Working Out with Chronic Conditions

While the gentlemen in this picture look hale and hearty, I am willing to guess that if they are still alive today, they are probably dealing with one or more chronic health conditions. The CDC defines chronic health conditions as those “that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States.” At Home Senior Fitness works with clients who are 55 and older, and nearly all of my clients deal with such conditions. How does it affect the way that we train and what results can be expected?

At the 2024 IDEAfit / ACSM Health and Fitness Summit in February, I took a course offered by Dr. Carol Ewing Garber entitled, “Prescribing Exercise to Clients with Chronic Diseases: A Cast Study Workshop.” Garber is Professor of Movement Sciences and Education and Chair of the Department of Biobehavioral Sciences at Teachers College (which is incidentally two blocks from where I attended Seminary in New York). The course looked at different hypothetical cases of individuals of various ages and backgrounds living with different chronic conditions. We worked together to determine the best course of action for training the individual to bring them to greater levels of fitness and health.

Over the years as I have worked with older adults, I have found myself in the same kind of “workshop,” just not in a large hotel with dozens of other people. It is, rather, a one-on-one with myself figuring out what would be most effective and what to avoid. I have had clients come to me with long-time diagnoses like atrial fibrillation (A-fib), dementia, and Parkinson’s Disease. I have also had clients come to me with new diagnoses like epicondylitis and camptocormia (look both of those up!). When we aware of such diagnoses, it is necessary to take into account how not to worsen a condition as well as what exercises might improve it. Many of these conditions I learned about when I was studying to become a personal trainer, but others required me to do research. I have even reached out to a client’s physical therapist on occasion for guidance. These chronic conditions cannot simply be ignored.

Garber’s class was a good reinforcement for me. It reminded me of the importance of understanding where my clients are (not just physically either) so that I can meet them there and then make a difference. If you or someone you loved is diagnosed with a chronic condition, make sure your fitness professional knows about it, knows what it is, and knows how to work with it. Personal trainers can be allies with doctors and therapists in building a better quality of life while living with a long-term condition.

Just for the Women

This is my third report on the IDEA/ACSM Health and Fitness Summit in Chicago at the end of last month. The third session I attended was entitled “Everyday Strength for the Older Female Client;” the instructor was Keli Roberts. I was very interested in this class because approximately half of my clients are older women. Over the years I have learned a lot about the needs of older adults, so I was looking forward to finding out what particular issues women face as they age.

In all honesty, most of the class really applied to older adults of any gender. We talked about different categories of aging: chronological, functional, biological, psychological, and social. Each contributes to the overall picture of a person’s health and fitness, and helps to determine the needs of the client and how best to meet them as a personal trainer. The class was mostly aimed at group or small-group fitness strategies; nevertheless, there was a lot to be learned.

There are a number of issues that relate directly to women. Because women have often been caregivers, it may mean that they did not have the time or opportunity to take care of themselves in the past; the result is that there may not be a history of exercise and other healthy habits. How do we create new patterns of behavior? Women may also be less likely to avail themselves of health services or have access to them in the first place. Some women, then, may not even be aware of the health conditions particular to themselves. All this needs to be taken into account so that an exercise program can be successful.

Older women may experience heart disease, diabetes, obesity, stroke, cancer, anxiety, and other mental health challenges. These are mostly shared with men. Osteoporosis, however, is much more prevalent in women. Osteoporosis a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Research has shown that women can benefit from resistance exercises that involve weight bearing and weight lifting. This can be done safely and effectively as long as all the other co-morbidities are taken into account.

I have already put some of my newfound knowledge into practice with my clients and my exercise class. Roberts made me more aware of areas of weakness for women and how to compensate for them. My main takeaway is that while all older adults share much in common when it comes to fitness, women have their own unique sets of circumstances that cannot be ignored. I will definitely be more aware in the future.

Let’s Move, Everybody!

One of the biggest obstacles facing us at all ages is sedentarism; this is just a fancy word for “not moving.” It is definitely a 21st Century word. For many, the situation got worse since COVID; we used to walk around an office or visit customers, but now a lot of us are just sitting in front of computers. I certainly was more active at the gym when I barely sat down; now I spend about half of my day working with clients virtually sitting on my kiester.

At the recent IDEA & ACSM Health & Fitness Summit, I took a session with Judy Juvance-Heltzel and Stephanie Davis Dierenger (both of University of Akron) entitled “Promoting Life-Long Physical Activity: Strategies for All Ages.” The course was divided into two parts: 1. theory and strategies, and 2. brainstorming and presenting.

We are being encouraged to focus less on the word “fitness” and more on the word “movement.” People are often put off by the word “fitness;” they think that if they are not “fit” then the activity will not be for them. “Movement,” on the other hand, is something that almost all of us do and we should strive to do more. Of course, as trainers, we do not want to focus just on movement; the progression should be from movement to physical activity to exercise to fitness. It is the obligation of fitness professionals to move individuals from one level to the next.

The active part of the program (pictured above) required us to grab a bunch of objects that we can find at home and find ways to make them into “fitness equipment.” Tennis balls to staplers to trash cans to paper plates all became devices to get people moving at home. Why articles that are found at home? Many folks are turned off by the idea of going to a gym or cannot afford it. We were challenged to provide ways for people to move more using what they can find close at hand. It was a real throwback to the early days of the pandemic when very few people had exercise equipment at home and we were working out with canned goods, books, and cans of paint. The solutions worked for people at any age with any level of fitness!

It is not ideal for individuals to exercise only in this kind of ad hoc way, but it can be a start to more frequent movement which will lead to activity, etc. What I liked was that the course got us all thinking creatively. Sedentarism is a serious problem and if the old solutions worked the issue would be solved already. Using a little ingenuity, we can help to bring greater levels of fitness and awareness of activity to those who are mostly just sitting around–from children in front of their screens to older adults in front of the TV.

What have you got at home that you can use to exercise? Here is a hint: can you squat while picking up a full trash can?

Finally! Exercises for Couch Potatoes!

One of the leading causes of some many of the health issues that we face is being sedentary. The word “sedentary” comes from the same word as “seated,” and refers to the habit of sitting and not moving around. This is a common condition for many who work at jobs where they are tied to a desk or a computer. Others who may have a disability or are more frail simply find it too difficult to keep moving. For many, though, it is just a question of laziness and inertia–a non-moving object simply prefers to remain non-moving. Unfortunately, being a couch potato comes with a price: less favorable health outcomes.

Fitness expert, Dana Santas, recommends four exercises that can be done right on the couch! The first is an elevated Push-Up; rather than doing the exercise face down on the floor, it can be done using a couch. The easiest is off the back of the couch; more difficult is off of the arm of the couch, and most difficult is off of the cushions. Of course, one still needs to pay attention to having the proper form; aim for a plank posture. Next is the Single-Leg Squat (quite challenging!); stand close to the front of the couch and begin to sit down—but before you do, extend one leg forward so that you are only on one leg as you touch the couch. Ideally, one should not fully sit on the couch but rather just tap it with your bottom. This can be modified by starting with a regular squat (using both legs) on the couch which is also called a Sit and Stand. The third exercise is a Seated Pillow Twist. Take a pillow and hold it by the edges out in front of you; twist to the side and tap the pillow on the cushion, then twist to the other side and tap, and repeat. To make it more difficult, you can squeeze another pillow between your knees (knee adduction) while doing the exercise; over time, you can also switch from going side to side with a pillow to something heavier. Finally, there is the Side-Lying Leg Lift. Lie on one side with hips, knees, and ankles stacked one on top of the other; lift the top leg up without rotating the leg/foot toward the ceiling (in other words, make sure your toes are pointing forward) to get a great stretch through the hip flexors. Repeat on the other side.

Of course, there are many other exercises that can be done on couch that Santas does not mention in the article. I have clients who are unable to get up from the floor do some of the following on a couch: Glute Bridges, Dumbbell Chest Presses, Supine Single-Leg Raises, Knee-Ins, “Windshield Wipers,” Supine “Skull Crushers,” and Supine Chest Flys. The possibilities are nearly endless; any exercise that can be done seated or on the floor can usually be done on a couch as well.

So for those who complain that it is too difficult to get to a gym, or to the room downstairs with the exercise equipment, or even to get off the couch (!), you no longer have an excuse. Get moving–even on your favorite sofa–and see the difference it can make!

Aging Doesn’t Have to Mean Steep Physical Decline

As I myself age, I begin to notice how my body is changing; there are certain activities I cannot do as well as I used to. Working with an older population, I often hear the concerns of my clients about their current and future physcial fitness. Will they be able to walk (better) in the future? How will they be able to negotiate stairs? Will carrying bags of groceries into the house from the car be too much? How about picking up a grandchild or beloved pet?

A recent article in Fortune, touched on these concerns. The author, Dr. Zachary M. Gillen, is an expert in Exercise Physiology and is an assistant professor at Mississippi State University. Gillen suggests that one kind of exercise can make the biggest difference for older adults, allowing them to carry out these physical activities without being wiped out at the end of the day. The key: resistance (or weight) training.

This blog has touched on this idea many times in the past. One of the issues confronted by older adults is sarcopenia–loss of muscle mass. Sarcopenia can lead to other diseases such as Type-2 Diabetes. This happens as a natural part of the aging process, but a steep decline in muscle strength in not necessarily an inevitability. Muscle mass can be maintained and even increased throughout our lives.

Gillen states that the evidence shows that low muscle strength is a key factor in sarcopenia. The way to combat it is with the proper kinds of weight/resistance exercises. It is important to do these exercises properly and safely, which is why it is a good idea to consult a fitness professional. Sadly, only 13% of adults over the age of 50 do some kind of strength training at least twice weekly; across the fitness world, the recommendation for older adults is 2-3 times per week. Gillen suggests that 6-12 repetitions of each exercise working at 50-85% of one-repetition maximum; this means that if the maximum weight at which you can do an exercise is 20 lbs., you should aim to do 6-12 reps at 10-17 lbs. There should be a 2-3 minute rest between these sets (or longer if needed–especially at the beginning) with 24-48 hours of break between these workouts. Since we should all aim for 150 minutes of moderate exercise each week, the other days should focus on cardio activities.

Gillen ends the article by recommending that older adults take seriously the risks involved in starting a new exercise program. Those with little history of working out can do more harm than good. A fitness professional, like a personal trainer, can help us make sure we avoid steep physical decline–either because of inactivity or injury. If done properly, an exercise program at age 60 or even 90 can help us in the process of healthy aging.

New Study: Improving Fitness Decreases Risk of Prostate Cancer

It has long been known that exercise can contribute to lowering the risks of many diseases including cancer. Even though other factors such as genetics, environment, stress, etc., play a role, on average, those who keep physically fit have better health outcomes.

A new study by the British Journal of Sports Medicine was reported on by nbcnews.com focusing on prostate cancer–a cancer that is diagnosed in 113 of every 100,000 men each year. The study focused on cardiovascular exercise; these are exercises that increase heart and respiratory rates (as opposed to those that are focused on building muscle). Examples of these types of activities are swimming, jogging, dancing, and cycling, as well as many sports activities. It found that no matter what level a man’s fitness, a 3% increase in cardiorespiratory fitness each year for 5 years leads to a 35% decrease in risk for prostate cancer compared to those whose cardiorespiratory fitness decreased 3% each year for 5 years.

Studies in the past seemed to indicate that more exercise might lead to an increase in prostate cancer, but those studies did not take into account many factors. The most recent testing accounted for factors that might have skewed the results. Interestingly (and vexingly), there is still no certainty as to how these changes in fitness levels affect the occurence (or not) of prostate cancer. More research will be needed.

In the meantime, it appears that men have yet another reason to improve their cardiovascular fitness levels. As Dr. William Ho, Chief Medical Officer of the Prostate Cancer Foundation (that was not involved in the study) pointed out, the research shows that “no matter what age, no matter where you are in your life or your relative fitness, that if you improve your fitness, even by a relatively small amount, you may significantly decrease your risk of developing prostate cancer.”

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!