Saturday, November 8, 2014

Don’t Call Me Spry!

“Aging is for people who don’t know better.” This Tony Horton quote came to mind as I read Alison Gopnik’s column in today’s Wall Street Journal (“A More Supportive World Can Work Wonders for the Aged.”) The article highlights the demeaning language that is often applied to old people and the negative impact of those messages on their condition. Gopnik contrasts the experience of people 60 to 99 years old in a Yale study who were exposed to positive (though unconscious) ideas about aging and saw their physical functioning improve

Yet even the word “spry,” which was treated as a positive adjective in the study, carries with it the patronizing implication of “pretty good for your age.” Disparaging talk about aging is sometimes encountered in medical offices. “You can’t expect to be able to do what you could do when you were younger,” said one orthopedist to a very athletic woman in her forties. With all due respect to doctors in general, this is presumptuous nonsense. Some of us are fitter and in better health than we were as sedentary young adults. As a thirty-year-old, I couldn’t do even one pushup; now, at age 68, I can do at least forty. I’m not spry, I’m strong!

Much of the mental and physical deterioration traditionally considered to be an inevitable part of aging is actually a consequence of improper diet and inadequate exercise. Diet-wise, it’s important to get enough vegetables and fruit and enough protein. If you can’t or won’t buy and prepare lots of vegetables, drink vegetable juice. There are low sodium varieties at the store or you can make your own. Even if you eat vegetables anyway, drinking juice is like having extra insurance. And, drinking juice, any kind of juice, at least three times a week was associated in a Vanderbilt University study with a 76% lower risk of developing Alzheimer’s disease.

For years, my annual blood work showed that my protein was a bit low, yet my doctor never suggested a protein supplement. These days I have a protein smoothie in the mid-morning (recipes here) and a take an enzyme supplement that helps me to digest protein. The proteolytic enzyme also helps me to recover from injuries more quickly. Take protein supplements or eat protein bars to maintain muscle strength. Keeping muscles strong is one of the most important (and most underrated) contributors to a good old age. Strong people can pursue a greater variety of activities and are less likely to be injured if they have an accident. Also, the heart is a muscle; what’s good for the other muscles is likely to be good for the heart as well.

Keeping muscles strong means that exercise, especially weight lifting, is essential. But there are other types of movement that also need to be practiced and maintained, including flexibility, balance, explosive movement (plyo or jump training), and cardio. When it comes to cardio, older people are often told that a little swimming or walking around the neighborhood is enough. My own experience has been that you have to work a lot harder if you want to stay in really good shape. Everyone’s body is different but my particular body requires 33 minutes of intervals on an elliptical twice a week, averaging 85% of maximum heart rate. (I use a heart rate monitor.) For exercise overall, it takes about a little over an hour six days a week for me to feel comfortable and get a good night’s sleep.

Finally, I think it’s important to keep doing things for myself. Once you’re retired, to farm out tedious chores and errands to someone else seems like an attractive idea. After all, you’re retired, you should take it easy, right? Wrong! I don’t necessarily love grocery shopping or house cleaning but doing those tasks means that I am taking care of myself. The more I delegate the workings of my day to other people, the more I will have the sense that I can’t do those jobs anymore, almost as though I have become a child again. Doing things for myself helps me to maintain a sense that I am capable and in control of my own life. In this world there are only two things that I actually own: my physical body and my time. If I take care of one, I will have more of the other.

Thursday, October 30, 2014

Is There a Role for Fitness Professionals in Health Care?

About six months ago a friend of mine started having trouble sleeping. He was being kept awake by a nagging pain under his rib cage. During the day when he was standing or sitting up the pain was barely noticeable but at night it was enough to disturb his rest. It was also worrisome because he had had cancer surgery a number of years earlier.

He went to his primary care doctor, who ordered an ultrasound and blood work, followed by a HIDA scan to check for gallbladder problems. All of these came back negative. Still concerned, my friend sought out a GI specialist, who, after verifying that he was not experiencing any digestive symptoms, told him that this was not a GI matter but muscle-related. Both doctors felt around his abdomen and found nothing; neither had anything further to suggest to help him get a better night’s sleep.

By coincidence, I had been seeing a certified massage therapist who works with athletes. When I described the situation to her she said immediately, “That is a herniation of the iliopsoas muscle and I’ve seen several of them recently.” When she examined my friend she was able to feel a lump about the size of a quarter where the muscle belly protruded through an opening in the muscle band. In a standing position, she explained, the muscle was pulled flat and the hernia would retract into its proper place; but lying down caused the tear in the muscle band to open up and the hernia to bulge out like a balloon, creating a pinching sensation. After several sessions with the therapist, my friend was able to sleep again. What to do in order to prevent a recurrence? Strengthen the muscle so that it is less likely to tear.

The tests at the hospital had done nothing for my friend but generate medical bills and expose him to radiation. The real answer was waiting at the gym. There are a number of common and disabling injuries where muscle weakness is implicated as a contributing factor, such as rotator cuff tears and carpal tunnel syndrome, yet few doctors talk with their patients about the importance of maintaining muscle strength. Isn’t it time for physicians to collaborate with fitness professionals for the benefit of patients?

Wednesday, September 24, 2014

Having Respect for Limitations – in Medicine and in Life

Recently, I heard the story of a bright and ambitious young woman who aspired to be a physician. She finished pre-med in college but, as she started to get to know more doctors, she found that many were addicted to alcohol or drugs or just plain angry. She decided that she didn’t want that kind of life and went on to a different career.

In an earlier blog post I talked about some of the stresses on doctors today. ”The vast majority of physicians are sincere, caring people who are doing their best to treat too many patients in too little time. … Doctors work impossible hours; they are harassed and talked down to by insurance providers; and they must protect themselves (at great cost) against lawsuits for malpractice.”

What I see in the way medicine is practiced in the United States today is a lack of respect for limitations, both of the individual medical practitioner and of the field of medicine itself. As more and more patients are stuffed into doctors’ schedules, communication is limited, treatment is standardized, and subtle nuances are overlooked. All of this sets the stage for medical errors that arise, not from incompetence or a lack of caring, but from too little time for listening attentively and framing a careful response to the patient’s situation.

In addition to schedule constraints, physicians are limited by their individual education and experience. Diagnosis is too often guided by what tests are available and commonly applied rather than by the patient’s own medical history (which the doctor may not have had much time to review). In some cases, unfortunately, doctors’ training has predisposed them to believe that the solutions offered by modern medicine are always to be preferred and that if modern medicine doesn’t offer a solution to the patient’s problem, there is no solution. This school of thought often involves a blanket rejection of all supplements, traditional remedies, and alternative treatments.

When I was in my late forties, juggling a career and graduate classes, I tore something in the back of my shoulder. It was quite painful and, as the weather got colder, it got worse until I was having trouble sleeping. My doctor recommended over the counter anti-inflammatory remedies and then a course of therapy with a clinic run by the local hospital but none of it helped. After about six months of this, with no other option but surgery, I decided to try acupuncture. My doctor was scornful, “All that does is stimulate endorphins.” Over a couple of months, the injury healed; after that, I did stretching myself to restore normal movement in my shoulder. My doctor was so impressed that she later sent at least one other patient to the same acupuncturist.

I have enormous respect for modern medicine, which has probably saved my life a number of times, but modern medicine doesn’t always work and doesn’t have much to offer in some areas. Most athletes will tell you that there is little to be done for any but the worst soft tissue injuries. Rest, Ice, Compression, Elevation are what doctors and trainers alike will recommend; the body just needs time to heal itself. Another weak area is the wide range of food allergies and sensitivities and other digestive disorders termed “irritable bowel syndrome.” Doctors can’t do much about these so they don’t give them much attention, but for affected patients these conditions can lead to long term malnutrition.

Fortunately, there are remedies out there. Acupuncture and massage can accelerate the healing of soft tissue injuries; probiotics and enzyme supplements benefit many people with ill-defined digestive disorders. Unfortunately, most doctors won’t have anything to do with these therapies because they are not part of the standard canon taught in American medical schools. Doctors may also be motivated by fear of a malpractice lawsuit if harm comes to the patient.

A lack of respect for limitations, both the human limitations of doctors and the practical limitations of medical science, creates hardship for both doctors and patients. We need to find an approach to medical care that is more respectful of the individual and more open to therapies outside the conventional realm of medical care.

Wednesday, September 10, 2014

What I Like About mytrainerbob

If you’re already in decent shape and want to take it to the next level, the Bob Harper workouts are a good option. These are challenging, businesslike programs packed with a variety of well-paced exercises ̶ no jokes or funny voices and not much down time here. Based on the reviews in Amazon, I selected and tried a total of four DVDs, all of which have improved my condition, though not necessarily in ways I expected.

I started out with Totally Ripped Core and Total Body Transformation. Both of these came out in 2011 and are similar in format. Both come with shorter routines to do when you have less time. In both cases the first half or two-thirds of the workout is not too hard, working mostly with light or medium weights, the last third is difficult-to-almost-impossible, using body weight, isometrics, and jumping. My abs were pretty strong before I started so the Bridge series near the end was actually a relief. The planks and other isometric exercises were good for me because I don’t normally do much of those. The hardest move for me was the side plank lifting the top leg and holding it up. At first I couldn’t do this at all but now I can. For both of these workouts, I saw the most change in the muscles in the back of my body and my outer legs, abs not so much. The benefits you get from any workout depend on where you were strong to start with.

Total Body Transformation is billed as “the hardest workout ever” but for me Body Rev Cardio Conditioning is even tougher, working with a heavier weight (as well as a light one), more balance moves, and a generally faster pace. I don’t see this so much as a cardio workout, because my heart rate doesn’t get up and stay up high enough for long enough, but more as an intense workout with weights and body weight. I haven’t totally mastered this one yet but I’m working on it. BRC and Kettlebell Sculpted Body both appeared in 2010. The kettlebell workout features the GoFit contoured kettlebells that have flat sides and a vinyl coating that make them more comfortable to use than the traditional round variety. KSB is fifty minutes of squats, lunges, and lifts combined with pushups, mountain climbers and jumping jacks for a tough workout emphasizing the swinging weight of the kettlebell.

The first three workouts show Bob with a class. In each of them the standouts are women ̶ Shaela Luter in Totally Ripped Core and Total Body Transformation and Roxanne Mari in Cardio Conditioning ̶ and some of the men struggle. Kettlebell Sculpted Body features the amazing Stephanie Czajkowski, who manages to keep her sense of humor in spite of the hard work and some mischievous needling by Bob. Are the workouts designed this way because the intended audience is women? I don’t know.

I only have a couple of minor quibbles with these workouts. One is that at times they are unrealistically hard. At certain points you see form starting to fall apart because these very fit twenty-somethings are simply worn out. The other is that Bob doesn’t do all of the moves himself. I find it more impressive when the teacher actually does most or all of the workout with the class. Of course this makes it impossible to monitor and comment on how people in the class are doing.

Bob Harper is one of the trainers on The Biggest Loser. Since I never watch the show, I had no particular impression of him one way or the other. Last year, when contestant Bobby Saleem was agonizing about whether to tell his parents about his homosexuality, Bob supported him by telling him (and everyone else) that he is gay. I thought that this sacrifice of personal privacy by a celebrity was an extraordinarily generous act.

Thursday, August 14, 2014

If Exercise Isn’t Working For You…

1. Change the program.

After you’ve been doing the same routine for a few months your body adapts to it and you don’t make any further progress. This is true even with varied, ambitious programs like P90X; sooner or later you stall out. Find new exercises in books and magazines, on TV or on the Internet. Reviews of DVDs on Amazon can show you where to look. Some are written by trainers and serious fitness buffs and describe in detail their own experiences with a particular DVD.

2.  Increase the frequency.

When I was doing Ab Ripper X once a week I saw no change at all. Once I got up to three times a week the results were so impressive that my husband wanted to learn too. For general fitness, the trainers I follow recommend an hour a day five or six days a week, doing different routines on different days.

3.  Increase the intensity and measure with a heart rate monitor.

For years I listened to the people who said that moderate exercise is enough. I spent hours walking at a brisk clip and never saw any benefits. It wasn’t until I bought a heart rate monitor and got my heart rate up high enough for about 30 minutes twice a week that I reduced my body fat percentage and resting heart rate. For me, “high enough” means intervals averaging 85% of resting heart rate. Other people may get good results with less exertion – you just have to see what works for you.

4.  Assess your strengths and weaknesses; work more on your weaknesses.

I used to have a very sedentary lifestyle and spent much of my day bent over a book. I arrived in my fifties with not much upper body strength and was getting little pains in my shoulders and arms. When I started lifting weights the pain went away and my posture improved. I even think upper body work may be good for the heart because it brings circulation to that part of the body.

If your abs, for example, are already strong, you may not get any benefit from doing crunches, even hundreds of crunches. You need to find other exercises that feel hard and will work the muscles in different ways. For abs, my current favorite is the Brook Benten core workout that came with a contoured kettlebell I bought recently.

5.  Do all types of exercise.

Exercise isn’t just workouts with weights and cardio; it also includes stretching, work on balance, plyometrics or explosive movement, and isometric exercise. A good exercise program includes all of these areas. Over time you will find that one type of training helps you with another. For example,, stronger abs mean better balance.

6.  Pursue a sport you enjoy.

Once you’re in better shape you’ll be able to get back to activities you may not have been able to do for years. For me, that was roller skating, actually rollerblading. I like to go out on some of the paved trails in different parts of town. Linking exercise with fun makes it more likely that you will stick with the program.

7.  Know when you need a break.

An essential part of improving fitness is getting enough rest. This includes getting enough sleep, but it also means taking time off for a day or two when you feel you’ve been working too hard. Step back, take a breather, then get right back to it.

Saturday, June 28, 2014

Could a Simple Neck Exercise Improve Circulation to the Brain?
Someone Should Check It Out.

Recently I started doing exercises to strengthen the muscles in my neck. I lie on a flat surface, lift my head an inch or two, and count. My initial goal was a count of thirty but over a period of weeks I’ve made it up to a hundred. Then I rest for a few seconds and repeat.

After that, I do a variation. I lift my head as before but this time I turn my face from side to side in a smooth steady movement and count the number of reps; my current goal is thirty side-to-side turns. This one helps when you’re driving and need to look into your blind spot.

All exercise brings circulation to the area being worked. It makes sense that neck exercises would increase blood flow to that part of the body, but could it also have a beneficial effect on the brain? Somebody should really research this; it would be easy and not too expensive and the consequences could be significant.

Bonus Features: 
  • Improves the appearance of the front of the neck and jawline.
  • Strengthens the abs.

Tuesday, May 6, 2014

If More Doctors Believed in Diet and Exercise, Maybe Patients Would Too

Anyone who reads this blog knows that I have profound respect for doctors. That said, I find it disheartening when I encounter large ads for hospitals and medical practices that feature photos of very overweight doctors. I am sure that these individuals have impossible schedules, lots of stress, and little opportunity to exercise or seek out healthy food options. On the other hand, there is such a thing as leading by example. If the intelligent, well educated, highly respected doctor believes it’s OK to live this way, she or he is unlikely to succeed at persuading patients to do otherwise – and, in many cases, doctors don’t even try.

How much do medical schools teach doctors about diet and exercise? Not much, is my impression. Do medical schools ever talk to their students about how they should take care of themselves? I doubt it. So doctors who weren’t already a fitness buffs (not too many of those) are left in the position of trying to coach patients in areas where they are quite ignorant themselves. Most doctors don’t understand how exercise works and the way exercise works goes against the grain of the way doctors are taught to approach patients. Because their time with individual patients is quite limited, doctors tend to group patients by category, lumping people together by age, sex, and so forth. Yet each individual body is unique; what works well for some may be useless or even harmful for others. This is especially true with diet and exercise. If you want to get into shape you may have to try a number of different approaches until you find what works for you. And what works for you for a while may eventually stop working, so you have to start looking all over again.

Doctors don’t have the time – and often not the educational background – to supervise this sort of longtime, unpredictable process. Instead, they take shortcuts. Rather than broach the awkward subject of the patient’s obesity and poor living habits, they prescribe medication. Controlling your diet and pursuing a successful exercise program take planning, persistence, and hard work. After talking to their doctors, patients are likely to come away with the idea that all this effort is really unnecessary because a pill will produce the same results. For example, individuals who take statins may think of the medication as a license to overeat. In a study recently reported in JAMA, statin users increased their fat and caloric intake over eleven years, while nonusers saw no such increases. Prescribing medication for conditions that could and should be treated with diet and exercise may actually steer people away from making healthy lifestyle choices. Medications do not produce the same results as diet and exercise. In addition, they are costly and may have harmful side effects.

It is time to bring accurate, individualized information about diet and exercise into doctors’ offices. Some hospitals and medical practices have started using health coaches to work with individual patients and support their efforts to improve their fitness. With the help of a coach, patients can gain a better understanding of their particular strengths and weaknesses and their individual needs. This, in turn, will improve their ability to communicate and work with their doctor.
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