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.

I’m in Parade Magazine!

Do you remember Parade magazine? It used to come inside over 700 Sunday newspapers. Its circulation was over 30 million and its readership was over 50 million. Recently, it went to an all on-line format and is ranked as the #3444 magazine on the web; it is still a recognizable name and a trusted source of information.

Which is why I felt honored to be asked to be interviewed for two different articles. The first is on osteoporosis and exercises for women over 50, and the second on the effects of doing 10 push-ups every day. When I was contacted by the magazine, I asked how they found me–especially since I am in the Cleveland area and they are headquartered in Nashville. Amazingly, it was a google search that led them to me. By the way, this is the way that most of my clients find me as well. This shows that since my business occupies a certain niche–exercise for older adults only–I have become somewhat of an expert on the topic. I sometimes have a sense of imposter syndrome, but then I realize that I have the certifications and over 5 years of experience in the field. My work with clients with a wide range of physical and cognitive abilities has pushed me to learn more and really focus in on new techniques and approaches.

My wife tells me I should write a book, and perhaps one day I will. For now, it just feels good to be recognized for the important work I am doing. Check out the links ahead to see the articles!

Please Rise…. You May Be Seated.

Rosh Hashanah, the Jewish New Year and one of the holiest days on the Hebrew calendar, begins this coming Friday at sunset. It marks the beginning of the Ten Days of Repentance, at period of prayer, introspection, atonement, and more prayer. A key aspect of the services–in fact, all Jewish services throughout the year–is that there are quite a few parts when the congregation stands. On Rosh Hashanah and Yom Kippur, when services are a lot longer (hours and hours), the sitting and standing is especially noticeable. There is even one service at the end of Yom Kippur, Ne’ilah, when worshippers do not sit throughout nearly it entirety.

In the past I have blogged about the benefits of prayer and repentance/forgiveness. Not only do they bring spiritual uplift, but they can also affect our physical being. This got me thinking about the physical demands of Jewish prayer (all that standing and sitting) how it might affect our health.

One of the best exercises for strengthening legs–which is important for activities like walking and climbing stairs–is the Squat. Many people mistake the Deep Knee Bend for the Squat, but they are very different; in general, I do not recommend Deep Knee Bends for older adults as it puts so much stress on the knees, which can damage them and lead to pain. During a Squat, the knees are bent, but not in a forward motion; the knees (ideally) stay directly above the ankles as the rear end goes back and down. If you have ever gone to sit in a chair and then, at the last moment, realized you do not have a soup spoon so you get up before your butt hits the chair…this is pretty much what a Squat is. Because older adults may have muscle loss and issues with balance, Squats are a scary proposition; for some, they are just an impossibility. A good substitute for Squats (wait for it….) is an exercise called a Sit and Stand; it is exactly what it sounds like and it works all the same muscles as a Squat: glutes and quads.

During the coming weeks, worshippers in synagogues will hear the Rabbi say “Please rise,” and “You may be seated.” It is good to know that not only will the sitting and standing add to the spiritual dimension of the holiday, but also to the physical. We are literally strengthened by the ups and downs.

Of course, if you are not the praying type (no judgment), remember that Sit and Stands are a great alternative to the Squat for those who are worried about balance and lower body strength.

Wishing all those who celebrate, a happy and healthy New Year!

Assessing and Correcting Bad Posture

Did you see the article by Dr. Pamela Peeke about posture in the most recent issue of the AARP Magazine? I have blogged about the importance of posture for older adults in the past, but it bears some review.

Peeke’s article addresses six different ways that we can assess our posture, and work toward fixing it. Not only can it improve our appearance, but it can also relieve pain.

The first three are done in front of a mirror, but standing perpendicular to it (ie, with our side toward the mirror). Turn your head so you can see your reflection.

Where are your ears? If they are not directly over your shoulders as they should be, scapular retractions and/or chin tucks can help.
Where are your hips? If your hips tilt forward, tighten your abdominal muscles and push your hips forward so that they are directly beneath your shoulders.
Where are your ankles? If your ears or hips are out of line, your ankles may not be in the right place–directly below your shoulders. Work on 1 & 2 above, and 3 should resolve itself.

Now, turn so that you are facing the mirror.

Where are your shoulders? If one is higher than the other, try forward and reverse shoulder rolls. If one or both is rounded forward, stretch your chest muscles (which pull the shoulders forward) by clasping your hands behind your back and interlacing your fingers; now pull your hands up and away as far as you can from your back for 10 seconds and repeat throughout the day.
Where are your feet? They should be shoulder-width apart, parallel, and with toes facing forward. If that is not the case, shuffle your feet until they are in the correct position; note the balanced feeling and strive to maintain it throughout the day.
Where are your knees? If your knees are out of alignment, you can stand with toes pointing inward and heels slightly apart. Fold forward at the hips and let everything hang loose. This will help re-align the knees and stretch the hamstrings.

There are many reasons for poor posture. For serious issues that lead to pain or major misalignments, talk to a physician; physical therapy or other treatments may be necessary.

Remember, posture is not just about appearance. When we are out of alignment, it can cause a cascade of negative effects on the body. A little bit of work each day can go a long way.

Older Adults and Marijuana

A number of studies out in the past few years suggest that older adults (in this case 65+) are using marijuana in greater numbers than expected. An article in the Washington Post suggests that several factors account for the rise in its use.

Perhaps the most important is the fact that it has become legal for medical and/or recreational use in many parts of the country. Older adults may be more concerned about participating in an illegal activity than adolescents/younger adults; now that it is legally available, many are giving it a try for the first time. The article suggests that among the youngest of the Baby Boomer generations (which is where I am), use was more common during our earlier days, took a dip for several decades and is ticking up again. A fascinating aside is that folks who are more politically liberal (those who listen to NPR!) are more likely to partake.

In addition to legalization, there has been a lot of hype written about the benefits of marijuana use (as oppposed to abuse). Older adults with various medical conditions are finding relief for problems with sleeping, pain, Parkinson’s Disease, and side effects of chemotherapy for cancer. It is noteworthy that AARP has even weighed in on the issue. On their website and in their print materials there has been ongoing coverage of the proposed benefits of marijuana and CBD. The news is somewhat mixed: on the one hand, there is much anecdotal evidence that there is a positive impact; on the other hand, more research is needed to conclusively determine whether the risks outweigh the benefits.

I know of older adults who have found relief. I also have older clients and others who ask me my opinion on the matter. I am not a doctor, but I do recommend that they discuss it with their physician. It seems to me that there are lots of people who suffer from a wide variety of ailments where marijuana may actually improve the situation.

I look forward to more research in the years ahead–especially as I age and may have to deal with medical conditions where marijuana can make a difference.