Sun’s Out, Suncreen Out

There is an expression, “Sun’s out, gun’s out;” here “guns” refers to biceps, not the epidemic of violence in our country. In other words, when the weather is warm, it is time to expose all those muscles that we have been working on during the colder months of the year.

Perhaps the expression should be changed to “Sun’s out, suncreen out.” This is true at every age. When I was younger, there was not much awareness around the dangers of sunburns and the importance of wearing protective lotions/clothing to prevent them. As person with light skin, I was especially prone to damaging burns and I am paying for it now. Over the last 20+ years I have had more than five skin cancers; thankfully, all of them have been basal cell carcinomas which are removed (sometimes easily, and sometimes with more difficulty) and do not require further treatment.

Older adults, however, should be extra cautious for a number of reasons. First, many older adults are retired and that means (depending on the climate) they spend less time inside and more time playing golf, gardening, sitting by the pool, or engaging in other outdoor activities. Second, many retire to places where not only is more time spent outside, but due to the latitude the rays of the sun are more direct and intense. Third, as we age our skin becomes thinner and more vulnerable, meaning that burns can have more serious consequences. Finally, older adults are usually not in the habit of applying sunscreen–even if they are going to be at the beach–so this requires an extra step in our regular routines. We must remember that the more exposure to sun, the more likely that burns will occur, and the greater the chances of developing skin cancers–some of which can have very serious consequences.

When should sunscreen be used, and what kind is best for older adults? Some say that it is okay to skip the lotion if you are going to be out less than an hour; this is not good advice since it is often difficult to control how long one will actually be outside. Any time you will be exposed to direct sunlight for more than 5-10 minutes it is a good idea to apply to exposed areas; certainly more than 20 minutes makes it a obligatory. Also, remember that it is necessary to re-apply sunscreen; check the usage directions on the product for more details. Experts recommend at least a 30 SPF for older adults, but depending on the kind of skin you have it may make sense to go with a higher number. I never use anything less than 50 because of the sensitivity of my skin and my past history of basal cell carcinomas. When in doubt, this is a great conversation to have with a dermatologist; if you do not have an appointment coming up soon, you can usually send an email message to your doctor through the practice’s website or through apps like MyChart.

I wish that I knew when I was a kid what I know now. It would have avoided a lot of scares and procedures. I have two children with fair skin and I am grateful that there is much more awareness and better products to prevent sunburn.

It is officially summer! So, sure, go ahead and flash those biceps, quads, pecs, or abs…but make sure they have a layer of sun protection on top first!

Slow Down, You Move Too Fast…Or Not

A recent article on CNN.com reports on a new large study appearing in the Journal of the American Medical Association that shows a connection between slower walking speeds (or gait) and development of dementia. The research seems to show that a decrease in the speed at which older adults walk year to year may be an early indicator of cognitive decline and dementia. The study looked at the pace of walking as well as the ability of participants to answer certain cognitive/memory questions, then drew conclusions about their relationship.

Although it was a large study (17,000 subjects), more research should follow. As I read the article, I wondered about a chicken and egg question. Did walking speed decrease because of lower cognition, or did cognition somehow decrease because of slower walking? If the second is the case, then it would make sense that we should regularly monitor people to see if they are literally slowing down; if so, they should be put on a program to increase the velocity of their gait. The research does show that when both factors (slower walking and cognitive decline) are present, there is a much greater chance of dementia–as opposed to mild cognitive impairment, which is a “normal” part of the aging process.

The study seems to indicate that the connection may exist in the right hippocampus–the area of the brain associated with memory. Believe it or not, the size of the right hippocampus can actually be increased with regular aerobic exercise (the kind that elevates heart and breating rates). It is not as if we simply have to accept the fact that once we slow down we are on a slippery slope to dementia; keeping up the pace of our exercise can have a positive impact. Even stretching exercises were shown to make a difference.

More research will surely be forthcoming. This study will certainly become an important tool in assessing the risks of dementia. It also provides another reason why it is so important for older adults to remain active and engage in regular exercise. It is not just about our physical health, but about our mental well-being too!

Wading (Literally) into Fitness

As a kid I loved going to our local pool each summer. It was a great way to beat the heat, see friends, and have fun.

As an adult, I heard over and over again that exercise in the water was beneficial; I spent a lot of time during my days at the Seminary in the Columbia University swimming pool, and have continued to lap swim up until just a few years ago. I did not stop because I did not like it, but rather because my interests took me elsewhere (running and bicycling). After I became a fitness professional, I learned that there is more to the swimming pool than just swimming. Water aerobics and other water fitness classes can play an important role in better health outcomes, especially as we age. I experienced this first-hand when I was recovering from surgery on my foot and was allowed to participate in water aerobics.

Just as in childhood days, being in the pool is fun and it still helps to beat the heat, but is there an advantage for older adults to exercise in the water as opposed to on dry land? Two recent Australian studies were published in Journal of Sport and Health Science and Journal of Science and Medicine and Sport that indicate that this kind of exercise has a positive impact on cardiorespiratory health–aside from other benefits.

The studies took 72 men and women averaging 62 years of age. All were mostly sedentary, and were randomly assigned to 3 groups: 1. water walking, 2. land walking, and 3. no changes (control group). Groups 1 and 2 increased intensity during the 24 weeks of the research program. Compared to the control group, these two groups saw an increase in maximal aerobic capacity of 4%, a measure that shows how well the heart and veins circulate blood to the rest of the body. Interestingly, they also saw a decrease in visceral fat which is associated with cardiovascular disease, high blood pressure, type 2 diabetes, and insulin resistance. The water walking group also saw improvement in lower limb lean muscle mass–most likely a result of resistance provided by the water.

This news is especially welcome since many older adults avoid walking due to fears of falling. Additionally, those with joint problems may find it easier to do exercises in water and see less impact on affected areas. And did we mention, it is fun? The more enjoyable it is, the more likely we are to stick with the program.

4% may not seem like a huge difference, but even small increases in aerobic capacity have been shown over and over again to decrease mortality from cardiovascular disease. So, what are you waiting for? Come on in, the water is fine!

How Much Dairy Should Older Adults Have?

Saturday at sunset begins the Jewish holiday of Shavuot–known in English as the Feast of Weeks or Jewish Pentecost. This festival recalls the harvest of the first fruits in the Land of Israel as well as the receiving of the Law at Mt. Sinai.

Over the centuries, the custom has developed to eat dairy products on Shavuot; cheese blintzes and cheesecake are particularly traditional, popular, and tasty. How did this custom develop? There is no single answer. One explanation has to do with a verse from the Song of Songs (4:11), where it states “honey and milk are under thy tongue;” since this book is seen as an allegory of the love between God and the Israelites, the honey and milk are thought to refer to the Torah, whose words are always spoken (by the tongue). Another interpretation is that the journey to Mt. Sinai was so arduous that the Israelites did not bring animals to slaughter and eat–it would have been too much bother–but rather ate only dairy leading up to the Revelation. Yet another explanation is that until the Torah was given at Mt. Sinai, there were no laws about what was acceptable to eat (the dietary/Kashrut rules are in the Torah); in order to not transgress God’s will, the people only ate vegetarian and dairy. Whatever reason you like best, it all adds up to a tasty and rich holiday.

I will admit that I usually overdo it a little on Shavuot when it comes to the cheesecake and ice cream. It got me wondering just how much dairy is “right” for older adults. Most sources recommend 3 servings daily (each serving being one cup). It seems like a lot; what is the rationale behind this? As we age, the need for calcium becomes all the more important; it helps us to keep our bones strong. We know that one of the biggest fears of older adults is breaking bones, because the healing process is slower and can lead to complications. When it comes to calcium, there are few sources that pack as much punch as dairy products.

Unfortunately, many older adults have a hard time digesting dairy products. There are also many vegans who do not consume them at all. What alternatives exist to get the proper amount of calcium in their diets? Many non-dairy foods contain calcium: soy products (like tofu, tempeh, edamame), legumes (such as beans, peas, lentils), nuts, seeds, some grains, and other vegetables. There are also some drinks such as oatmilk and orange juice that may come enriched with calcium.

Is the real reason why we eat dairy on Shavuot because God knew that the Israelites would need strong bones to wander for 40 years in the wilderness? There is no way to know for sure, but it is about as plausible an explanation as those put for by Jewish tradition over the generations.

In any case, as we grow older, we must be diligent about maintaining the proper levels of calcium in our diets. Maybe that should be the 11th Commandment!

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.

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.