special certification that has taught me the best practices for training this group. Just as I would not train a 70- or 80-year-old in the same way as a student athlete, individuals with PD require a different approach. I knew a tiny bit more than when I went to Denver, but I was inspired to dig a little deeper.

I contacted my local Parkinson’s Foundation and the next day they called me to let me know that one of the best (if not THE best) resources in the United States was located about two miles from my home; they encouraged me to contact InMotion, a free community-based program for people with PD. I called InMotion and got a return call very soon afterward from the co-founder and Chief Program Officer, Ben Rossi. It turns out that we have similar backgrounds although he has been in the fitness industry much longer than I. He invited me to come see the place; this surprised me a little bit since my company, At Home Senior Fitness, could be seen as competition.

Today I visited what I would say is one of the most impressive facilities I have seen in a long time. InMotion has fitness facilities, group therapy, individual therapy, and classes that cater to the entire person. I sat with Ben for a while and discussed my interest and got some great advice about where to go next. It turns out that we really are not in competition; the truth is they are much better at working with people with PD than I will probably ever be. What I can do is help to provide a continuum of treatment for my clients and partner with this organization.

I will do some more digging in the weeks ahead and see if there is a certification program that makes sense for me and my business. In the meantime, it is heartening to know that there are amazing professional, volunteers, and supporters who make this place a hub of activity and healing. It is a resource for those with PD and for those of us who care about and for them.

Is Your Trainer still Certified?

I just returned from the Health & Fitness Summit in Denver. This is the fifth conference sponsored or co-sponsored by IDEA that I have attended. IDEA is an educational organization that provides on-line courses and in-person events that allow fitness professionals to stay up-to-date on the newest research and trends in the industry, as well as to work toward new areas of expertise. Aside from gathering with our fellow trainers, for many of us, it is an opportunity to obtain the all-important Continuing Education Credits that we need to keep our certification(s).

Just as attorneys and doctors have to keep learning after they finish their formal school training, fitness professionals are required to participate in continuing education. It varies for each certifying agency, but usually is around 10-20 hours of study per year. I have two certifications and they require 10 credits per year; luckily, I can use the same course for both accreditations.

Why is this important? No one wants an attorney who is not up on the latest changes in the laws where they practice; there is perhaps nothing worse than paying big bucks to get out-of-date or otherwise incorrect legal advice. The same is true of doctors; would you want a procedure that was standard in the 1960s or do you want the latest techniques that offer the greatest chance for success with the least difficult recovery? Research about human physiology and exercise continues on a regular basis–although some of it is in jeopardy based on current threats to funding of the NIH and CDC. What trainers thought was best for older adults and clients with chronic illnesses such as Parkinson’s, Diabetes, or cognitive decline in the past is not necessarily what is recommended today. Every year, when I attend these conferences–as well as when I do on-line courses–I learn more about how to best get my clients the results they desire while keeping them safe and injury-free. CECs are not just what I need to keep my certification current; they are what keeps me at the top of my game and of value to my clients. If your trainer has let their certification lapse, it is not just a formality; it means you may be getting inferior services.

In the next blog posts, I will discuss some of what I learned this year. I will share some of the latest research–which I can do because I take my continuing education seriously.

Dental Health & Physical Fitness

Earlier today I went to the dentist for the final step of having a crown replaced–unfortunately, not the kind worn by royalty! As the dentist was making sure the crown fit perfectly, I wondered just how much dental health impacts physical fitness and vice-versa.

When I was studying for my personal training certification, I remember briefly learning about overall physical health (including oral) as part of the big picture. We were taught that having good oral hygiene was not only beneficial for teeth and gums, but also for overall wellness.

Some of the key connections are:

Brushing and flossing regularly prevent cavities, gum disease, and bad breath. Having a “fresh” mouth (not the kind that gets you in trouble) is important during exercise. Besides, who wants to work out with someone whose breath could knock over a horse?
Having healthy teeth and gums are necessary for eating the proper foods to promote fitness. Certain foods can help with this (leafy greens, fruits, dairy), while others are harmful (sugary snacks and drinks). If your teeth and gums are unhealthy, the proper diet will suffer.
When we exercise it is important to keep well-hydrated. Drinking plenty of fluids can help wash away food particles reducing the odds of developing plaque and gum disease. It also can help produce healthy saliva to protect tooth enamel.
Chewing (and jaw exercises) help maintain stronger bite and jaw muscles. When we exercise we often think of the building of muscles like biceps, calves, pectorals, and abs, but what would happen if the muscles we use in the eating process got so weak that we could not eat on our own?
Avoid bad habits like consuming too many sugary drinks, excessive alcohol, and smoking. They increase the risk of damage to teeth and gums…and can cause bad breath! They are counterproductive to our fitness as well.
Just like our physical fitness routines work best when done on a regular basis, have a regular habit of visiting the dentist for check-ups and cleanings. Dentists can spot little problems before they become serious; they now even check for different forms of oral cancers.

Other benefits of exercise are a stronger immune system which can fight infections (including those of the mouth) and other oral health issues. Working out can reduce stress, which can in turn lead to reduced teeth-grinding and jaw-clenching; these take a real toll on dental health.

Make it a regular habit–just like exercising–and you will find that improved oral health will lead to improved overall health and fitness. On the flipside, exercising regularly can help ensure that our teeth and gums will be there for as long as we need them.

“Getting Back on the Horse”

Today was my first day without any physical restrictions after having a surgical procedure four weeks ago; luckily, I am fully recovered and the procedure was successful. This was not the case six weeks ago; I had actually undergone the same procedure in mid-November and was not given the clearest guidelines for what recovery should look like. As a result, the procedure was not successful and I had a second go-around at the end of December. The second time, before surgery I was told to plan on 7-10 days without strenuous activity, but at the 7-day mark the nurse practitioner told me since I was a “repeat offender,” I should count on four weeks instead! Not fun for a personal trainer and someone who likes to stay active. I did not, however, want to undergo the procedure a third time so I took an entire week off of work after surgery and did not exercise for three weeks afterwards–although walking was encouraged.

I did blog about my recovery from foot surgery a few years ago. In that post, I shared five important pieces of advice for “getting back on the horse.” 1. Listen to your doctor, but also listen to your body. (I knew within a few days that the procedure in November had not worked even when I was told to give it some more time.) 2. Go slow; after an absence from the gym, do not just jump in where you left off but ease back into it carefully. 3. Set goals and have a plan for how to get there; having this written out clearly will facilitate a safe return to exercise. 4. Do not get impatient or give up; everyone’s recovery time is different and it may take longer than expected or desired. 5. Do some research; the more you know about the recovery before the procedure, the more realistic you will be going into it.

This afternoon when I taught my on-line fitness class, I participated in the workout instead of just sitting in a chair and giving instructions. I planned a workout I knew I could handle and…so far, so good. Many people do ask, though, how much “damage” or regression occurs when we do not exercise…and how soon does it happen?

Cardiovascular capacity can be decreased within just a couple of weeks–even more quickly for those who are endurance athletes like long-distance runners or cyclists. Muscle strength that is recruited during resistance training begins to suffer after about 3-4 weeks. These are just estimates and the actual amount of time will vary due to the level of fitness before the break, how active a person remained during the break (bed-bound vs. walking), and the cause of the recess. Obviously, a person who has joint replacement may take much longer to recover fully as opposed to a person who has an appendectomy. Each person is different so, as noted above, listen to your body.

I am grateful to my doctor and the nurses for getting me hale and hearty. I am thankful that they were extra-demanding of me the second time around. It made the difference in a complete recovery–even if I was starting to get restless.

After a fitness break–due to health reasons, travel, etc.–it will take time to get back on that horse…but get back on that horse we must. The more we take care of ourselves, the less likely we will need to take those medical breaks in the first place.

Recovery Time

Sometimes less is more, and sometimes more is more. When it comes to fitness, both can be true.

When it comes to our workouts, more time spent on cardio exercises has a greater effect on the number of calories burnt, endurance, and circulatory and respiratory capacity. With regard to resistance training, the heavier the weight, the greater the number of reps and sets, the more likely muscle will be built. The more you do the, the more you accomplish. The Jewish sage Ben He-He said “the gain is in proportion to the effort,” and he had it right over two thousand years ago.

At the same time, there is such a thing as overtraining. Some people take “the more, the better” to mean that they should be working out seven-days-a-week, 365-days-a-year. Overtraining can cause all kinds of injuries that can set progress back. That is why recovery time is so important.

There are a number of factors to take into account when considering how long we should recover after a workout (or even after a specific exercise). When working with some of my clients I may alternate between a group of core, lower-body, and upper-body exercises to give the muscles an opportunity to recover before moving on to a second or third set; in other cases, when we are working the same set of muscles, we take a short break between sets. These all take place within one workout.

Between workouts, however, we must think about:

The intensity of the exercise. The more strenuous it is, the longer recovery will take. This could be anywhere from 24-48 (or even longer) between working specific muscle groups; less time may be necessary if the exercise is more moderate.
The type of exercise. For example, weight training usually requires more recovery time than cardio. Several sets of bench presses on Monday may necessitate waiting until Wednesday to do upper body resistance exercises, whereas a bike ride on Monday might easily be followed by a run or a hip-hop class on Tuesday.
Your fitness level. If you are just beginning, it is all the more important to allow for recovery; going from 0 to 60 in 5.4 seconds might be great for your car, but the effect on our bodies is dangerous. It is important to slowly build up weight, number of reps and sets, while including recovery time. On the other hand, those who are more fit may find that recovery times are faster.
Age. As we age, it takes longer to recover. This is not always the case, but in general it becomes more important to take rest between exercising muscle groups, as well as to have days with no exercise or light exercise.
How well you sleep. A good night’s sleep is key to a good workout. Some of us sleep better than others, but if you have had a particularly rough night or simply did not get in the requisite number of hours, a recovery day is a good idea, or at least aim for a less intense workout.
Stress. This seems like an odd thing to consider, but it can have several effects. Some of us, when we are stressed, have a tendency to work harder or at a faster pace because we are “wound up;” this can lead to overtraining, lack of attention to form, and even injury. Stress also saps our energy; we may think we have the power to do an exercise only to find that our strength is flagging.

We may worry that taking time off or resting is “cheating,” but it is an integral part of the process of staying healthy and boosting our levels of fitness. Recovery time allows muscles to build/rebuild and gives our metabolism a chance to adjust to activity. It is also key to preventing injuries due to overtraining. Regular allowances for recovery help ensure that we do not have to take an even longer time for recovery because we have “overdone it.” Anyone who has ever had a surgery due to an exercise injury knows just how far it can set us back.

Remember: Work hard. Rest hard.

Brain and Brawn

The question of which is more important in getting through life–brains or brawn–has been around for a long time. What brings the greatest success–physical strength or intellect? The truth is that at different times one or the other may be more critical to overcome an obstacle. The ability to pivot between them is key. A recent study shows that there is an important connection between them for older adults.

An article that came out in early December, 2024, in Medical News Today describes the results a study at Johns Hopkins Medical Institution that will be formally presented in the near future connecting sarcopenia and dementia. Sarcopenia is a condition in which a person loses strength and/or muscle mass; this generally occurs as a result of inactivity and is seen a great deal in older adults.

Researchers looked at the temporalis muscle in a statistically significant group of older adults; this is the muscle that is responsible for closing the jaw. A small temporalis is associated with smaller overall muscle mass in the body, and a larger temporalis points to larger overall muscle mass; this makes it an easy indicator to assess whether a person has sarcopenia or not. The temporalis of each study participant was evaluated and it was found that those with smaller ones (ie., with lower muscle mass) were much more likely to develop dementia at the end of the study (around six years later).

This news is significant because it points to another way that dementia can be identified early, and even how the odds of it developing can be reduced. The greater the muscle mass, the lower the risk. How can muscle mass be increased? Two main factors are at play. First is exercise; resistance exercises (using weights) help to increase muscle mass. There is a misconception that older adults necessarily lose muscle mass, but it can be prevented or slowed with continued exercise. The second is consuming enough protein; protein is what helps to maintain and build muscle. Protein can be found in meat, poultry, fish, and eggs, but there are many plant-based options such as beans, nuts, and lentils.

People ask me why individuals use a personal trainer in their senior years. The motivation, in general, is different than younger folks; it is less about appearance or sports performance and more about maintaining general health and independence. We have known for a while that cardio exercise (the kind that gets your heart pumping like running, cycling, dancing, etc.) is good for the brain; it gets the blood to circulate so that it brings rich nutrients to all the cells–including brain cells. Add to this now that resistance exercise is another brain healthy activity!

This study is just one more reason for us to ensure that we are getting both cardio and resistance exercise. It is not just good for our muscles, but for our brains too!

News About Arthritis and our Knees

CNN.com recently shared an article about new research on Osteoarthritis of the knee. It caught my attention because, as a personal trainer for older adults, one of the key complaints I hear about is knee pain. I also work with clients who have had knee replacements or other knee surgeries. This is not surprising since nearly 800,000 knee replacements are performed each year in the USA.

Osteoarthritis is a chronic disease that causes the cartilage of a joint to deteriorate; this leads to pain and stiffness and is especially seen in the hips, hands, lower back and knees. As we age, osteoarthritis can have a negative effect on our quality of life; depending on where it is found it can even influence our ability to remain independent.

The new research was published in the Journal of the American Medical Association and based on data from studies conducted in the Netherlands. The key finding is that the effects of the disease can be lessened or even eliminated by strengthening leg muscles. The research indicates that there is no link between a person’s total physical activity and the odds of their developing the disease. The subjects were then divided into two groups: those whose activity was non-weight bearing (like swimming and bicycling) and those who activity was weight bearing (like walking or running). The latter group was at greater risk for knee osteoarthritis–but only if they lacked sufficient lower limb strength. It has long been thought that one of the best ways to protect the knees is to build mass in the muscle groups around the knee. This research bears this out; the more muscle mass around the knee, the more it is “cushioned” from the forces that affect it through weight bearing movement.

This research reinforces the work of doctors and physical therapists who work with patients to strengthen the muscles around arthritic joints. While those who participate in non-weight bearing exercise have less cause for concern, it is important to know that runners and walkers have a strategy that can help ease pain, increase movement, and even prevent the need for joint replacement.

Is Going Backward Ever OK?

Time Magazine recently featured an article that was brought to my attention by one of my alert clients. Angela Haupt discusses the benefits of walking backwards. You have probably seen some folks doing this on a treadmill and wondered whether it is effective or just plain silly. It might even remind you of an old Monty Python sketch. Does it really help? According to the article there are at least five distinct benefits.

People of any age and fitness level can try it. It is especially effective for older adults because it helps to improve balance and coordination, which can in turn prevent falls.
It works different muscles than the ones we typically use or works the ones we do use in a different way. Studies have shown that walking backwards can increase muscle strength.
It has been shown to help those with injuries or pain. Walking backwards has long been a part of PT and OT strategies. Research has shown that it can reduce pain for those with arthritis in the knees, as well as alleviating the symptoms of plantar fasciitis and lower back pain.
Backward walking can increase flexibility. We know that sitting all day (being sedentary) is an epidemic and can cause muscles to tighten up. Walking backward can stretch muscles and lead to greater flexibility and reduce the risk of injuries.
It can improve gait. Physical therapists use this technique to help patients improve their gait patterns. It can assist with slight limps or range-of-motion issues. As mentioned above, it can help with balance control by forcing us to really focus on the way our muscles and joints are moving, as well as being aware of what is around us.

It is imperative to ensure safety when trying backward walking. Start slowly in an area that is free of hazards. Begin with just a few minutes a day and work toward more time and greater speed.

Typically, going backward is not seen as a positive. In this case, however, it can help us–especially older adults–to improve our health and fitness.

Super Agers: What Are They and How Can We Become One?

It is no secret that Americans are living longer and longer. Just because the quantity of our years is going up does not necessarily mean that the quality of those years (especially closer to the end of our lives) is going up as well. In fact, one of the greatest fears of older adults is remaining physically sound while losing cognitive and mental capacity.

There are, however, those who manage to live well into their 80s and beyond while remaining “sharp as a tack.” Those who reach the age of 80 with the cognitive capabilities of someone decades younger is referred to as a Super Ager. Who would not want to be a Super Ager? It is the best of all worlds! The good news is that researchers have found six “habits” that Super Agers have in common that can guide us as we hope to achieve this status.

Super Agers maintain a healthier diet. 2 servings of vegetables/day, 2 servings of berries/week, and one serving of fish/week have a positive effect on brain health. Other foods to include for better brain health include nuts, whole grains, olive oil, beans, and poultry.
They have connected social lives. Studies show that more loneliness leads to greater chances of memory loss. Super Agers seek out social networks and meet new people.
They are better at managing stress. Older adults who find ways to manage stress (through exercise, meditation, etc.) have better health outcomes. (More about this below.)
Super Agers are intentional about getting enough rest. The more sleep-deprived we are, the lower our cognitive ability, the worse our mood, the weaker our immune system, and the more difficult it is to manage blood sugar. 7-8 hours of sleep per night is recommended.
They engage in a variety of brain-stimulating activities. Aging can cause declines in our cognitive abilities due to increased dysfunction in the pre-frontal cortex of the brain. Activities like crossword puzzles, Sudoku, reading, listening to lectures and music, as well as some word games can actually improve brain function, problem-solving skills, and the ability to think nimbly.
They exercise regularly. This very much related to #3 since exercise can be a stress-reducer. Regular exercise (both aerobic and non-aerobic) increases the production of Brain-Derived Neurotrophic Factor (BDNF), a protein in the brain and spinal cord that helps nerve cells survive and grow. Aerobic (or “cardio”) specifically reduces cognitive impairment and the risk of dementia.

The trend seems to be toward continued rising life expectancies. Medical science has focused on the quantity of years; our personal behavior, energy, and priorities should be focused on the quality of those years. Following the steps above are no guarantee that we will become Super Agers, but it is noteworthy that Super Agers share these commonalities.

For some of us, this will require a lot of adjustment (especially in our diet). Even modest changes can have an impact. The effort certainly seems to be worth the payoff.