Exercises for Older Adults

johnnysfit ohana reports and opinions are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provideruct

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JULY 30

Listen to Your Body

The best way to achieve a high level of fitness without injuring yourself is to listen to your body. Don’t depend on heart rate monitors, fitness trackers or other gadgets. The most sophisticated fitness tracker and injury-avoider is your brain. Training to achieve a high level of fitness and to prevent diseases usually involves intense exercise, and most exercise injuries are caused by continuing to exercise intensely when your body tells you to slow down, stop exercising, or take the day off.

You Don’t Need Electronic Devices to Track Exercise
You can buy clever gadgets to monitor your heart rate, blood lactic acid, carbon dioxide, sugar and oxygen levels, speed or cadence, number of steps or breaths or arm motions that you take, stride length, and so forth. However, these devices cannot tell you whether you are exercising intensely enough to gain your maximum improvement in ability to take in and use oxygen or to damage your muscles enough for maximum strength gain. Only your brain can tell you:
• whether you are at your maximum,
• when you need to slow down because you are exhausted, or
• if you need to stop because you are about to injure yourself.
Fitness gadgets can help to motivate you and can be fun to use, but do not count on them to tell you how intensely you should exercise or when you are at the edge of an injury.

Your Brain Talks to You
Your brain can tell you when you are tired, short of breath and your muscles hurt. All you have to do is to ask yourself, “How do I feel?” Researchers can measure signs of fatigue such as lactate levels, VO2max, heart rate, heart-rate variability, rapid morning heart rate, recovery heart rate, hormone levels, red cell counts, your immune system’s activity (white blood cells, interleukins, inflammation), muscle damage, blood pressure, and much more. But in the real world for athletes and regular exercisers, all you need to do is listen to your body.
For example, the test called VO2max measures the maximum amount of oxygen you can take in and use over time, which is the major limiting factor to how fast you can move. However, you do not need to monitor VO2max with a machine; you can increase VO2max just by exercising intensely enough to become short of breath.

Stress and Recover
Almost all competitive athletes use the training principal of “stress and recover”:
• On one day they take an intense workout to damage their muscles.
• On the next day they feel sore and go less intensely to allow their muscles to heal.
• Then when their muscles feel fresh again, they take their next intense workout.

Running causes tremendous muscle damage, so runners usually run very fast only two or three times a week, run long once a week and have three to five slower recovery days, even if they are working out twice a day. Competitive swimmers are different. The water seems to protect their muscles so they usually try to take one hard and one easy workout every day. Pedaling causes less muscle damage than running, so bicycle racers do some fast riding on most days, and have to learn when to slow down.

How Does This 84-Year-Old Bicycle Rider Train?
I spent my entire competitive running career (from 1954 to 1989) injured because I competed with my training log in the mistaken belief that the runner who does the most miles is the best. Of course, that is ridiculous. It took me 35 years to learn when to take days off. Today, I am no longer a runner. Bicycle riding is done in a smooth rotary motion with no road shock, so cyclists can stress their legs almost every day.

Diana and I ride very fast in a tandem bicycle group of couples in their 40s to 80s. We usually ride about 30 miles on Tuesday, Thursday and Saturday. After these hard rides, my legs are always sore when I get up the next day. I take a very slow 10-minute warm up. If my legs still feel tired or stiff or I have localized pain after the warm up, I take the day off. If my legs feel fresh after the warm up, I take an easy ride for an hour or so. If I feel really fresh, I do a series of standing 50-pedal-stroke intervals fast enough to make me short of breath each time, followed by a slow recovery for as long it takes to get my breath back and for my muscles to feel fresh again. I do not time recoveries, since starting an interval before full recovery would slow down my next interval. As soon as my legs start to feel heavy, I stop the interval workout and start my short, slow cool down.

I am riding about 125 miles a week (30-mile fast group ride three times a week plus about 12 miles of warm up and intervals three times a week). My 30-mile rides are fast, but not flat out, and depend on how I feel. Of course I go slower on some days. I do 21 to 24 fifty-pedal-stroke intervals on my average interval workout, which takes about 40 minutes. I always stop my interval workout when my legs start to feel heavy. I am usually forced to take off or go very slow at least one or two days a week.

Rules to Prevent Wear-and-Tear Injuries
• When you are training or exercising properly, your muscles are likely to feel sore almost every morning when you get up. If you warm up for a workout and your muscles don’t feel fresh after 10 minutes, take the day off or go very slow, no matter what kind of workout you have planned for that day.
• Wear-and-tear injuries don’t just happen; they give you plenty of warning. If you feel soreness or pain in one area that worsens as you continue to exercise, or doesn’t go away when you slow down, stop your workout immediately. You are headed for an injury.
• Wear-and-tear injuries are usually not symmetrical. One side of your body will feel far more uncomfortable than the other. Stop your workout if you feel localized tenderness in one muscle group and you do not feel the same discomfort in the same muscle group on the other side of your body.
• Stop your intense workouts immediately when your legs start to feel heavy or hurt.
• You recover faster from a workout by eating food and drinking fluids as soon as you finish, and getting off your feet as much as possible. You recover faster by lying down instead of sitting, and sitting instead of standing. Eat lots of food soon after you finish an intense workout and then take a nap.

Caution: People who have narrowed arteries leading to the heart can suffer heart attacks when they exercise intensely. All vigorous exercisers must learn when to back off of training because not allowing enough time to recover from hard exercise can damage your heart muscle as well as your skeletal muscles. Check with your doctor before beginning an exercise program or making a sudden change in the intensity of your existing program

JULY 24
Resistance Exercise You Can Do at Home

Resistance exercise is the best way to slow down the loss of muscle strength that occurs with aging, and I believe that everyone should do some type of resistance exercise (moving your muscles against an opposing force) as part of their regular exercise program. I have always recommended joining a gym and using the weight training (Nautilus-type) machines there, but now, because of COVID-19, we are staying away from our local gym and had to find a way to do our resistance exercises at home.

With aging, everyone will lose muscle size and strength, which markedly increases risk for:
• diabetes (J Endocrine Society, July 2020;4(7):bvaa043),
• heart attacks (J Epidem and Commun Health, Jan 2020), and
• some cancers (JAMA Netw Open, May 2, 2020;3(5):e204783).
Between 25 and 50 percent of North Americans over the age of 65 suffer from loss of muscle that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80–85). After age 40, people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Nutr Rev, May 2003;61:157-67). The smaller the muscles in your arms, legs and trunk, the smaller and weaker the upper and lower chambers of your heart (J Am Geriatr Soc, Dec 2019;67:2568-73), which makes you more likely to suffer heart failure (Cardiology, March 25, 2019).

Resistance Exercise Workouts
If you want to grow larger and stronger muscles, you have to exercise against increasing resistance. The only stimulus to make muscles larger and stronger is to stretch them while they contract against resistance. When you lift a heavy weight, your muscles start to stretch before they start to contract, which can cause swelling of the muscle fibers at their Z-lines. When the muscles heal, they will be stronger than they were before you exercised them against resistance. Read my reports on Making Muscles Stronger and Weight Lifting for Middle-Aged and Older People for detailed explanations and diagrams.

The basic principle of growing larger muscles is the same no matter how you do your resistance training. You don’t need special equipment; many exercises use your own body weight for resistance, such as sit-ups, planks, push-ups, stair-stepping or squats. You can create your own weights to lift using cloth shopping bags filled with cans (adjusting the weight by adding or subtracting cans), or you can use plastic gallon jugs filled with varying amounts of water. Stretchable bands are inexpensive and can be used for resistance exercises for virtually every part of the body; instructions are available on YouTube. You can get many more ideas by searching YouTube using phrases such as “resistance exercises at home.”

We chose to buy a home gym with weights, and we are able to get an excellent workout with it — but you need to be able to spare a few hundred dollars and have space to put it in. Lots of different models are available. We chose a Marcy Multifunction Home Gym MWM-988, available from Amazon. Note: We paid less than $500 for this home gym in March; the price showing now on Amazon is a ridiculous $1000+. If you are interested in this type of equipment, do some comparison shopping and check for other offers. We have used the home gym every day since we got it in March, doing 10-15 exercises in single sets of up to 100 repetitions, which takes us about 25-30 minutes a day. Regular gym goers are surprised when they hear that we do so many repetitions, but many older people have such weak muscles and joint problems that they can’t do full range-of-motion exercises or lift very heavy weights, and they need to avoid any exercise that causes pain when they do it. Instead, they can do more repetitions of each exercise to fatigue their muscle fibers enough to gain the Z-line swelling necessary to grow larger muscles.

Resistance, Repetitions, and Range-of-Motion for the Beginner
Many older people who start a resistance exercise program quit because of an injury (Internat J Sport and Exer Physiol, 2009;6:89-100), so you must learn to listen to your body and know when to increase a weight and when to take an easy day or a day off. Older people are susceptible to injuries when they try to lift very heavy weights, so the first rule is to lift a lighter weight with more repetitions to the point where your exercising muscles start to feel a burn, stretching or fatigue, and then stop that exercise. As long as you exercise “to the burn” or to fatique, you can gain almost the same muscle growth and strength by lifting a lighter weight many times as you do by lifting a heavier weight fewer times (J Appl Physiol, Jul 1, 2016;121(1):129-3). Beginners should start with a resistance or weight that they can comfortably lift and lower at least 10 times. Once you have decided on a weight that you can move 10 times, you may prefer to do more repetitions by reducing the range-of-motion so that you are moving a shorter distance.

As soon as your exercising muscles start to fatigue, burn or feel tight, stop that exercise and move to your next exercise, even if you have moved the weight only a few times. Pick 10-15 exercises that use different muscles, and try to do them every day. If your muscles feel sore with your first lift, skip that exercise and move on to the next exercise. Listen to your body and never work through pain — your body talks to you. If you push through pain, you can expect an injury that could end your exercise program completely. As you continue in your program, you will find out that you can do increasingly more repetitions. As you become stronger, you may also be able to extend your range-of-motion with each lift. When doing your target number of repetitions becomes easy, you can add to the weight for that exercise.

My Recommendations
Everybody loses strength and muscle size with aging, which can result in considerable disability and increased risk for diabetes, heart attacks and certain cancers. You can slow muscle loss with aging significantly by doing resistance exercises.
• Older people who start a resistance exercise program are at high risk for injuries, and the heavier the weight you lift, the more likely you are to injure yourself. You are far less likely to get injured if you lift lighter weights with more repetitions.
• Taking extra protein will not grow muscle or slow the loss of muscle with aging. See Extra Protein Does Not Enlarge Muscles
• You have lots of choices for resistance exercises that can be done in your home with little or no special equipment. If you want to get a substantial home gym, I am very happy with my Marcy Multifunction Home Gym MWM-988, but shop around to get exactly what you want and to get a better price than what Amazon currently offers.

JULY 21

Muscle Loss from Inactivity: 34 Percent in Just Two Week

A study from the University of Copenhagen shows that wearing an immobilizing knee brace for just two weeks caused men in their 20s to lose 22 to 34 percent of their leg muscle strength, while men in their 60s lost 20 to 26 percent (Journal of Rehabilitation Medicine, June 26, 2015).

It took them six weeks of exercising on a bicycle 3-4 times a week to restore the leg muscle size and ability to exercise, but even that did not fully restore the leg muscle strength. This study shows that:
• When muscles of young men are immobilized for two weeks, they lose strength equivalent to aging 40 or 50 years.
• As soon as you stop moving, your muscles start to weaken.
• The larger your muscles, the more muscle you have to lose.
• Younger and stronger people lose strength even faster than older people.
Other studies show that it takes three times the amount of time you were inactive to regain the muscle size that you have lost, probably because you were immobilized 24 hours a day and you exercise for only a short time each day.

Aging Weakens Muscles Even if You Exercise
Inactivity at any age causes muscles to weaken, and you are likely to lose muscle strength with aging no matter how much you exercise. Every muscle in your body is made up of thousands of muscle fibers just as a rope is made up of many strands. Every muscle fiber is innervated by a single nerve fiber. With aging you lose nerves, and when you lose a nerve attached to a muscle fiber, that muscle fiber is lost also. A 20-year-old person may have 800,000 muscle fibers in the vastus lateralis muscle in the front of his upper leg, but by age 60, that muscle would have only about 250,000 fibers. For a 60-year-old to have the same strength as a 20-year-old, the average muscle fiber needs to be three times as strong as the 20-year-old’s muscle fibers. You cannot stop this loss of the number of muscle fibers with aging, but you certainly can enlarge each muscle fiber and slow down the loss of strength by exercising muscles against progressive resistance using strength-training machines or by lifting weights (Experimental Gerontology, August 13, 2013).

How to Strengthen Muscles
To enlarge and strengthen muscles, you need to exercise them against resistance forceful enough to damage the muscle fibers. You will know that you have done this because you will feel a burning in the stressed muscle during the later lifts and on the next day, your muscles will feel sore. Then you lift lighter weights, or engage in other sports, for as many days as it takes for your muscles to heal. You can tell this has happened when the soreness goes away.

My Recommendations
We are all likely to have some enforced periods of inactivity, but if you realize how quickly you lose muscle strength and how much longer it takes to gain it back, you will avoid voluntary inactivity as much as possible. For example, when you plan a vacation, make sure it involves physical activity that is at least equal to your regular exercise program.

As you age, expect to become weaker and more likely to fall and break your bones. To enlarge muscles and slow the natural loss of strength with aging, you should lift weights a few times in a row or lighter weight many times in a row. You can become quite strong by using 10 to 15 strength-training machines (for different muscle groups) three times a week. Do two or three sets of 10 repetitions on each machine. Always stop immediately if you feel any pain, tearing or excessive burning.

JULT 17

Strengthen Bones with Weight Training

Your bones weaken progressively after age 30, and between ages 35 and 50, about 28 percent of North American men and women suffer from bone weakening called osteopenia (J Amer Osteo Assoc, June 2019;119:357-363). By age 65, 25 percent of women and six percent of men are at high risk for breaking their hips or spine with minor falls (CDC/National Center for Health Statistics, August 2015). Just one year of lifting weights can strengthen the bones enough to help protect people from these fractures (Bone, Oct 2015;79:203-212).

Why Bones Weaken with Aging
Bones change all the time. Bone cells called osteoclasts take calcium out of bones and osteoblasts constantly bring calcium back into bones. Exercise increases the rate that osteoblasts bring in calcium to make bones stronger, while inactivity slows osteoblasts to weaken bones. Two hormones, irisin and sclerostin, help signal our bodies to begin the process of breaking down old cells so that new ones can form. Recent research shows that exercise may increase irisin to slow bone loss and prevent osteoporosis in mice susceptible to that condition (Cell, Dec 13, 2018;175(7):1756-1768), so in the future we may have medicines that actually cure osteoporosis.

Bone loss directly parallels loss of muscle. Aging causes you to lose strength, no matter how much you exercise. After age 65, 50 percent of North Americans suffer from loss of muscle that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80-85). The people who lose the most muscle are usually the ones who die earliest, and they are also most at risk for falls and broken bones. If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Any prolonged period of inactivity, such as bed rest, injured nerves, wearing a cast or even living in a decreased force of gravity, will cause loss of muscle tissue (Med Hypotheses, 2007;69(2):310-21).

Exercise Against Resistance to Strengthen Bones
The greater the force on bones, the stronger bones become. Resistance exercise strengthens bones, but only those bones that are stressed by resistance on their specific muscles (Am J of Phys Med & Rehab, 2001;80(1):65-77). Lifting weights in your late 60s, three times a week for just one year, can strengthen bones significantly (Brit J of Sprts Med, 2000;34(1):18-22). A review of 37 studies of men and women over 60 found that a proper exercise program enlarged and strengthened the muscles in 93 percent of the participants (Osteoporosis International, March 1, 2017). In only 14 percent of the participants was there any additional benefit from nutritional changes. It would be best to start a resistance weight program when you are younger because lifting weights during adolescence helps to prevent osteoporosis when you are older (J Ped, 2001;139(4):494-500).

Inflammation Increases Risk for Osteoporosis
Loss of bone and muscle with aging is accelerated by inflammation. Older people who suffer from severe loss of muscle are far more likely to have high levels of the markers of inflammation, measured with blood tests such as CRP, SED rate and adiponectin (Aging Clinical and Experimental Research, August 2017;29(4):745-752). See Inflammation Can Help or Harm

Osteoporosis and sarcopenia of aging are found with other conditions associated with inflammation, including:
• having excess body fat (J Gerontology A Biol Sci Med Sci, 2011;66:888-895; Curr Gerontol Geriatr Res, 2012;2012:216185)
• eating a pro-inflammatory diet that raises blood sugar levels (J Gerontology A Biol Sci Med Sci, Jan 2012;67A(1):74-81)
• being diabetic (Med J Aust, 2016;205(7):329-333)
• having low vitamin D levels (Molecular Aspects of Medicine, Dec 2008;29(6):407-4140)
• not exercising
• having any chronic disease

To make a muscle stronger, you have to exercise that muscle vigorously enough to feel burning in your muscle and damage muscle fibers. Then, when the muscle heals, it is bigger and stronger. Theoretically, damage to any cells in your body turns on your immune system and therefore can cause inflammation, but most studies show that exercise helps to prevent or reduce overall inflammation.

My Recommendations
Since aging weakens your bones and muscles and increases your risk for breaking bones, every person who can do so safely should try to exercise every day. Try to include both activities with continuous motion and exercises against resistance in your program. Continuous endurance exercise such as biking, running, and swimming strengthen primarily your heart, while weight lifting strengthens primarily your skeletal muscles and bones.

If you are not already doing strength-training exercise, first check with your doctor to make sure you do not have any condition that may be harmed by exercise. Then join a gym and ask for instructions on how to use the weight-training machines (Nautilus and similar brands). Used properly, these machines will guide your body to use the correct form and help to prevent injuries as you move weights that match your level of strength. Resistance exercise can increase muscle size and strength in older people (Med Sci Sports Exerc, 2011;43 (2):249-58), but with aging you need to work longer to gain the amount of strength that a younger person would get with the same program (Med Sci Sports Exerc, 2011;43(2):249-58). Since lifting lighter weights many times is less likely to cause injuries, I recommend lifting lighter weights with more repetitions.

• Stop immediately if you feel severe pain or if you have pain that does not go away as soon as you stop lifting the weight. Pain in a muscle or tendon is often the first sign of an impending injury.
• Take the day off if your muscles feel sore or fatigued after a 5-10 minute pre-workout warmup.
• Just using and contracting your muscles in any activity offers health benefits, but you can gain additional benefits by adding intensity with some form of interval training.

In addition to your exercise program, other anti-inflammatory lifestyle habits will also help you to maintain bone strength:
• follow an anti-inflammatory diet
• maintain a healthful weight
• avoid smoke and alcohol
• keep blood levels of hydroxy vitamin D above 20 ng/ml
For more on strengthening bones, see my report on Lifestyle and Drugs to Prevent and Treat Osteoporosis

JULY 14

Exercisers Have More Stable Plaques

Two recent breakthrough studies give the best explanation yet of how exercise helps to prevent heart attacks. Competitive older endurance athletes may have more plaques in their arteries than non-exercisers, but they have the type of plaques that are far less likely to break off and cause heart attacks (Circulation, April 27, 2017;136:138-148; May 2, 2017;136:126-137).

The studies showed that competitive master athletes have:
• low 10-year-history risk scores for likelihood to suffer heart attacks (Framingham study data)
• higher plaque thickness
• more calcium in their plaques
• more stable plaques that are far less likely to break off to cause heart attacks. By comparison, more than 61.5 percent of the older men who did not exercise regularly had “mixed morphology” plaques with much higher risk for breaking off to cause heart attacks.

An editorial accompanying these studies states that having more stable plaques can explain why endurance athletes have such a low rate of heart attacks, and increasing endurance training also increases protection from heart attacks. Michael Joyner of the Mayo Clinic said that the papers show that “Stable plaques plus larger coronary arteries that dilate more in high volume exercisers should be highly protective against coronary events.”

How Plaques Form in Arteries
If you understand what happens during a heart attack and what causes these events, you will be able to see why plaque stability is so important. Your immunity is good for you because it helps to protect you from infections. When a germ gets into your body, your immunity makes cells and proteins that attack and kill germs. When the germs are gone, your immunity is supposed to dampen down. However, if your immunity stays active all the time, it can use the same cells and chemicals to attack you to increase your risk for a heart attack.

Different types of bacteria that live in your colon turn your immunity on and off. What you eat determines which types of bacteria grow in your colon because these bacteria eat the same food that you do. These colon bacteria determine how quickly you form plaques in your arteries. Foods favored by the bacteria that turn on your immunity are classified as pro-inflammatory and increase risk for forming plaques in your arteries to increase risk for heart attacks. Anti-inflammatory foods are favored by types of bacteria that help to prevent plaques from forming and decrease heart attack risk. A diet that is high in whole grains, fruits and vegetables, and legumes and nuts is associated with reduced risk for cardiovascular disease, while less healthful diets that are high in sweets, refined grains, juices, red meats and processed meats are associated with increased risk (Journal of the American College of Cardiology, Volume 70, Issue 4, July 2017).

When your immunity stays on all the time to cause inflammation:
• Immune cells and proteins can punch holes in your arteries in the same way that they punch holes in the membranes of invading bacteria.
• The holes bleed and clot.
• Plaques form at the site of the clots and start to cover the inner linings of arteries. We know that cholesterol isn’t the primary cause of forming plaques because cholesterol does not start to show up in plaques until long after the holes, bleeding and clotting have occurred on the inner linings of arteries.

Breaking Off of Plaques Causes Heart Attacks
A heart attack is a sudden complete obstruction of the blood flowing to part of the heart muscle. A 90 percent blockage of an artery does not cause a heart attack because blood can still flow through and the heart muscle can still get some oxygen. A heart attack is not caused by plaque buildup on the inner lining of arteries; it is caused by a sudden breaking off of a plaque, followed by bleeding where the plaque broke off. Then clots form at the bleeding sites. Next, the clot extends to block completely the flow of blood to the part of the heart muscle supplied by that artery. The part of the heart muscle deprived completely of blood flow then dies.

How Doctors Measure Plaque Stability
A CT scan can show how stable plaques are (American Journal of Roentgenology, March 2015;204(3):W249-W260). X rays can show the difference between stable plaques that are safe and those that are unstable and more likely to break off to cause heart attacks. Signs of plaque stability include extensive calcification, less lipid-rich areas, increased fibrous areas and structural changes.

Amount of Exercise Does Not Determine Amount of Plaques
A new study shows that older men (average age 60), who had run marathons for 26 to 34 years and completed 27 to 171 marathons, had plaques in their arteries that were related to their own risk factors for heart attacks and not to the number of miles or marathons they had run (Med & Sci in Sports & Ex, July 17, 2017). This suggests that plaques in arteries are not caused by endurance training, but are caused by other factors such as a pro-inflammatory diet, high blood pressure, high cholesterol and previous use of tobacco.

My Recommendations
• To help prevent or reduce plaque formation, follow a heart-attack-preventing diet that is high in anti-inflammatory foods and low in pro-inflammatory foods. This means that you should eat plenty of plants and restrict red meat, processed meats, sugar-added foods, all sugared drinks and fried foods.
• Avoid overweight
• Do not smoke
• Limit or avoid alcohol
• To stabilize existing plaques and widen your coronary arteries, try to exercise every day for at least a half hour a day. Exercising more than that may be even more protective.

Caution:  Intense exercise can cause a heart attack in people with blocked arteries. Check with your doctor before starting a new exercise program or increasing the intensity of your existing program.

JULY 4

Resting Heart Rates Can Be Too High or Too Low

Your resting heart rate should average between 50 and 70 beats a minute. Athletes can have rates between 30 and 50 and still have healthy hearts, and your heart rate temporarily can go above 70 when you are sick, stressed or sleep deprived, but all people who have persistent resting heart rates greater than 70, non-athletes who have heart rates below 55, and anyone with a heart rate below 60 with heart palpitations, fainting , dizziness or other symptoms may want to check with a doctor. Resting heart rates greater than 70 are associated with increased risk for diabetes (Int J Epidemiol, Jun 2010;39(3):900–906), heart attacks, certain cancers and premature death (CMAJ, Oct 18, 2016;188(15):E384–E392).

The Research
• More than 6000 men were followed for more than 25 years. Those with resting heart rates greater than 73 beats per minute were 140 percent more likely to die from cancer than those with resting heart rates of less than 60 beats per minute (PLoS ONE, published online August 03, 2011).
• Of more than 53,000 men followed for almost 30 years, those with resting heart rates greater than 80 beats a minute were far more likely to suffer heart attacks and cancer than those with fewer than 60 beats a minute (Mayo Clinic Proceedings, 12/12/2013).
• 58 obese men and women exercised five times a week at 70 percent of their maximum heart rate for 45 minutes. In just 12 weeks they lowered their resting heart rates by five to nine beats per minute (Br J Sports Med, 2009; 43: 924-927).
• The Copenhagen Study of 3,000 men followed for 16 years found that those with a resting heart rate between 71 and 80 beats per minute were at a 50 percent elevated risk of death, between 81 and 90 beats per minute had double the risk, and resting heart rates over 90 beats per minute tripled the risk (Glob Cardiol Sci Pract, Oct 9, 2015;2015(3):33). Furthermore, high resting heart rates were associated with lower levels of physical fitness, higher blood pressure, overweight, and higher levels of circulating blood fats. The authors concluded that “a high resting heart rate is not a mere marker of poor physical fitness, but is an independent risk factor for disease.”

A High Resting Heart Rate May Predict Heart Disease
A strong heart pumps lots of blood with fewer beats, while a weak heart has to beat more often to pump the same amount of blood. A high resting heart rate may indicate that arteries are blocked or that there is heart muscle damage so the weakened heart has to pump more often to circulate oxygen to your body.

How a High Resting Heart Rate Relates to Cancer
Telomeres are the end caps of chromosomes that help to protect them from being destroyed when a cell reproduces. The longer your telomeres, the less likely you are to develop cancer, and people who exercise regularly have longer telomeres (Front Physiol, Dec 18, 2018;9:1798). Exercise also helps to protect the body from inflammation, a risk factor for cancer. The more you exercise, the lower the heart rate and the greater the protection against inflammation.

How to Check Your Resting Heart Rate
To find out your resting heart rate, check your pulse when you first wake in the morning, before you get out of bed. You can use a heart rate monitor, a blood pressure cuff that includes a pulse check, one of the many fitness trackers that have a heart rate feature, or any watch that shows seconds. If you have a smart phone you can download a free heart rate monitor app. Set your device on your bedside table the night before so you do not have to move around when you wake up. If you are using a watch, place your fingers on the side of your neck where you feel a strong heartbeat. Count the beats for ten seconds and multiply by six. Do this for several days and take an average.

My Recommendations
A morning resting heart rate consistently over 70 is often a warning signal that you have a weak heart and may be headed for serious disease. If your resting pulse rate is over 70 beats per minute and you are not sick or taking stimulants, check with your doctor, particularly if you also have:
• LDL cholesterol greater than 100,
• blood sugar greater than 145 mg/dL one hour after eating,
• systolic blood pressure greater than 120 at bed time, or
• a C-reactive protein greater than 10 mg/L.

Athletes often have exceptionally low heart rates indicating a strong heart, but in non-athletes a low heart rate can be caused by damage to the heart’s electrical conduction system or muscle. If you have a resting heart rate of less than 60 and are not a regular exerciser, or if you are regular exerciser and have a bedtime systolic blood pressure greater than 120 or below 90, chest discomfort, dizziness or fainting, a bad LDL cholesterol greater than 100, or any possibility of an irregular heartbeat, you should check with your doctor.



Dick Buerkle and Multiple Systems Atrophy 

Dick Buerkle ran 3:54.93 to break the world record in the men’s indoor mile in 1978, and earned places on the 1976 and 1980 U.S. Olympic teams. From age 12 onward, he had suffered considerable taunting from his classmates because he lost all the hair on his head to an auto-immune disease called alopecia areata. He reacted to these bullies by working harder than everyone else and being able to tolerate more pain. Training for competitive sports involves taking painful intense workouts that approach your limits and damage your muscles, and then doing easier workouts for as long as it takes for your muscles to recover. Then when your body recovers, you take your next workout near your limits.

Buerkle’s response to the heckling crowds was to become one of the best runners of his generation. He later said that he was forever thankful to Michael Jordan for shaving his head and making bald cool.

Becoming a World Class Runner
As a high school senior, Buerkle went out for the first time for his school track team in Rochester, NY, and ran one mile in a very fast 4:28 and two miles in 10:01. He did not receive any college scholarship offers, but he must have had a lot of confidence in his running ability because he chose to attend Villanova College, one of the top cross country and track and field schools in America.

June 30

Weak Muscles Increase Risk for Dementia

Many studies show that having excess fat in your belly is associated with increased risk for dementia, but a new study shows that as a person ages, lack of muscle size and strength appears to be an even stronger predictor of dementia than having excess belly fat (Clinical Interventions in Aging, July 5, 2018;13).

The authors followed 353 men and women, average age 69, and found that those who had both excess body fat and small, weak muscles had the worst memory, speed in answering questions and executive function such as making intelligent decisions. Those who had the weakest and smallest muscles had even worse mental function than those who were just obese and did not have excessive muscle weakness. Another well-performed study of more than 5000 people, with an average age over 70, also found that low muscle size is associated with increased risk for dementia (Age and Ageing, March 2017;469(2):250–257).

Significance of “Skinny Fat”
This new study found that many people who do not have conventional measures of obesity such as excess weight or a high BMI (Body Mass Index) can still be at high risk for obesity-related diseases such as dementia, heart attacks, strokes, diabetes, certain cancers and premature death. The authors call this “skinny fat,” a combination of low muscle size and strength and high fat mass that significantly increases risk for dementia. Sarcopenia (loss of muscle size and strength) and obesity are part of the aging process for many people, and can both be used to predict potential mental decline, dementia, and diseases associated with aging. These conditions can be caused by sedentary behavior, weight gain and an unhealthful diet.

Testing and Treating People with “Skinny Fat”
Strength testing can be as simple as measuring a person’s grip strength with a simple inexpensive hand-held dynamometer. Excess fat can be measured with belly circumference or thickness of the fat layer underneath the skin near the belly button. An MRI of the body will be more accurate but is far more expensive and time consuming. People with weak grip strength or high belly fat are at increased risk for dementia with aging, even if they appear otherwise to be thin and healthy. An earlier study showed that a program of strength training and aerobic exercise and a healthful diet can help slow the frightening loss of muscle size and strength and increase in body fat in people as they age (Clinical Interventions in Aging, August 6, 2015;1267—1282). See my recent report on How Exercise Reduces Dementia Risk

A recent review of many studies showed that the typical Western diet (high in sugar, red meat, processed meat and fried foods) is associated with a marked increase in the incidence of mental decline and dementia throughout the world (presented at the 2018 Alzheimer’s Association International Conference, July 22, 2018 in Chicago, Illinois). Another study of 2200 people, presented at this same conference, shows that people who consume the equivalent of two-and-a-half teaspoons or more of added sugar a day have a 54 per cent increased risk for developing Alzheimer’s disease. A high rise in blood sugar can damage every cell in your body, particularly your brain.

To prevent blood sugar levels from rising too high, your pancreas releases insulin which lowers blood sugar by driving sugar from the bloodstream into the liver. However, if you have a lot of belly fat, you are also likely to have a liver full of fat, and a fat-filled liver cannot accept sugar from the bloodstream. Contracting muscles can lower blood sugar just by pulling sugar from the bloodstream without even needing insulin. A single bout of exercise will allow your muscles to pull sugar out of your bloodstream without needing insulin for up to 17 hours after you finish exercising. Lack of exercise and low muscle size are associated with high blood sugar levels and increased risk for both diabetes and dementia.

My Recommendations
A high rise in blood sugar after meals is a major risk factor for dementia. You will help to prevent dementia by preventing high rises in blood sugar if you:
• grow larger and stronger muscles
• avoid foods that cause high rises in blood sugar
• avoid having excess belly fat that specifically causes high rises in blood sugar
To help you keep your muscles strong as you age, see my report on

JUNE 16

Walk Faster, Live Longer

Paul T. Williams, a statistician at Lawrence Berkeley National Laboratory, has followed almost 40,000 men and women who walk for exercise for more than 10 years. His latest report shows that the faster you walk, the longer you live (PLoS One, December 2013). Picking up the pace is more healthful than just walking slowly, even if you go longer than the recommended 30 minutes per day. In his study group, those who walked at a very slow pace (24 minutes per mile) were 44 percent more likely to die in 10 years than those who walked at a faster pace.

Six years ago, the same author showed that among older runners, the faster runners had healthier medical profiles. They had lower blood pressure, lower cholesterol and lower blood sugar levels (Medicine and Science in Sports and Exercise, October 2008).

Intervals: The Best Way to Increase Intensity
The most efficient way to increase intensity and feel less stress on your muscles is to use interval training. When you exercise, pick up the pace for a short period. As you start to feel burning or fatigue in your muscles, slow down. When the burning and fatigue are gone, pick up the pace. When you feel the burning again, slow down. Alternate these pickups and recoveries until your muscles start to feel stiff and then quit for the day.

Intervals Better than Continuous Pace Exercise
Norwegian researchers showed that high intensity interval training improves every conceivable measure of heart function and heart strength and also helps to prevent both the pre-diabetic metabolic syndrome and the heart damage it causes (Exercise and Sports Sciences Reviews, July 2009). Controlled interval training is now a treatment for heart failure. High-intensity interval training:
• raises the good HDL cholesterol far more than less intense exercise does (Journal of Strength and Conditioning Research, March 2009).
• enlarges telomeres, the end caps that protect your chromosomes. The size of your telomeres predicts how long you will live (Proceedings of the National Academy of Sciences USA, Jan 2012).
• increases both the number and size of mitochondria. The larger and more mitochondria, the longer you can expect to live.
• increases VO2max, the maximum amount of oxygen that your body can take in and use. VO2max can be used to predict your likelihood to suffer a heart attack (Med Sci Sports Exerc, November 2011;43(11):2024-30).
Calculate your VO2max
• makes your cells more sensitive to insulin, which in turn helps to prevent diabetes, heart attacks, obesity and certain cancers.

Interval Training Takes Less Time for Greater Health Benefits
To be competitive, all athletes must train very intensely some of the time. Interval training on a bike can provide you with all the health and fitness benefits of exercising less intensely for a much longer period of time (The Journal of Physiology, March 2010). In this study, subjects used a stationary bicycle to do ten one-minute sprints with a one-minute rest between each at 95 percent of their maximal heart rate, three times a week. This takes less effort than an all-out sprint at close to 100 percent of maximal heart rate. The study supports other research that shows that high-intensity interval training improves all the measures of fitness far more than continuous, less intense exercise. The same authors showed that a similar short workout of all-out sprinting at maximal heart rate took about 90 minutes per week (three workouts of 30 minutes each) and was as effective in achieving fitness and health benefits as many hours of exercising at a much more leisurely pace (The Journal of Physiology, September 2006).

More Benefits from Intense Exercise
Intense exercise for older people is still a controversial subject, but it is far more effective than casual exercise in preventing and treating diabetes (Circulation, July 2008) and reducing belly fat (Medicine & Science in Sports & Exercise, November 2008); Vigorous exercise protects obese people from heart attacks and prolongs their lives, even if they don’t lose weight (Medicine and Science in Sports and Exercise, October 2006); Intense exercise is more effective in preventing heart attacks than less intense exercise done more frequently (MSSE, July 1997); Death rate from cardiovascular disease is lowered by high intensity activities such as jogging, swimming, hiking, tennis and climbing stairs, but not by lower intensity activities such as walking, bowling, sailing, golf and dancing (Heart, May 2003).

What Does This Mean for You?
Since exercise can cause heart attacks in people who already have blocked arteries leading to their hearts, you may want to check first with your doctor. If you are not a regular exerciser, start out very slowly and jog, cycle or do your chosen exercise at a very low intensity each day until you feel the least fatigue in your muscles and then stop. If your muscles feel stiff when you start to exercise, take the day off. In six weeks, most people can work up to a half hour a day of very slow exercise.

You are now ready to start training. Your new workouts will start as your old ones did. Start out very slowly. After five or more minutes, you should be warmed up and ready to start training. Pick up the pace for a few seconds and slow down as soon as you start to feel short of breath or burning in your muscles. Go slowly for as long as it takes to recover your breath and for your muscle to feel fresh again. Then pick up the pace again. Alternate these pickups and recoveries until your muscles start to feel tight and then stop for the day. If your muscles feel tight at the start of a workout, take that day off. Tight muscles mean that your muscles have not recovered from a previous workout. You are now training like a real athlete.

JUNE 5

Your Muscles Make Your Heart Stronger

When you read about people dying of “natural causes,” it usually means that they died of heart failure because they spent too much time lying in bed. When you become inactive, you lose your skeletal muscles at an alarming rate, and losing skeletal muscle causes loss of heart muscle until your heart can become too weak to pump blood to your brain and you die.

In 1914, Dr. Ernest Starling described what is today known as Starling’s Law, that strengthening skeletal muscles strengthens heart muscle and not the other way around (Circulation, 2002;106(23):2986-2992). When you contract your skeletal muscles, they squeeze the veins near them to pump extra blood back to your heart. The extra blood flowing back to your heart fills up your heart, which stretches your heart muscle, causing the heart muscle to contract with greater force and pump more blood back your body. This explains why your heart beats faster and harder to pump more blood when you exercise. The harder your heart muscle has to contract regularly in an exercise program, the greater the gain in heart muscle strength.

Inactivity Damages Brain and Nerve Cells
Preventing mice from using their hind limbs for just 28 days interfered with normal function of mitochondria in cells so that blood levels of oxygen dropped, preventing the sub-ventricular zone of the brain from maintaining normal nerve function and making new nerves (Frontiers in Neuroscience, May 23, 2018). Many studies show that physical activity is necessary for the healthy growth of new nerves during a human lifetime (J Neurosci Res, 2016;94:310–317). On the basis of these and many other studies, this means that not using your legs and arms causes loss of nerves, which causes loss of muscles (particularly heart muscle), that can eventually lead to heart failure and death.
• The larger your skeletal muscles, the stronger your heart and the lower your chance of suffering heart attacks and heart disease (J Epidem & Comm Health, Nov 11, 2019).
• The less you exercise, the weaker your heart and the more likely you are to become diabetic (Diabetes Care, 2002; 25:1612–1618).
• The larger your muscles, the less likely you are to die of heart diseases (Am J of Cardiology, Apr 15, 2016;117(8):1355-1360).
• A study of almost a million adults with no history of heart disease followed for 10 years found that those who did not exercise were at 65 percent increased risk for strokes and heart attacks, the same rate as that found for smoking (Euro J of Prev Cardiology, Feb 10, 2020).
• A study of 900 heart failure patients found that those who did not exercise were twice as likely to die within three years (Am J Cardiol, 2016 Apr 1; 117(7): 1135–1143).
• A study of 51,451 participants, followed for 12.5 years, found a strong association between exercise and decreased risk for heart failure (J Amer Col of Cardiol, Mar 2017;69(9)).
• A study of 378 older adults showed that the smaller the muscles in their arms, legs and trunk, the smaller and weaker the upper and lower chambers of their hearts (J Am Geriatr Soc, Dec 2019;67:2568-2573).
• Low skeletal muscle size predicted death in people who had chronic heart failure (Cardiology, March 25, 2019).

Severe Loss of Muscle with Aging is Common
Between 25 and 50 percent of North Americans over the age of 65 suffer from severe loss of skeletal muscle (sarcopenia) that is significant enough to limit their daily activities (J Am Geriatr Soc, 2004;52:80–85). A regular exercise program is the best way to slow down this loss of strength and coordination, but even if you exercise regularly, you will still lose muscle as you age (Aging Male, September-December 2005). After age 40, people lose more than eight percent of their muscle size per decade and by age 70, the rate of muscle loss nearly doubles to 15 percent per decade, markedly increasing risk for disability and disease (Am J Epidemiol, 1998;147(8):755–763; Nutr Rev, May 2003;61(5 Pt 1):157-67).

The people who lose the most skeletal muscle are usually the ones who die earliest. They are also most at risk for falls and broken bones. Muscles are made up of hundreds of thousands of individual fibers, just as a rope is made up of many strands. Each muscle fiber is innervated by a single motor nerve. With aging you lose motor nerves, and with each loss of a nerve, you also lose the corresponding muscle fiber that it innervates. For example, the vastus medialis muscle in the front of your thigh contains about 800,000 muscle fibers when you are 20, but by age 60, it probably has only about 250,000 fibers. However, after a muscle fiber loses its primary nerve, other nerves covering other fibers can move over to stimulate that fiber in addition to stimulating their own primary muscle fibers. A regular exercise program can help to slow the loss of muscle fibers and improve mobility (Physiol Rev, Jan 1, 2019;99(1):427-511). Lifelong competitive athletes over 50 who train four to five times per week did not lose as many of the nerves that innervate muscles and therefore retained more muscle size and strength with aging than their non-athlete peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Lifelong competitive runners over 60 can have almost the same number of muscle fibers as 25-year-olds.

Researchers reviewed eight studies using accelerometers to follow 36,383 adults, 40 years of age and older, for six years and found that exercising regularly in adulthood, regardless of intensity, is associated with reduced risk for early death, while sitting for more than nine hours a day is associated with increased risk for premature death (Brit Med J, August 21, 2019). The death rate dropped progressively as light physical activity increased up to five hours per day and moderate activity increased up to 24 minutes per day. Examples of:
• light intensity included walking slowly, cooking and washing dishes;
• moderate activity included brisk walking, vacuuming or mowing the lawn; and
• vigorous activity included jogging or carrying heavy loads.
Lack of physical activity doubled a person’s chances of suffering a heart attack, while a regular exercise program helps prevent it (Eur Heart J, January 15, 2019).

Preventing Muscle Loss
Resistance exercise increases muscle size and strength in older people, but with aging you need to work longer to gain the amount of strength that a younger person would get with the same program (Med Sci Sports Exerc, 2011;43(2):249–58). Competitive masters athletes, 40 to 80 years old, who train four to five times per week, lose far less muscle size or strength than their non-exercising peers (The Physician and Sportsmedicine, October 2011;39(3):172-8). Eighty-year-old men who still compete in sports have been found to have more muscle fibers than inactive younger men (Journal of Applied Physiology, March 24, 2016). Inactivity causes rapid loss of muscle size and strength. If you inactivate a leg by putting it in a cast, you lose a significant amount of muscle size in just four days (Nutrition, Acta Physiol (Oxf), March 2014;210(3):628-41). Prolonged periods of inactivity due to bed rest, injured nerves, casting or even decreasing the force of gravity (in astronauts) causes loss of muscle tissue which leads to insulin resistance, higher blood sugar levels and increased risk for diabetes (Med Hypotheses, 2007;69(2):310-21).

My Recommendations
A key to prolonging your life and preventing disease is to keep on moving. Lying in bed for many hours each day is a certain way eventually to kill yourself. Each day that you spend not moving your muscles weakens your heart until eventually you can die of heart failure.
• Exercise will prolong your life, but you do not have to have a specific exercise program. You just need to keep on moving for a large part of each day. It is harmful just to sit or lie down all day long. It is healthful to mow your lawn, wash your dishes, make your bed, vacuum your house, go for a walk, and participate with your friends in activities in which you are moving your arms and legs — dancing, cycling, swimming, running, nature walks and so forth.
• To gain maximum health benefits from your skeletal muscles, you should include some sort of resistance exercise. If you are not already doing strength-training exercise, first check with your doctor to make sure you do not have any condition that may be harmed by exercise. Caution: Exercise can cause a heart attack in a person who has blocked arteries or heart damage. Then join a gym and ask for instructions on how to use the weight-training machines. Since lifting heavier weights is far more likely to injure you than lifting lighter weights, I recommend that you lift lighter weights with far more repetitions. Older people, in particular, can use each specific weight machine and lift and lower a lighter weight up to 100 times in a row. Stop that exercise when the muscles start to feel tight or hurt.

MAY 16

Which Burns More Calories, Running or Cycling?

Have you wondered whether you burn more calories when you run or when you ride a bicycle? The standard comparison is that one mile of running equals a little more than three miles of cycling, but that’s lousy science. It all depends on how intensely you exercise. Running requires the same amount of energy per mile at any speed (generally 110 calories per mile), but cycling is slowed so much by wind resistance that the faster you ride, the harder you have to pedal and more energy you use. This means that you have to compare your running and cycling at different cycling speeds.

If you hate math and don’t want to crunch the numbers yourself, you can use this handy online calculator

If you want to understand the math, Dr. Edward Coyle of the University of Texas in Austin has made the calculations easy by providing conversion factors for different riding speeds. First he determined average values of oxygen consumption by cyclists to estimate the approximate caloric equivalence between running and cycling. For example, riding 20 miles at 15 mph causes you to burn 620 calories (20 miles X 31 calories per mile = 620 calories). To find the same value for runners, take the 620 calories and divide them by 110 calories per mile for running and you get 5.6 miles to burn the same number of calories. So riding a bicycle 20 miles at 15 miles per hour is equal to running 5.6 miles at any speed.

Dr. Coyle’s conversion factors for different cycling speeds are:
• 10 MPH (26 calories per mile) = 4.2
• 15 MPH (31 calories per mile) = 3.5
• 20 MPH (38 calories per mile) = 2.9
• 25 MPH (47 calories per mile) = 2.3
• 30 MPH (59 calories per mile) = 1.9
Divide the number of miles ridden by the conversion factor for your riding speed to tell you the equivalent miles of running at any speed. Thus, for 20 miles ridden at 10MPH, divide 20 miles by 4.2, which tells you that your ride is equivalent to 4.8 miles of running.

This formula is for an average-size adult who weighs approximately 155 pounds. A larger cyclist would divide by a slightly higher number; a smaller cyclist, by a slightly lower one. Wind and hills are not accounted for, nor is drafting (riding behind another cyclist), which can reduce your energy expenditure by up to one-third.

Other Factors to Consider When Comparing Running and Cycling
Running causes more wear-and-tear injuries: If you exclude getting hit by a car, it is safer to cycle than to run. Cycling is done in a smooth rotary motion with almost no impact force. On the other hand, runners are far more likely to become injured than cyclists because of the high impact of their feet hitting the ground. When you run at a six-minute-per-mile pace, your foot hits the ground with a force equal to three times your body weight. This force is transmitted up your legs to your hips and back, and done repetitively, it can shatter bones and tear muscles and tendons (Br J Sports Med, Apr 2016;50(8):450-7). Runners who are injured frequently are likely to benefit most by shortening their strides, which then coincidentally increases likelihood of their landing on the front part of their feet, rather than on their heels.
Cycling does not strengthen your bones: The high impact force of running strengthens bones and helps to prevent osteoporosis. Cycling has not been shown to prevent osteoporosis because it has little or no impact force. Cyclists need to add a resistance training program (weight lifting) to gain the bone-strengthening benefits of exercise.

My Recommendations
All aerobic exercise makes your heart stronger and helps to prevent heart attacks, and exercising intensely is more effective than just casual exercise. Everyone should try to exercise every day to help prolong life and prevent disease. Choose running, cycling, or any other aerobic exercise that you enjoy and will do on a regular basis. If you exercise with a partner or make other friends who share your love of your sport, you will be more likely to continue to exercise faithfully as you age.

MAY 12

Lifestyle Changes to Reduce Joint Pain

Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and 60 percent have significant joint pain. Osteoarthritis is the most common type of joint pain and since there is no effective treatment, doctors usually just prescribe medications to reduce the pain. When pain medication is not enough, you may be advised to have the joint replaced. More than 700,000 people in North America have their knees replaced each year, mostly because of osteoarthritis.

Researchers at Surrey University in England reviewed 68 studies on the effects of diet on osteoarthritis and found that osteoarthritis is associated with everything that increases inflammation, and that the joint pain can be reduced by everything associated with the control of inflammation (Rheumatology, May 1, 2018;57(suppl_4):iv61–iv74). Steps recommended to reduce inflammation include:
• A diet high in omega-3 oils (seafood, seeds), leafy green vegetables (kale, spinach, parsley) and other anti-inflammatory foods
• Weight reduction in people who are overweight (but not in skinny people)
• Strengthening and flexibility exercises (Arthritis Care & Research, Dec 5, 2017;69(12)) and aerobic exercise (The Knee, January 18, 2018)
• Avoiding smoke
• Restricting alcohol

What Causes Inflammation?
Inflammation means that your immunity stays on all the time. Your immunity is good for you because it kills germs that try to invade your body, as well as the countless cancer cells that your body makes every day. However, after a germ or defective cell is gone, your immunity is supposed to slow down. If your immunity remains active, it uses the same chemicals and cells that attack germs to attack you, and that includes destroying the cartilage in your joints. Common health problems linked to inflammation and osteoarthritis include obesity, high blood pressure, high cholesterol (Rheumatology, Jan 1, 2016;55(1):16–24), diabetes and metabolic syndrome.

My Recommendations
• If your joints hurt, try to find out the cause of your pain. Check with a doctor to see if you have a hidden infection, gout, psoriasis or some other known cause of joint pain.
• If you have sudden locking of your knee that gets better and then recurs, you may have “joint mice,” loose pieces of cartilage that slip between the cartilage to cause horrible pain. Your doctor can usually cure you by removing these lose pieces by arthroscopy.
• Whatever the cause of your joint pain, try an anti-inflammatory diet that includes lots of vegetables, fruit, whole grains, beans, nuts and other seeds and nuts, and severely restricts red meat, processed meats, foods with added sugar, all sugared drinks including fruit juices, and refined carbohydrates (foods made with flour or white rice).
• Lose weight if overweight. I recommend Intermittent Fasting
• Osteoarthritis always worsens with inactivity, so keep on moving, but be guided by pain and slow down or stop when your pain worsens. You should not do sports that involve impact, because the force of your foot hitting the ground can break off cartilage. Good non-impact sports include cycling and swimming.
• It is acceptable to try to control your pain with non-steroidal anti-inflammatory drugs (NSAIDs). However, they are only pain medications and do nothing to cure the cause of your joint pain. NSAIDs do have side effects, so take the lowest dose that helps relieve pain.
• If the pain becomes so unbearable that it keeps you awake at night, you can consider a knee replacement. However, replacing the joint requires driving a spike into the middle of the bones of your knee and that pushes aside the shock-absorbing marrow and weakens the bone to increase your chances of breaking the bones if you fall. If that happens, the knee cannot be replaced again until the broken bones heal. You may be unable to walk or be bedridden for a very long time.

APRIL 24

High-Intensity Interval Training Can Increase Injuries

A recent study shows that people who use high-intensity interval training (HIIT) are far more likely to become injured than people who use less intense exercise and that the highest injury rate from interval training is in men at ages 20 to 39, the ages when they are at their highest potential to be at their best competitive level to become champion athletes (J Sports Medicine and Physical Fitness, Feb. 12, 2019).

Almost all competitive athletes use some form of interval training because shorter bursts of very intense exercise are far more effective than more casual exercise to make you stronger and have greater endurance. Intense interval training has also been shown to be more effective in maintaining fitness and preventing diseases such as heart attacks than casual exercise, because intense interval training strengthens the heart more, widens blood vessels more and increases maximum circulation (Cell Metabolism, Mar 7, 2017;25:581-592). Interval training also takes far less time than continuous training for these exercise benefits (J of Physiology, March 2010).

Most Non-Athletes Prefer Less Intensity
People who exercise just for fitness, weight control and health tend to prefer longer, more moderate-intensity, continuous exercise workouts that burn the same number of calories compared to short but very intense interval training (J Sport & Exercise Psychology, April 2016). Athletes need to use intense interval training to be competitive, but the average non-athlete may be happier in a less intense program, even if it takes an hour to gain the same benefits as they would gain from a few all-out intense intervals lasting only a minute or two. However, the amount time it takes to exercise is very important to some people, so they may prefer to suffer in order to gain the benefit of saved time.

Rules for Preventing Injuries During Intense Exercise
Note: These tips for preventing injuries are the same for competitive athletes working at very high intensity and non-athletes doing my modified interval workouts (see below).

• Before every intense workout, warm up by going slowly until your muscles feel fresh. When your training includes intense workouts, your muscles will often feel sore when you start to exercise, but they usually feel better after you warm up for several minutes.

• Do not even start an interval workout when your muscles still feel sore after you warm up for 5-10 minutes or if you feel sick.

• Do not try to do interval workouts on consecutive days or more than two or three times a week. Each time you do interval training, you will probably develop a soreness 6-24 hours after you finish exercising. Physiologists call this Delayed Onset Muscle Soreness (DOMS). If you exercise intensely when you feel DOMS, you are at increased risk for injuring yourself. Skip a planned interval workout if your legs feel heavy or hurt from a previous workout.

• Cooling down means that after you exercise intensely, you slow down and exercise at low intensity for a while before you stop exercising for that session. The scientific literature is controversial on whether cooling down helps to reduce next-day muscle soreness to help muscles to recover faster. I believe that cooling down may help you to heal faster from muscle soreness after intense exercise, which allows you to recover faster from intense workouts. There is some evidence that cooling down augments your immune system response to help muscle fibers heal faster from the Z-line damage caused by hard exercise (Sports Med, July 2018;48(7):1575-1595; Nat Rev Immunol, 2011;11:607-615).

• After each intense workout, get off your feet and do as little walking as possible.

• Try to sleep within a few hours after your intense workout as you may recover faster by sleeping than remaining awake (South African J Research in Sport, Physical Education and Recreation, Jan 2012;34(1):167 – 184). Loss of sleep can impair exercise performance (European Journal of Applied Physiology, April 2017;117(4):699-712).

• Drink fluids for a faster recovery, particularly on hot days (Journal of Sports Sciences, January 2004).

• Add salt on hot days, if your muscles feel excessively fatigued or if you develop cramps (Can J Appl Physiol, 2001;26 Suppl:S236-45).

• Eat as soon as you finish your intense workout (J Sports Sci Med, 2004 Sep; 3(3): 131-138). It doesn’t matter what you eat in your post-intense-workout meal, as long as it contains protein and carbohydrates (Am J Clin Nutr, Jan 2017; Med Sci Sports Exerc, Oct 2008;40(10):1789-94). In one study, fast foods such as French fries, hash browns and hamburgers helped athletes recover just as quickly from hard workouts as sports nutrition products such as Gatorade, PowerBars and Clif Bars (International Journal of Sport Nutrition and Exercise Metabolism, March 26, 2015).

• Do not take non-steroidal anti-inflammatory drugs (NSAIDs) to relieve muscle soreness. NSAIDs can block gains in strength and endurance (PNAS, June 27, 2017;114(26):6675-6684; Med & Sci in Sports & Ex, April 2017;49(4):633-640).

Easier Intervals for Non-Competitive Exercisers
A typical interval workout for non-competitive exercisers would be a session of jogging, walking or cycling in which you:
• Warm up by moving slowly for 5 to 10 minutes
• Pick up the pace until you feel a slight burning in your muscles (this usually takes 10-20 seconds)
• Slow down as soon as you feel this muscle burning, and go slowly until the burning is gone and breathing is back to normal
• Alternate picking up the pace for 10-20 seconds and slowing down until you have recovered, and then stopping the workout when your legs start to feel heavy or stiff

If you have not been exercising regularly, spend several weeks exercising at a casual pace. Try to exercise every day and exercise until your legs start to feel heavy or hurt and then stop for the day. You may be able to exercise for five minutes on one day, and then have to take the next day off because your muscles feel sore. You may have a progression of five minutes on one day, then zero on the next day, then 10 minutes, then three minutes and so forth. Gradually you should be able to work up to exercising for 30 minutes every day and not feel sore. Then you should be able to start your interval workouts.

Caution:People with blocked arteries leading to the heart can get a heart attack from intense exercise. Check with your doctor before starting a new exercise program or making a sudden change in the intensity or duration of your program.

APRIL 21

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People
Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).
Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).
High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).
Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program
The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger
Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations
Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION: People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

APRIL 20

How to Prevent Wear-and-Tear Injuries

You can help to prevent wear-and-tear injuries from any type of exercise by warming up, by stopping exercise when you feel pain and by not exercising intensely when your muscles feel heavy or sore. Muscles are made of millions of individual fibers. When you first contract a muscle, you use only one percent of the fibers. As you continue to exercise, you contract more fibers to share the load, which places less force on each fiber and helps to prevent injuries. Always warm up. Go slow before you go fast. If you take a hard workout and feel sore the next day, go easy on every day that your muscles continue to feel sore after you have warmed up. It usually takes at least 48 hours for muscles to recover from hard exercise. When you feel pain in one muscle during exercise, that’s a signal that it may be starting to tear and you should stop exercising for that day.

Runners Get More Injuries
If you think that football is the sport with the most injuries, you are wrong. Each year, 79.3 percent of long-distance runners suffer injuries that force them to take time off from running (Br J Sports Med, Aug, 2007;41(8):469-80). The most-injured part is the knee and the chance for an injury increases with running longer distances and having previous injuries. Injuries occur most often after a rapid increase in weekly distance, intensity, or frequency of hill or track workouts (Sports Med, 1996. Jan;21(1):49-72).

A survey of participants in a Rotterdam marathon found that:
• 55 percent of the runners had suffered serious injuries during the year before the marathon
• 15.6 percent of the runners reported at least one new lower extremity injury in the month before the race
• 18.2 percent reported injuring their legs during the marathon
• Immediately after the marathon, runners reported severe pain in two to four different parts of their legs
• One week later, most felt well enough to go back to work, even though almost all had painful muscles (Scand J Med Sci Sports, April, 2008;18(2):140-4).

Why Running Causes So Many Injuries
When you run, one foot is always off the ground, so each foot strikes the ground with a force equal to three times body weight (at 6-minute-mile pace) and the faster you run, the greater the force of each foot strike. Walking is much safer. When you walk, you always have one foot on the ground, so the force of a walking foot strike almost never exceeds your body weight. To convince yourself, place your hands on the huge quad muscles in the front of your upper leg while you run. Each time your leg strikes the ground, you will feel the muscle shake like jelly.

A study from the University of Wisconsin-La Crosse shows that as people start to feel tired during running, they shorten their strides and this decreases the force of their foot striking the ground (Medicine and Science in Sports and Exercise, Dec 1999;31(12):1828-33). The shorter stride lessens the force of their heel striking the ground and places it forward to the area behind the big toe. To compensate for the decreased force of their feet hitting the ground, they move their legs at a faster cadence. You can use this information to help you prevent injuries when you run. Shortening your stride will help to protect you from injuries by shifting your foot strike force forward. You can keep your speed by moving your legs at a faster cadence.

When You Need To Take a Day Off
The most common cause of injuries is not listening to your body when it talks to you. Every wear-and-tear injury you have had probably gave you signals long before you were injured. Most exercisers who are training properly have sore muscles every day when they wake up in the morning. However as they start to exercise, the soreness goes away and their muscles feel good. On days when your muscles do not feel better after you start to exercise, take the day off. If you are exercising and you feel discomfort in one or more non-symmetrical areas, stop exercising and take the day off. Pain in one area, such as a leg, and no discomfort in the other leg, is a strong warning of impending injury that could still be prevented.

Understanding How to Train Helps to Prevent Injuries
I think it is unwise to do the same workout at the same intensity every day because:
• it will not give you the same health benefits as a stress/recover training program,
• it will not make you a better athlete,
• it may increase your chances of injuring yourself,
• it will not help you to lose as much weight as you may want, and
• it makes no sense.

To strengthen your heart and increase your ability to take in and use oxygen, you have to exercise intensely enough to feel muscle burning and become somewhat short of breath. That stresses your muscles also. To make a muscle stronger, you need to exercise vigorously enough to damage it. You go a little faster on one day, damage the muscles and feel sore on the next day. This delayed-onset muscle soreness (DOMS) is evidence that you have damaged muscles. The soreness is a sign that you should spend that day exercising at a more relaxed pace and not put much pressure on your healing muscles.

In a stress/recover training program, you should set up your schedule to go a little faster with more intensity on one day, feel sore on the next day and go at low intensity for that day and as many additional days as it takes for the soreness to go away. Then, when the soreness is gone, you exercise more intensely again.

Arches and Running Injuries
Runners with high arches are at increased risk for suffering stress fractures, small cracks in the bones of their feet and lower legs. Those with low arches are at increased risk for knee cap pain. Your legs are shocked by the force of each foot hitting the ground, and the faster you run, the harder your foot strikes the ground. This force can break bones, damage joints and tear muscles. To protect yourself from this tremendous foot-strike force, your leg is designed so that you never are supposed to land flat-footed when you run. Almost all people land on the outside (lateral) bottom of the foot and roll inward toward the medial side where the big toe is. This is called pronation and helps to distribute the force of your foot strike throughout your foot and leg and protect you from injury. The further you roll inward, the greater the protection against this force. However, when you roll in too much, your lower leg twists inward excessively, causing your kneecap to rub against the long femur bone behind it and cause pain. Pain behind the kneecap is called Runner’s Kneewhich is one of the most common running injuries.

If you have pain behind the knee cap during running or walking, ask your podiatrist to look at your feet. If your arches appear to be flat, you usually will have a normal arch, but you roll inward so far that your arch touches the ground. Flat feet usually means that your foot rolls inward so far that the arch rolls all the way to touch the ground. If you have flat feet and no pain, you do not need to do anything. However if you have pain anywhere from your feet all the way up to your lower back, the treatment is to place special inserts called orthotics in your running shoes. You can also do special exercises that strengthen your vastus medialis muscle that pulls your knee cap inward.

If you develop pain in the medial side of your lower leg or your feet, your podiatrist will probably order a bone scan to check for stress fractures, small cracks in the bones of your feet. If you have stress fractures, you should stop running for a while and ride a bike, which causes no road shock. When you can run without feeling pain, you can start running again, but you should take shorter strides to decrease the force of your foot striking the ground. If you have high arches, you probably are not pronating enough to reduce the force of your foot strike. You can reduce the force of your foot strike by shortening your stride.

Strengthening Muscles Helps to Prevent Injuries
A study from Sweden showed that pre-season strength training for the hamstring muscles helped to prevent injuries to those muscles (Scandinavian Journal of Medicine & Science in Sports, 2003;13(4):244-250). Hamstring tears are very common soccer injuries, so players from two of the best soccer teams in Sweden were divided into two groups: a group that received specific hamstring training for 10 weeks, using a special device twice a week to overload the hamstrings eccentrically, and a control group that received no special training. The trained group had less than one third the hamstring injuries and also had greater improvement in hamstring strength and running speed. Muscles are injured when the force on them is greater than their inherent strength, so they tear. Resistance training makes muscles stronger so that they can withstand greater forces and therefore helps prevent injuries.

My Recommendations
• Do not do the same exercise at the same intensity every day. Use the hard/easy principle: faster on one day and much slower on the next.
• Always go much slower for several minutes before you go faster.
• If your muscles do not feel fresh after you have warmed up for a few minutes, take the day off.
• Stop exercising immediately if you feel pain in one area that worsens with exercise.
• Whatever your sport, understanding the principles of training helps to prevent injuries.

Caution: Almost everyone should exercise. Check with your doctor before you start a new exercise program or increase the intensity of your existing program. Blocked arteries leading to your heart can cause a heart attack during exercise.

APRIL 17

Everyone Should Exercise After Meals

A study from New Zealand shows that walking 10 minutes after meals lowers high blood sugar by more than 22 percent in diabetics, which is more effective than 30 minutes of exercise done once a day (Diabetologia, October 17, 2016). This agrees with other studies that show that exercising after meals helps to treat and prevent diabetes (Am Med Dir Assoc, July 2009;10(6):394-397). Another study shows that walking up and down stairs for just three minutes after a meal dramatically lowers blood sugar in diabetics (BMJ Open Diab Res Care, July 25, 2016;4(1):e000232).

A review of 28 published studies covering more than 1.2 million people, of which 82,000 developed type 2 diabetes, showed that the more people exercise, the lower their risk of developing diabetes (Diabetologia, October 17, 2016). Exercise lowers high blood sugar by making the cells respond more effectively to insulin to drive sugar from the bloodstream into muscles. People who doubled their exercise time, from 150 to 300 minutes per week, reduced their risk of developing diabetes by 36 percent. More than 40 percent of North Americans have high blood sugar levels, to a large degree because fewer than 50 percent exercise at least 30 minutes a day, five days a week.

Intense Exercise Is More Effective and Takes Less Time
Intense interval exercise reduces high blood sugar levels more effectively than more casual exercise and takes less time. In one study, diabetics exercised a total of just six sessions of ten intervals (60 seconds of hard pedaling followed by a short rest between each interval) on a stationary bike. The workouts took only 20 minutes per session, three times a week for two weeks for a total of just two hours of exercise. After two weeks, they had reduced their average 24-hour blood sugar and 3-hour-after-eating blood sugar levels, and increased muscle mitochondrial capacity that controls blood sugar levels (Journal of Applied Physiology, December 1, 2011;111(6):1554-1560). Warning: Diabetics are at increased risk for having blocked arteries leading to the heart, so they need to check with their doctor before increasing the amount and intensity of their exercise program.

Why Resting After Eating Raises Blood Sugar
After eating, always try to move about and do not lie down (Diabetes Research and Clinical Practice, September 2007;77(3):S87–S91)). Your blood sugar virtually always rises after you eat anything. If it rises too high, sugar can stick irreversibly to the outer membranes of cells throughout your body to destroy them. This cell destruction causes virtually all of the miserable consequences of diabetes: blindness, dementia, loss of feeling and so forth. Resting muscles draw almost no sugar from your bloodstream and to draw any sugar, they need insulin. However, contracting muscles draw large amounts of sugar from the bloodstream and don’t even need insulin to do so. Any muscle contraction changes a muscle from needing insulin to pull sugar from your bloodstream to not needing insulin, and therefore removes large amounts of sugar from your bloodstream.

High rises in blood sugar after meals markedly increase your chances of gaining weight, developing diabetes and certain cancers, and suffering a heart attack. More than 40 percent of North American adults already have metabolic syndrome or diabetes and already have cell damage from high rises in blood sugar after meals. The older you are, the more likely you are to already have cell damage. The later you eat at night, the more likely you are to lie down after eating to increase your risk for cell damage.

My Recommendations
• Eat early in the day so you are still active after meals; avoid eating just before you go to bed.
• Try to move your body for at least 20 minutes after you eat.
• Exercise removes more sugar from your bloodstream than just moving around.
• Exercising intensely removes more sugar than exercising at a casual pace.

APRIL 10

Exercisers Have Fewer Heart Attacks

A study of 21,758 men, average age 51.7 years, followed for an average 10.4 years, showed that men who exercised the most have more plaques in their arteries, but do not suffer more heart attacks or deaths than those with less heart artery calcification (JAMA Cardiol, Jan 30, 2019). The least active men with excessive arterial plaques were twice as likely to die of heart disease. Compared to low-level exercisers, the heavy exercisers without increased plaques had half the risk of dying during the study period. This agrees with other studies showing that older athletes may have increased plaques in the arteries leading to their hearts (Circulation, 2017;136(2):138-148), even though they are at significantly reduced risk for suffering heart attacks and death from heart attacks (Prog Cardiovasc Dis, 2015;57(4):324-329). The studies have not shown whether exercise causes plaque formation or is just associated with it.

The CARDIA study, on 5,115 people who have been followed for more than 30 years so far, has shown that men who spend a lot of time exercising each week have more plaques than moderate exercisers, but do not suffer increased risk for heart disease (Mayo Clinic Proceedings, Oct 16, 2017). All of the recent studies showing increased plaques in older athletes showed that, compared to non-athletes, the athletes had stable plaques that are far less likely to break off to cause heart attacks (Circulation, 2017;136(2):149-151). Heavy exercisers live longer, and suffer far fewer heart attacks, than people who do not exercise (JAMA Intern Med, 2015; 175: 959–967; Circulation, 2007;116(9):1094-1105), and lack of exercise shortens lives and is associated with many different diseases (Lancet, 2012; 380: 219–229).

Heart Attacks Are Caused by Plaques Breaking off from Coronary Arteries
A heart attack has little to do with the size of plaques blocking arteries. A heart artery that is 90 percent blocked does not cause a heart attack. A heart attack is caused by a sudden complete blockage of blood flow to the heart muscle. First a plaque breaks off from the inner lining of an artery leading to the heart, followed by bleeding and clotting. Then the clot extends to block all flow of blood through that artery, which deprives the heart muscle of oxygen and the heart muscle dies.

Why People Who Exercise Extensively May Have More Plaques
Competitive older endurance athletes may have more plaques in their arteries than non-exercisers, but they often have the type of plaques that are far less likely to break off to cause heart attacks (Circulation, April 27, 2017;136:138-148; May 2, 2017;136:126-137). A possible explanation would be that plaques form in arteries from an unhealthful diet or undesirable genes, or both. Exercise does not prevent plaques from forming, but it can stabilize plaques so that they are less likely to break off to cause heart attacks. Since exercise burns lots of extra calories, it can make you eat more food. The studies do not tell us what these older athletes eat, but if you choose to eat more unhealthful foods (red meat, processed meats, sugared foods and drinks, fried foods and so forth), you can expect to have more plaques in your arteries (Journal of the American College of Cardiology, July 2017;70(4)). A heart-attack-preventing diet should be high in vegetables, whole grains, beans, nuts and other seeds. You also should avoid being overweight, restrict alcohol and not smoke.

However, people who spend a lot of time exercising have far more stable plaques. More stable plaques can explain why endurance athletes have such a low rate of heart attacks, and why increasing endurance training increases protection from heart attacks. Having stable plaques, and larger arteries that widen more, helps to prevent heart attacks. Exercisers have:
• lower 10-year-history risk scores for likelihood to suffer heart attacks (Framingham study, Prev Med, 2005;41:622–8)
• greater plaque thickness
• more calcium and less fat in their plaques
• more stable plaques that are far less likely to break off to cause heart attacks. By comparison, more than 60 percent of the older men who do not exercise regularly have soft plaques with a much higher risk for breaking off to cause heart attacks (Circulation, April 27, 2017;136:138-148 and May 2, 2017;136:126-137).

Diagnosing Stable or Unstable Plaques
An X-ray test called “calcium score” is used to measure the size of plaques in the arteries leading to the heart. This test can also tell whether the plaques are stable or unstable (American Journal of Roentgenology, March 2015;204(3):W249-W260). Many radiologists fail to report whether the plaques are stable and safe, or unstable and more likely to break off to cause a heart attack. A stable plaque is called “hard,” has a thick calcium periphery to keep the plaque in place, and is not full of fat. An unstable plaque is “soft,” has irregular calcium borders that may not hold the plaque in place, and is full of fat. If your calcium score results do not contain this information, ask your doctor to request it from the radiologist.

My Recommendations
Preventing heart attacks requires both eating healthfully and exercising. Since exercise stabilizes plaques to help keep them from breaking off from arteries, exercise should be part of any heart-attack-prevention program.

Dedicated exercisers who need to eat large amounts of food to meet their caloric needs should choose healthful, anti-inflammatory foods to avoid forming more plaques in their arteries. Check with your doctor if you have evidence of heart disease caused by a faulty diet: high blood pressure, high blood cholesterol, high triglycerides, high blood sugar, high CRP (c-reactive protein, a measure of inflammation), an abnormal EKG, or chest pain, particularly with exercise.

MARCH 29

Our general interest e-newsletter keeps you up to date on a wide variety of health topics.

Exercise: A drug-free approach to lowering high blood pressure

Having high blood pressure and not getting enough exercise are closely related. Discover how small changes in your daily routine can make a big difference.

By Mayo Clinic Staff

Your risk of high blood pressure (hypertension) increases with age, but getting some exercise can make a big difference. And if your blood pressure is already high, exercise can help you control it. Don’t think you’ve got to run a marathon or join a gym. Instead, start slow and work more physical activity into your daily routine.

How exercise can lower your blood pressure

How are high blood pressure and exercise connected? Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure.

Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 4 to 9 millimeters of mercury (mm Hg). That’s as good as some blood pressure medications. For some people, getting some exercise is enough to reduce the need for blood pressure medication.

If your blood pressure is at a desirable level — less than 120/80 mm Hg — exercise can help prevent it from rising as you age. Regular exercise also helps you maintain a healthy weight — another important way to control blood pressure.

But to keep your blood pressure low, you need to keep exercising on a regular basis. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only as long as you continue to exercise.

How much exercise do you need?

Aerobic activity can be an effective way to control high blood pressure. But flexibility and strengthening exercises such as lifting weights are also important parts of an overall fitness plan. You don’t need to spend hours in the gym every day to benefit from aerobic activity. Simply adding moderate physical activities to your daily routine will help.

Any physical activity that increases your heart and breathing rates is considered aerobic activity, including:

  • Household chores, such as mowing the lawn, raking leaves, gardening or scrubbing the floor
  • Active sports, such as basketball or tennis
  • Climbing stairs
  • Walking
  • Jogging
  • Bicycling
  • Swimming
  • Dancing

The Department of Health and Human Services recommends getting at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. Aim for at least 30 minutes of aerobic activity most days of the week.

If you can’t set aside that much time at once, remember that shorter bursts of activity count, too. You can break up your workout into three 10-minute sessions of aerobic exercise and get the same benefit as one 30-minute session.

Also, if you sit for several hours a day, try to reduce the amount of time you spend sitting. Research has found that too much sedentary time can contribute to many health conditions. Aim for five to 10 minutes of low-intensity physical activity — such as getting up to get a drink of water or going on a short walk — each hour. Consider setting a reminder in your email calendar or on your smartphone.

Weight training and high blood pressure

Weight training can cause a temporary increase in blood pressure during exercise. This increase can be dramatic, depending on how much weight you lift.

But weightlifting can also have long-term benefits to blood pressure that outweigh the risk of a temporary spike for most people. And it can improve other aspects of cardiovascular health that can help to reduce overall cardiovascular risk. The Department of Health and Human Services recommends incorporating strength training exercises of all the major muscle groups into a fitness routine at least two times a week.

If you have high blood pressure and you’d like to include weight training in your fitness program, remember:

  • Learn and use proper form. Using proper form and technique when weight training reduces the risk of injury.
  • Don’t hold your breath. Holding your breath during exertion can cause dangerous spikes in blood pressure. Instead, breathe easily and continuously during each exercise.
  • Lift lighter weights more times. Heavier weights require more strain, which can cause a greater increase in blood pressure. You can challenge your muscles with lighter weights by increasing the number of repetitions you do.
  • Listen to your body. Stop your activity right away if you become severely out of breath or dizzy, or if you experience chest pain or pressure.

If you have high blood pressure, get your doctor’s OK before adding weight training exercises to your fitness routine.

When you need your doctor’s OK

Sometimes it’s best to check with your doctor before you jump into an exercise program, especially if:

  • You’re a man older than age 45 or a woman older than age 55.
  • You smoke or quit smoking in the past six months.
  • You’re overweight or obese.
  • You have a chronic health condition, such as diabetes, cardiovascular disease or lung disease.
  • You have high cholesterol or high blood pressure.
  • You’ve had a heart attack.
  • You have a family history of heart-related problems before age 55 in men and age 65 in women.
  • You feel pain or discomfort in your chest, jaw, neck or arms during activity.
  • You become dizzy with exertion.
  • You’re unsure if you’re in good health or you haven’t been exercising regularly.

If you take any medication regularly, ask your doctor if exercising will make it work differently or change its side effects — or if your medication will affect the way your body reacts to exercise.

Keep it safe

To reduce the risk of injury while exercising, start slowly. Remember to warm up before you exercise and cool down afterward. Build up the intensity of your workouts gradually.

Stop exercising and seek immediate medical care if you experience any warning signs during exercise, including:

  • Chest, neck, jaw or arm pain or tightness
  • Dizziness or faintness
  • Severe shortness of breath
  • An irregular heartbeat

Monitor your progress

The only way to detect high blood pressure is to keep track of your blood pressure readings. Have your blood pressure checked at each doctor’s visit, or use a home blood pressure monitor.

If you already have high blood pressure, home monitoring can let you know if your fitness routine is helping to lower your blood pressure, and may make it so you don’t need to visit your doctor to have your blood pressure checked as often. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.

If you decide to monitor your blood pressure at home, you’ll get the most accurate readings if you check your blood pressure before you exercise.

MARCH 20

Sleep to Recover from Hard Exercise

Sleeping can help to prevent exercise injuries. Healthy U.S. soldiers in training are less likely to suffer exercise-related injuries such as fractures, sprains and muscle strains when they sleep at least eight hours at night (Sleep Health, February 13, 2020). Compared to soldiers who slept eight hours a night, those who slept for fewer than five hours a night suffered double the rate of injuries. The average college athlete gets 6.5-7.2 hours of sleep each night (J Sci Med Sport, 2014;18), and increasing their sleep duration to eight or more hours per night improves performance in many different sports (Sleep, 2011 Jul 1; 34(7): 943-950).

Athletes who train for competition in sports that require endurance learn sooner or later that after exercising long and hard, they feel sleepy and need to go to sleep to recover (Eur J Sport Sci, 2008;8:119-126). Older people may need even more sleep after intense exercise than younger people. If you don’t get lots of extra sleep when you do prolonged intense exercise, you don’t recover as quickly and are at increased risk for injuring yourself. It works both ways: regular prolonged exercise helps insomniacs fall asleep more quickly (Sleep Med, 2011;12(10):1018-27; 2010;11(9):934-40). Sleep is necessary for healing your brain and your muscles (Front Physiol, 2014 Feb 3;5:24). You sleep to catch up on the energy that you lose being awake, both moving and thinking. Your brain uses more than 20 percent of your total energy, and the energy supply to your brain and nerves is regulated to a large degree by a chemical called ATP (Front Neur, Dec 27, 2011;2:87). When you are sleep deprived, levels of ATP drop (Prog Neurobiol, 2011;95:229-274), and when you go to sleep, brain levels of ATP rise significantly (J Neurosci, 2010;30:9007-9016).

Get Off Your Feet
• Athletes in intense training recover faster by getting off their feet after they finish their hard workouts and not even walking around until it is time for the next day’s recovery workout.
• Intense exercise damages muscles, which causes your pituitary gland to produce large amounts of human growth hormone (HGH) that helps to repair injured tissues, and you produce the largest amounts of HGH when you sleep. A ninety-minute recovery nap after you exercise also improves your ability to reason and think (Sleep, April 12, 2019;42(1):A71-A72).
• Runners who slept after a morning workout were able to run much faster all out in the evening (European Journal of Sport Science, May 31, 2018;18(9):1177-1184).
• Napping for more than 20 min after exercising improves mental preparation for subsequent performance (Sports Med, 2018;48:683-703).

Excessive Napping Can Signal Health Problems
Napping is healthful unless a person’s brain or heart is damaged so they require a lot of extra sleep (Heart, Sep 2019;105(23):1793-1798). People who take naps lasting longer than two hours are far more likely to suffer serious heart disease than those who take shorter naps or no naps at all (Sleep, 2015;38:1945-53), and people who nap longer than two hours have increased risk for diabetes as well as for heart attacks (Sci Rep, 2016;6:1-10). Excessive total sleep time appears to be a marker for serious heart disease and brain disease. Those who take daytime naps in addition to sleeping more than six hours every night are more likely to suffer heart attacks than nappers who sleep less than six hours at night (Eur Heart J, 2019;40:1-10). See my recent report, Is Napping Healthful?

Signs of Overtraining
A regular exercise program is supposed to make you feel good, increase your energy level, and help to control your weight, but exercising too much can affect your brain as well as your muscles. Athletes and dedicated exercisers often suffer from an overtraining syndrome in which their performance drops, their muscles feel sore and they are tired all the time. You may be exercising too much if you:
• feel irritable, tired during the day and unable to sleep at night
• lose your appetite
• see no improvement in your athletic performance over an extended time
• feel no enjoyment from exercising
• have frequent colds
• have persistent muscle soreness
In particular, muscle soreness on one side of your body or localized discomfort in one part of your body are major signs of an impending injury. For my personal story of overtraining syndrome, see Avoiding Overtraining

My Recommendations
Getting enough sleep is just one of the keys to recovery from intense exercise.
• Immediately after a hard workout, eat whatever sources of carbohydrates and protein you like best. I eat oranges and nuts to help me recover faster for my next workout.
• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off.
• If you feel pain in one spot that does not go away during a workout, stop that workout immediately. Otherwise, you are likely to be headed for an injury.
For more of my recommendations, see Recovery: the Key to Improvement in Your Sport

MARCH 4

Don’t Just Sit at Any Age

Older people who move around live longer than those who are consistently sedentary, and sedentary older people who become more active live longer than those who remain sedentary (Med & Sci in Spts & Ex, Aug 2013;45(8):1501-1507). Researchers followed 2635 people over 60 for two years. Those who were active at the start of the study and continued to be active throughout the study had a death rate of only 75 percent of the consistently inactive group. Those who went from an inactive to a more-active lifestyle had a death rate of 86 percent of those who remained sedentary. Those who decreased their amount of activity had a death rate of 91 percent of those who were sedentary throughout the study.

A second study in the same journal issue showed that casual exercise does not help prevent the increased risk for heart attacks and diabetes caused by spending more than 10 hours a day sitting (Med & Sci in Spts & Ex, Aug 2013;45(8):1493-1500). To protect yourself from the health consequences of sitting more than 10 hours a day, you need to stop sitting so much or exercise longer and more intensely to compensate for the hours spent sitting.

The study followed almost 2000 men and women, all over the age of 65, who wore a special machine to measure how much they were moving during their waking hours. The subjects were then divided into four quartiles based on how many hours a week they spent sitting:
1) Zero to 7.9 hours of sitting each day;
2) 7.9 to 9.2 hours;
3) 9.2 to 10.6 hours; and
4) More than 10.6 hours of sitting each day.

They found that the more time the subjects were sedentary, the more likely they were to:
• have a big belly (a sign of high blood sugar levels)
• have high blood pressure
• have high HBA1C blood test (a measure of high blood sugar)
• have a high CRP blood test (a measure of inflammation)
• have higher blood sugar levels
• have heart disease
• have diabetes
• be a smoker
• be overweight
They also found that the most sedentary subjects were more likely to be older, male, and unmarried.

How Does Sitting for Prolonged Periods Damage Your Health?
If you look at the data presented above, you will notice that people who sit for long periods have higher blood sugar levels as well as the large bellies and overweight that are associated with high blood sugar levels. They are also more likely to be diabetic and suffer high blood pressure, inflammation, and heart disease.

A high rise in blood sugar causes sugar to stick to the outer surface membranes of every cell in your body. Once there, sugar cannot detach from these membranes and eventually is converted to sorbitol that destroys the cells. Contracting muscles can help prevent a high rise in blood sugar by removing sugar rapidly from the bloodstream and not even requiring insulin to do so. This benefit can last maximally for an hour after you stop exercising and disappears completely roughly 17 hours after you finish exercising.

Resting muscles remove no sugar from the bloodstream. Everyone has a rise in blood sugar after eating so the best time to contract your muscles is just before or after you eat. You should not eat late at night because you will suffer your highest rises in blood sugar by going to bed immediately after eating.

What Do These Studies Mean to You?
If you have a job that requires many hours of sitting, getting up and exercising during your work hours would probably hamper your job performance. The best way to prevent the side effects of not contracting your muscles is to exercise intensely every day.

FEB 18

Even a 100-Year-Old Can Improve with Training

You can improve athletic performance at any age with proper training, even if you are over 100 years old. Traditional feeling among scientists is that aging is progressive and inevitable, and that your genetic programming causes you to age no matter what you do. This paper shows that physical training can reverse established markers of aging (J Appl Physiol, February 15, 2017).

I have reported on Robert Marchand, the 105-year-old cyclist who had improved his world record for how far he could ride a bicycle in one-hour from 15.07 miles (24.25 kilometers) at age 101 to 16.73 miles (26.92 kilometers) at age 103. That is an 11 percent improvement in a world record after just two years of serious training, an impressive accomplishment at any age

Marchand’s Training Program
For two years, from age 101 to 103, Marchand trained by riding 3000 miles (5,000 km) per year, with 20 percent of his workouts doing hard, intense riding and 80 percent doing slow recovery riding. He spun his pedals at a cadence between 50 and 70 rotations per minute.

The newer study documents his training program and the improvements in his markers of aging. Athletes can run, ride, swim or ski faster if they improve their maximum ability to take in and use oxygen (VO2max) and their peak power output (strength). These same measurements are used by scientists to track aging in non-athletes. Marchand’s VO2max (maximal ability to take in and use oxygen) increased 13 percent, from 31 to 35 ml.kg-1.min-1, and his peak power output increased by 39 percent, from 90 to 125 watts.

These factors improved in Marchand because he was able to increase his maximal pedaling frequency by 30 percent, from 69 to 90 rotations per minute, and his ability to take in air through his lungs by 23 percent, from 57 to 70 liters per minute. His maximum heart rate and body weight did not change.

Training That Reduces Measures of Aging
Here is a program of training that is typical of the way competitive athletes in endurance sports work to become faster.
Muscle-sugar-depleting workout (one per week): You must exercise long enough to use up most of the sugar stored in your most-used muscles. Muscles use primarily fat and sugar for energy. You have an almost infinite amount of fat stored in your body, but only a very limited amount of sugar stored in the liver and muscles. Sugar requires less oxygen than fat to fuel your muscles, so when you run out of sugar stored in your muscles, you have to slow down. Exercising long enough to deplete muscles of their stored sugar supply increases the amount of sugar they can store and also increases your ability to move faster longer. The faster you move, the quicker you use up your muscles’ stored supply of sugar. The average runner can use up most of his stored muscle sugar supply while running fairly fast for two hours, and the average bicycle rider can use up his stored muscle sugar in three hours.

Intense oxygen deficit workout (two per week): The limiting factor to how fast you can move is the time it takes to move oxygen into muscles. You can increase your ability to take in and use oxygen by using interval workouts in which you run up severe oxygen debts and gasp for breath. You also have to damage muscles so that when they heal, they become stronger. To do this you must put great pressure on your muscles by moving very fast.
Type of Intervals: A short interval lasts less than 30 seconds. You can do lots of them in a single workout because in less than 30 seconds, you do not build up much lactic acid and do less muscle damage. A long interval lasts longer than two minutes and you should do only a limited number of these intervals because they cause considerable muscle damage and can take a long time for muscles to heal and recover.
Recovery workouts (at least four per week): Intense interval workouts cause considerable muscle damage, and it usually takes at least 48 hours for muscles to heal, so each intense workout requires easier workouts on the following day. If you are training twice a day, each intense workout is usually followed by three recovery workouts.Example of a Weekly Training Program
Sunday: race or depletion workout
Monday: recovery workout
Tuesday: short intervals
Wednesday: recovery workout
Thursday: long intervals
Friday: recovery workout
Saturday: recovery workout

How to Apply These Concepts to an Ordinary Exercise Program
While exercisers who are not competing are likely to spend far less time in their sport, they can still benefit from following the same training principles. Increasing evidence shows that intense exercise is more effective than casual exercise, so plan to introduce at least some intense intervals into your program. You can gain the health benefits and help to prevent injuries if you:
• Plan to exercise every day
• Realize that if you are training properly, your legs are likely to feel sore every morning. If your legs do not feel fresh after a 5-to-10-minute warm up, take the day off.
• Stop your workout immediately if you feel a tightness, discomfort or pain in one area.
• As soon as your legs start to feel heavy during a workout, stop for the day.

Caution: People with blocked arteries leading to their hearts can be harmed by intense exercise, so check with your doctor if you have any questions.

JAN 29

Avoiding Overtraining

Exercising too much can affect your brain as well as your muscles. Athletes and dedicated exercisers often suffer from an overtraining syndrome in which their performance drops, their muscles feel sore and they are tired all the time. In a new study, elite athletes were instructed to overtrain for three out of nine weeks, and were then compared to a group who did a normal nine-week training program (Current Biology, September 26, 2019). Not only did the overtrained athletes perform worse on endurance tests, their brains were affected as well as their muscles and other body functions. The overworked athletes suffered from mental symptoms including depression, irritability, restlessness, insomnia, and loss of appetite. They also made poor decisions in special tests such as choosing meager immediate personal rewards over more substantial delayed rewards (i.e., taking $10 now rather than $50 in six months). MRIs of their brains showed markedly reduced activity of the lateral prefrontal cortex, a key region in which a person makes important personal decisions. This study agrees with a previous study that used MRIs and tests to show that overworked office workers made poorer decisions and had reduced activity of the lateral frontal cortex of their brains (Proc Natl Acad Sci USA, 2016; 113: 6967-6972).

Signs of Overtraining
A regular exercise program is supposed to make you feel good, increase your energy level and help to control your weight. You may be exercising too much if you feel:
• tired all the time
• irritable
• unable to sleep
• loss of appetite
• no improvement in your performance over an extended time
• no enjoyment of exercising
You may also have:
• frequent colds
• increased resting heart rate
• reduced maximum heart rate
• persistent muscle soreness
In particular, muscle soreness on one side of your body or localized discomfort in one part of your body are major signs of an impending injury.

My Personal History of Overtraining
Athletes train by stressing and recovering. You make a muscle stronger by stressing that muscle, feeling sore on the next day, and taking easy workouts or days off until the soreness goes away. Then you are supposed to take a hard workout again. If you do not feel muscle soreness on the day after a hard workout, you have not injured your muscles and they will not become stronger. Sometimes your muscles still feel a little sore several days after a hard workout, but you think that you have recovered and are ready to stress your muscles again, so you go ahead and try to run very fast. You start to feel sore all the time, your joints, muscles and tendons ache, and you feel tired. You can still run with the soreness in your muscles and tendons, but the soreness prevents you from running fast. Each succeeding day, the soreness increases and you think that you are sick.

This happened to me when I was training for a marathon, so I ordered tests including a complete blood count, liver tests, BUN, creatinine, urinalysis, and a throat culture, but all the results were normal. I couldn’t run my intervals as fast as usual. I had been able to run 10 quarters in 65 seconds and now I couldn’t get through more than three of them without my muscles feeling very sore. I knew something was wrong, so I asked a friend who was a researcher at a nearby university to test me. He told me that I had impaired anaerobic lactic acid clearance and a reduced time-to-exhaustion in standardized high-intensity endurance exercise tests. My maximum heart rate was 10 beats lower than normal, my lactate levels were lowered during sub-maximal performance, and I had a reduced respiratory exchange ratio during exercise. By now I was quite depressed, so I got further tests and decided I might have a hidden lymphoma, but my complete diagnostic workup was normal. I was stuck with a diagnosis of training too much.

Recovery from Overtraining
When you are suffering from overtraining, you need to go back to background work. These principles apply to any sport. For a runner, jog on the days that you can. Take days off when you feel sore. After several weeks, you are able to start regular jogging and your muscles feel fresh again. When this happens, you are ready to start training, but first you must promise yourself that you will never try to run fast when you feel soreness in your muscles and tendons. Set up a schedule in which you take a hard-fast workout, feel sore on the next day, and then go at an easy pace in your workouts until the soreness has completely disappeared. You may set up a schedule to try to take a hard workout every third or fourth day, but you will skip a hard workout on any day that you feel sore.

Most runners plan to run very fast once a week and long once a week. You recover faster from a hard workout by doing nothing, but jogging slowly on recovery days causes more fibrous tissue to form in your muscles so that they are more resistant to injury. Don’t calculate total miles per week in your diary; that will encourage you to pile up junk miles and prevent you from learning how to run fast. You can run in races only as fast as your fastest workout intervals. Set up a program in which you run very fast on Wednesdays and long and brisk on Sundays, and make all your other workouts easy recovery ones.

Competitive runners usually use interval workouts to increase their speed. When you have recovered from overuse syndrome, you should start with short intervals before you try longer ones. For example, you could start with 110 yard intervals. Mark the track in quarters, using the fifty yard lines and the middle of the goal posts. Alternate running 110 yards fast and comfortably, and jogging 110 yards until your legs start to feel heavy and stiff. When you can run at last 20 repetitions of 110 yards fairly fast, try do repeat 220s, and as the weeks progress, work up to repeat half miles. Don’t try to run through the stiffness or you will take weeks to recover. If your legs are exceptionally sore, take the next day off. If they are not sore, jog easily on the next two or three days.

Use your Sunday workouts to try to gain endurance. Your endurance day should not be as fast as your interval day. Each Sunday, try to work up to where you can run fairly fast for up to two hours. You may have to start out with a long run of only 30 minutes, but be patient. Lack of patience can lead to overtraining syndrome. You should eventually be able to learn how to train without injuring yourself and avoid making the same overtraining mistakes again.

JAN 7

Excess Sugar Favors Growth of Harmful Gut Bacteria

Dietary sugar is supposed to be absorbed in the upper intestinal tract, but research from Yale suggests that taking in excessive amounts of sugar can cause some of the sugar to pass through the intestines unabsorbed. This sugar arrives in your colon where it can harm you by keeping healthful bacteria from growing in your colon and encouraging the overgrowth of harmful bacteria (PNAS, Dec 17, 2018). Specifically, unabsorbed sugar in your colon can prevent the good bacteria from producing a key protein called “Roc” (regulator of colonization), which is required for growth of the healthful species Bacteroides thetaiotaomicron (B. theta) in your colon. This research was done in mice, but it should also apply to humans.

How Too Much Sugar Harms You
We have known for many years that eating too much sugar can harm you by causing high rises in blood sugar, which can damage cells throughout your body and can also lead to diabetes. The new theory proposed by this study is that some excess sugar also passes unabsorbed all the way to your colon where it can harm you by changing the bacteria that live in your colon.

The Differences between Healthful and Harmful Colon Bacteria
More than 100 trillion bacteria live in your colon and these bacteria help to govern your immune system. The healthful bacteria are happy eating the food that reaches them in your colon, while the harmful bacteria are not happy with the food that you eat and instead try to invade the cells lining your colon. Your immune system tries to defend you by producing huge amounts of white blood cells and chemicals that work to destroy the invading bacteria by punching holes in their outer membranes and trying to kill and eat them. This constant invasion of your colon cells by harmful bacteria can cause your immune system to stay overactive all the time, which is called inflammation.

Findings of This Study
The good and bad bacteria compete for space in your colon. Healthful bacteria called B. theta produce a chemical called Roc that enhances their growth. Normally the sugars glucose and fructose do not reach your colon, but eating and drinking excess sources of sugar can cause these sugars to overload your intestines so that they are not all absorbed and reach your colon where they prevent the B. theta from producing Roc. Without Roc, the B. theta do not thrive and multiply, which allows harmful bacteria to replace them in your colon. The researchers at Yale demonstrated this by engineering a strain of B. theta in which sugar did not suppress Roc, and showed that these engineered bacteria were able to thrive in the colons of mice fed a high-sugar diet. If these results can be duplicated in humans, they will show how eating large amounts of sugar can affect the numbers of good and bad bacteria that grow in your colon.

My Recommendations
I will watch for more research on the effects of excess sugar on colon bacteria, but meanwhile, this study gives one more important reason to limit or avoid foods with added sugars and drinks with sugars in them, including fruit juices. Anything that hinders the growth of healthful bacteria and fosters the growth of harmful bacteria can increase your risk for obesity, heart attacks, strokes and some types of cancers

DEC10

Should Runners and Cyclists Lift Weights?

Competitive endurance athletes usually run or cycle very intensely on one day, feel sore on the next day and go easy for that day as they alternate hard-and-easy workout days. Adding strength training to an endurance program markedly increases athletes’ chances of injuring themselves unless they learn to recognize the signs of overtraining and back off training when their muscles feel excessively fatigued or sore. If endurance athletes add weights to their training programs, they should do the strength training on the same day that they take their intense running or cycling workouts, and not put stress on their leg muscles on their recovery days.

Muscles are damaged on hard training days, and they heal and get stronger on the following slower recovery day. Lifting weights on a recovery day prevents muscle healing. Extensive data show that lifting weights damages muscle fibers for at least a day afterwards, so that the involved muscles are weaker and would interfere with any attempted intense endurance workouts on the next day (Sports Med, Nov 2017;47(11):2187-2200). For at least a day after lifting weights, athletes are at high risk for tearing muscle fibers if they attempt  intense endurance workouts.

Research Supports Strength Training

In one study, 19 well-trained female duathletes were assigned to either:
• run and cycle with an added strength training program, or
• just run and cycle.
The strength training program included four lower body exercises, three times each, twice a week for 11 weeks. The added strength training improved their running and cycling performance done after strenuous exercise, but not after resting (Physiol Rep, Mar 2017;5(5)). This is just the latest of many conflicting studies that show either improvement or no improvement when strength training is added to an endurance sport training program.

A review of many scientific articles shows that runners and bicycle racers can run and cycle faster with added strength training (Scand J Med Sci Sports, Oct 2010;20 Suppl 2:39-47) because it makes them stronger (J Strength Cond Res, 2013;27(9): 2433–2443), so that they can run and cycle more efficiently with less effort (Med Sci Sports Exerc, 2008;40(6): 1087–1092). Other research shows that adding strength training to an endurance program can make muscles larger and stronger (Sports Med, Aug 2016;46(8):1029-39). However, the improvement in racing performance with added weightlifting is small, and sometimes nonexistent, because lifting weights does not improve VO2max (the ability to take in and use oxygen). The limiting factor for how fast an endurance athlete can run or cycle is the time it takes to move oxygen into muscles, and that is improved only by training that involves becoming short of breath (Med Sci Sports Exerc, 2002;34(8):1351–1359).

My Recommendations

• Non-competitive runners and cyclists should alternate faster and more intense days with slower recovery days. They should do strength training only for their core and upper bodies and not do strength training on their legs. Combining endurance and strength training on the same muscle groups increases risk for injury.

• Most competitive athletes are best off with the same program: leg endurance training and upper body and core strength training.

• Elite runners and cyclists can try to combine leg strength training with leg endurance training, but they should do the strength training not more than twice a week, only on the hard days after intense endurance workouts and never on recovery days. They should skip the weight workouts when their muscles feel excessively sore or tight, stop the strength training workouts during their competitive season, and watch for signs of impending injuries (such as localized pain in just one leg).

DEC 3

Exercise Promotes Good Gut Bacteria

Good bacteria that live in your gut can help to keep you healthy, while the bad colon bacteria increase your risk for heart attacks, strokes, diabetes, certain cancers and autoimmune diseases. Researchers have focused mainly on how diet affects the growth of good and bad gut bacteria, but now two new studies–one in humans and one in mice–show that exercise encourages the growth of good bacteria in your colon and reduces the number of bad ones. These studies suggest that exercise can do this without any changes in diet.

Exercise and Gut Bacteria in Humans
Researchers had 18 lean and 14 obese subjects exercise for 30 to 60 minutes, three days per week for six weeks (Medicine & Science in Sports & Exercise, Nov 11, 2017). Then they were told not to exercise for six weeks. All subjects were told not to change their diets. After the six weeks of exercise, all of the subjects, both obese and lean, had an increase in the good colon bacteria that make short chain fatty acids (butyrate) and suppress inflammation. The lean subjects had the greatest increase in the good bacteria after exercising and the obese subjects had a more modest increase in the good bacteria.

When the same subjects were checked after six weeks of not exercising, all had a marked drop in these good colon bacteria. This study shows that exercise appears to increase the number of good colon bacteria without any dietary change whatever, that lean people have a greater increase than obese people, and that the potential benefit does not last if exercise is stopped.

Exercise and Gut Bacteria in Mice
Researchers took fecal material from groups of exercising mice and sedentary mice, and transplanted it into the colons of the bacteria-free mice (Gut Microbes, published online Sep 1, 2017). The bacteria-free mice developed the same types of colon bacteria that they received from each donor group. Fecal samples taken from exercising mice gave the recipient mice much higher levels of the beneficial bacteria that produce high levels of short chain fatty acids (butyrate) that are anti-inflammatory and help to lower cholesterol.

Then the researchers gave the recipient mice chemicals that cause inflammation to damage their colons and cause colitis. The mice that had received bacteria from the exercising mice had far less inflammation, far less colon damage and much quicker recovery times than the mice who had received bacteria from the sedentary mice.

Functions of Gut Bacteria
More than 100 trillion microorganisms live in your colon (FEMS Microbiol. Rev, 2014;38:996–1047), which means that only about ten percent of the total number of cells in human body are human cells, with the rest coming from symbiotic bacterial cells (Nature, 2010 Jun 17; 465(7300):879-80). Over the last few years, a very large number of studies have increased our understanding of the many functions of gut bacteria. My reports on this important research include:
How Soluble Fiber Promotes Good Gut Bacteria
Gut Bacteria and Auto-Immune Diseases
How Gut Bacteria Affect Weight
Colon Cancer, Gut Bacteria and Diet
Anti-Inflammatory and Pro-Inflammatory Foods
Gut Bacteria to Help Treat and Prevent Cancers

NOV 24

Warming Up

Warming up before you exercise helps to prevent injuries and lets you jump higher, run faster, lift heavier or throw further. Your warm-up should involve the same muscles and motions you plan to use in your sport. For example, before you start to run very fast, do a series of runs of gradually-increasing intensity to increase the circulation of blood to the muscles you will be using (J Clin Diagn Res, 2017;11(3):YC05–8)..

Muscles are made up of millions of individual fibers, just like a rope made from many threads. When you start to exercise at a very slow pace, you increase the blood flow to muscle fibers, increase their temperature, and bring in more oxygen, so the muscles are more pliable and resistant to injury. When you contract a muscle for the first time, you use less than one percent of your muscle fibers. The second time you bring in more fibers, and you keep on increasing the number of muscle fibers used in each contraction for several minutes of using that muscle. It’s called recruitment. When you are able to contract more muscle fibers, there is less force on each individual fiber to help protect them from injury. Usually you are warmed up when you start to sweat.

The same principle applies to your heart. Angina is a condition in which the blood vessels leading to the heart are partially blocked so the person has no pain at rest, but during exercise, the blocked arteries don’t permit enough blood to get through to the heart muscles, causing pain. If people with angina exercise very slowly before they pick up the pace, they are able to exercise longer and more intensely before they felt heart pain. Always check with your doctor if you feel any heart pain during exercise.

Competitive athletes in sports requiring speed and endurance perform better after they warm up with increasing intensity. Warming up slowly does not increase the maximum amount of oxygen that you can bring to muscles that you need during competition. If you are a runner, skier, cyclist, or an athlete in any sport that requires endurance, warm up at a gradually increasing pace. Use a series of increasingly intense repetitions of 10 to 30 seconds duration, with short recoveries, until you are near your maximum pace. This type of warm-up increases endurance because intensity increases the maximum amount of oxygen that you can bring to your muscles, as you continue to compete, and lets your muscles contract with greater force as you begin to fatigue. You will then be able to bring in more oxygen to your muscles than you could have done without the intense warm-up.

NOV 5

Inactivity Causes Muscle Loss

Even short periods of inactivity cause dramatic loss of muscle size and strength. After just two weeks of having one leg put in a cast, all 32 men in the study lost a tremendous amount in all measures of physical fitness, strength and muscle size in the immobilized leg. After six weeks of pedaling a bicycle for rehabilitation, they still did not regain all of the strength that they had lost (Journal of Rehabilitation Medicine, June 2015). Another study showed that a person loses significant strength after stopping exercise for just four days (Exp Gerontol 2013; 48: 154–161).

Young Men Lost More Than the Older Men

The new study compared 17 young men (average age 23) and 15 older men (average age 68). The younger men lost 30 percent of muscle strength and the older men lost 25 percent. People with the largest muscles to begin with are the ones who will lose the most strength when an injury, illness or vacation stops them from exercising. That explains why younger people lose strength at a faster rate than older people. A young man who is immobilized for two weeks loses muscular strength in his leg equivalent to aging by 40 to 50 years.

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The more muscle mass you have, the more you will lose. Young men have about two pounds more muscle weight in each leg than older men do, but after two weeks of inactivity, young men lost 17 ounces of muscle, compared to older men who lost nine ounces. This means that an injury causes fit people with larger muscles to lose more muscle size and strength than inactive people.

Muscles are made up of thousands of individual fibers like a rope is made of many strands. Regular exercise enlarges fiber size. Inactivity causes muscle fibers to become smaller. Therefore those with the largest fibers lose the most muscle size and strength when they stop exercising.

Rehabilitation after Inactivity

After the two weeks of immobilization, the participants trained on a bicycle 3-4 times a week for six weeks. They regained some but not all of the muscle size and strength that they lost. Aerobic training (such as running and cycling) should not be used as the only rehabilitation training. Strength training should be used along with aerobic activity to regain lost muscle strength and size. You need to lift weights or do some other form of strength training for recovery. Other studies show that it usually takes at least three times as long as the period of inactivity to recover full strength (J Am Med Assoc, 2007; 297: 1772–1774).

Why Aerobic Exercise is Not Enough

To make a muscle larger and stronger, you must exercise intensely enough to damage muscle fibers. When you use your muscles, you contract the muscle and shorten its fibers. However, you do not contract a muscle fiber equally throughout its length. Muscle fibers are made up of blocks touching end to end to form the long stringy muscle fiber. Each block touches the next block at a point called the Z-line. You have to damage the Z-line to make a muscle grow larger and stronger. If you pedal with great pressure, you will damage the muscle fibers at the Z-lines and when they heal, muscles will become stronger. However, most people do not pedal hard or long enough to cause enough damage to make the muscle larger and stronger when it heals. Adding weight training to the recovery program will help to regain the lost strength and muscle size.

What Does This Mean for You?

If you have to stop exercising for even just a few days because of an injury, vacation or illness, expect to lose strength and endurance. When you resume exercising, you should do some form of strength training to regain your lost strength. Caution: Pain at the site of an injury means that you are tearing the previously injured muscle fibers and should stop exercising immediately.

OCT 22
Push-Ups: Train to Do the Most

If you want to be able to do 100 push-ups in a row, do not try to do as many push-ups as possible every day. You’ll probably injure yourself and end up unable to do any push-ups at all. Training for competition requires an understanding of the stress-and-recover rule and the interval-sets rule.

The best way to improve any athletic skill is to stress your body on one day and then allow enough time for your body to recover before you stress it again. On one day, take a hard workout. On the next morning, your muscles feel sore. Take easy workouts until the soreness disappears and then take a hard workout again.

For your hard workouts, you can do far more work by exercising in sets, rather than continuously. If you can do six continuous push-ups, you can probably do ten sets of two with twenty-second rests between each set. Do repeat sets of two until your muscles feel sore. Try to take workouts that are hard enough to make your muscles feel sore for no more than 48 hours. An ideal training program would consist of sets of three until you feel sore on the first day, take off the second day, do sets of five on the third day until you feel soreness, and rest on the fourth day. Repeat these four-day cycles, and you’ll soon be ready to compete.

OCT 18

NSAIDs May Block Gains in Endurance and Strength

A study io mice showed why taking NSAIDS (Non-Steroidal Anti-Inflammatory Drugs), to reduce muscle pain before, during or after exercise, can reduce the gains in endurance from aerobic training (PNAS, June 27, 2017;114(26):6675–6684). The processes that heal damaged tissue in your body use the same immune cells and chemicals that fight infections. Certain prostaglandins that heal damaged tissues are the same prostaglandins that cause muscle soreness. These prostaglandins can hasten healing of muscles damaged by vigorous exercise by increasing production of stem cells to replace damaged muscle cells. They also increase endurance by increasing blood flow to damaged muscles, widening blood vessels and increasing the ratio of blood capillaries to muscle fibers. Taking NSAIDs hinders this process and can prevent the gains in endurance that you would expect to get from your exercise. Earlier studies in humans showed that taking NSAIDs can reduce the gains in endurance from aerobic exercise by restricting the ratio of blood capillaries to muscle fibers and decreasing the number of strength fibers in muscles (J Physiol Pharmacol, Oct 2010;61(5):559-63).

How NSAIDs Can Reduce Benefits of Strength Training
I recently reported on a study showing that taking NSAIDs before or after lifting weights can delay recovery and reduce the beneficial effects of lifting weights to strengthen muscles and bones (Med & Sci in Sports & Ex, April 2017;49(4):633–640) .   To make a muscle stronger and to increase its endurance, you have to exercise it long enough and hard enough to damage the muscle fibers. Then when the muscle fibers heal, the muscles become larger and stronger. Bones also need resistance force on them to make them stronger (Nutr Res Pract, 2010;4(4):259–69), and anything that makes muscles stronger should also make the corresponding bones larger and stronger. To make muscles and bones stronger, you take an intense workout that makes your muscles feel the burn during the workout and the next day your muscles feel sore because of the fiber damage you have caused. If you take NSAIDs such as ibuprofen to reduce the muscle soreness, you are also likely to reduce your gains in muscle and bone strength (Bone Rep, 2015;1:1–8; 2016;5:96–103).

My Recommendations
• If you want to become significantly stronger and have greater endurance, you need to exercise intensely enough to feel a burn in your muscles during exercise. You can gain the benefits from your exercise and help to prevent injuries if you slow down or stop to take yourself out of the burn as soon as you start to feel it. When you have recovered your breath and the muscle burning is gone, you can pick up the pace again. Competitive athletes usually train by alternating going in and out of the burn during a single workout.
• You may be able to reduce after-exercise muscle soreness by taking NSAIDs before, during or after exercise, but they can reduce your gains in strength and endurance. Also be aware of their other possible side effects such as increased risk for kidney damage (Emergency Medical Journal, July 5, 2017) and gastro-intestinal bleeding.
• Applying ice to sore muscles will reduce the soreness as it helps to reduce pain, but cooling also can delay healing.

OCT 6
Avoiding Overtraining
Exercising too much can affect your brain as well as your muscles. Athletes and dedicated exercisers often suffer from an overtraining syndrome in which their performance drops, their muscles feel sore and they are tired all the time. In a new study, elite athletes were instructed to overtrain for three out of nine weeks, and were then compared to a group who did a normal nine-week training program (Current Biology, September 26, 2019). Not only did the overtrained athletes perform worse on endurance tests, their brains were affected as well as their muscles and other body functions. The overworked athletes suffered from mental symptoms including depression, irritability, restlessness, insomnia, and loss of appetite. They also made poor decisions in special tests such as choosing meager immediate personal rewards over more substantial delayed rewards (i.e., taking $10 now rather than $50 in six months). MRIs of their brains showed markedly reduced activity of the lateral prefrontal cortex, a key region in which a person makes important personal decisions. This study agrees with a previous study that used MRIs and tests to show that overworked office workers made poorer decisions and had reduced activity of the lateral frontal cortex of their brains (Proc Natl Acad Sci USA, 2016; 113: 6967-6972).

Signs of Overtraining
A regular exercise program is supposed to make you feel good, increase your energy level and help to control your weight. You may be exercising too much if you feel:
• tired all the time
• irritable
• unable to sleep
• loss of appetite
• no improvement in your performance over an extended time
• no enjoyment of exercising
You may also have:
• frequent colds
• increased resting heart rate
• reduced maximum heart rate
• persistent muscle soreness
In particular, muscle soreness on one side of your body or localized discomfort in one part of your body are major signs of an impending injury.

My Personal History of Overtraining
Athletes train by stressing and recovering. You make a muscle stronger by stressing that muscle, feeling sore on the next day, and taking easy workouts or days off until the soreness goes away. Then you are supposed to take a hard workout again. If you do not feel muscle soreness on the day after a hard workout, you have not injured your muscles and they will not become stronger. Sometimes your muscles still feel a little sore several days after a hard workout, but you think that you have recovered and are ready to stress your muscles again, so you go ahead and try to run very fast. You start to feel sore all the time, your joints, muscles and tendons ache, and you feel tired. You can still run with the soreness in your muscles and tendons, but the soreness prevents you from running fast. Each succeeding day, the soreness increases and you think that you are sick.

This happened to me when I was training for a marathon, so I ordered tests including a complete blood count, liver tests, BUN, creatinine, urinalysis, and a throat culture, but all the results were normal. I couldn’t run my intervals as fast as usual. I had been able to run 10 quarters in 65 seconds and now I couldn’t get through more than three of them without my muscles feeling very sore. I knew something was wrong, so I asked a friend who was a researcher at a nearby university to test me. He told me that I had impaired anaerobic lactic acid clearance and a reduced time-to-exhaustion in standardized high-intensity endurance exercise tests. My maximum heart rate was 10 beats lower than normal, my lactate levels were lowered during sub-maximal performance, and I had a reduced respiratory exchange ratio during exercise. By now I was quite depressed, so I got further tests and decided I might have a hidden lymphoma, but my complete diagnostic workup was normal. I was stuck with a diagnosis of training too much.

Recovery from Overtraining
When you are suffering from overtraining, you need to go back to background work. These principles apply to any sport. For a runner, jog on the days that you can. Take days off when you feel sore. After several weeks, you are able to start regular jogging and your muscles feel fresh again. When this happens, you are ready to start training, but first you must promise yourself that you will never try to run fast when you feel soreness in your muscles and tendons. Set up a schedule in which you take a hard-fast workout, feel sore on the next day, and then go at an easy pace in your workouts until the soreness has completely disappeared. You may set up a schedule to try to take a hard workout every third or fourth day, but you will skip a hard workout on any day that you feel sore.

Most runners plan to run very fast once a week and long once a week. You recover faster from a hard workout by doing nothing, but jogging slowly on recovery days causes more fibrous tissue to form in your muscles so that they are more resistant to injury. Don’t calculate total miles per week in your diary; that will encourage you to pile up junk miles and prevent you from learning how to run fast. You can run in races only as fast as your fastest workout intervals. Set up a program in which you run very fast on Wednesdays and long and brisk on Sundays, and make all your other workouts easy recovery ones.

Competitive runners usually use interval workouts to increase their speed. When you have recovered from overuse syndrome, you should start with short intervals before you try longer ones. For example, you could start with 110 yard intervals. Mark the track in quarters, using the fifty yard lines and the middle of the goal posts. Alternate running 110 yards fast and comfortably, and jogging 110 yards until your legs start to feel heavy and stiff. When you can run at last 20 repetitions of 110 yards fairly fast, try do repeat 220s, and as the weeks progress, work up to repeat half miles. Don’t try to run through the stiffness or you will take weeks to recover. If your legs are exceptionally sore, take the next day off. If they are not sore, jog easily on the next two or three days.

Use your Sunday workouts to try to gain endurance. Your endurance day should not be as fast as your interval day. Each Sunday, try to work up to where you can run fairly fast for up to two hours. You may have to start out with a long run of only 30 minutes, but be patient. Lack of patience can lead to overtraining syndrome. You should eventually be able to learn how to train without injuring yourself and avoid making the same overtraining mistakes again.

SEPT 28

The Guide to Training Over 40: What happens to your body when you get older?

There are pros and cons as you get older, and a little more decline if you’re into training, but there are also interventions that you can make to adapt to changes and maintain a lifestyle of efficiency long into what is perceived as old age. First, we’ll take you through the changes that occur when you get older:

You’ll see a decrease in muscle mass and strength with age as exemplified by this study. But it does go on to explain that resistance and strength training, making use of rubber bands or weights, can significantly delay this loss and aid you in maintaining your size and strength. If done with regularity it can even lead to continued increases.

Loss of bone density which can lead to you picking up injuries more easily, by keeping this in mind you can be proactive about how you train, being conscious of what your body is saying to you.

Aging might not only affect strength and power but your flexibility too and this is why exercise classes like yoga and Pilates are highly recommended to keep yourself elastic, while keeping your range of motion.

Your VO2max levels will also decrease and this should be of concern to endurance athletes. Although it has been shown that there is a difference in VO2max drops between sedentary individuals, moderate exercises and endurance athletes.

Production of testosterone also decreases and this can mean weight gain. This is the reason why many older people can see a bit more difficulty growing muscle mass, but it’s also attributed to having a protective effect.

But it isn’t all so bad!

A study shows that you are more content with life – which can help when it comes to staying motivated and determined to train more.

But many studies like this one agree that with proper exercise and diet the effects of aging can be modified. Therefore, it appears that your lifestyle contributes greatly to how you’ll feel later in life.

And how can you know what your proper diet and exercise is?

First of all, it’s always good to consult a personal trainer or nutritionist. They will be able to help guide you and discover what is best for you.

But different solutions work for different people. Everyone is unique so general solutons are less likely to work for everyone. This is why it’s important to get to know your body better. Genetic testing is one of the easiest ways to do that. Special genetic tests which are optimized for fitness and nutrition will help you find the optimum fitness and nutrition plans for you as well as give you the extra insight into your body.

You’ll have the confidence to run faster, lift more and aim higher – even during your older years, equipped with the knowledge that what you are doing allows you to perform at an optimal level.

SEPT 25

Can You Exercise Too Much

Countless studies have shown that exercise helps to prevent heart attacks, but some researchers have found scarring in heart muscle and increased plaques in the heart arteries of men who have run many marathons and triathlons, resulting in news headlines warning of “too much exercise.”

• A study of 50 men who ran 3,510 marathons showed that some of these men had excess plaques in their heart arteries (Med Sci Sports Exerc, Dec 2017;49(12):2369-2373). The increase in plaques was proportional to the individual’s conventional heart attack risk factors (previous smoking, high blood pressure, high cholesterol, a pro-inflammatory diet, etc.,) and appeared to be totally unrelated to the distances or number of years they ran. Indeed, those who had started running later in life had more plaques.
• A study of endurance athletes who exercised more than 2000 METs/week showed more plaques in their arteries than those who exercised less. However, the endurance athletes had primarily stable plaques, not the mixed plaques that are the type that is more likely to break off to cause heart attacks (Circulation, April 27, 2017;136:138-148). See Exercisers Have More Stable Plaques
• Master athletes who compete in endurance events in later life have far fewer plaques and the plaques that they have are far more stable than the plaques of non-exercisers (Circulation, May 2, 2017).
• A study of 12 lifelong endurance athletes over 50 years of age found that six had evidence of scarring in their heart muscles that was associated with the number of years spent training and the number of competitive marathons (J Appl Physiol, Jun 2011;110(6):1622-6). None of these men had any heart problems or difficulty with running very long distances. Nobody knows the significance of this finding and nobody has shown that this scarring is associated with any heart problems in endurance athletes.

At this time, the prevailing opinion is that:
• heart attacks are the result of sudden complete obstruction of blood flow to the heart caused by clots formed by plaques breaking off from arteries leading to the heart,
• plaques form in arteries primarily from a faulty diet, and
• exercise helps to prevent heart attacks by stabilizing plaques so that they do not break off to start the process that causes heart attacks.

My Recommendations
Everyone should exercise unless they have a specific reason why they should not exercise. In addition to trying to exercise every day to stabilize the plaques in your arteries, you should follow a lifestyle that prevents plaques from forming in your arteries in the first place by:
• eating lots of vegetables, fruits, nuts, beans, whole grains and other seeds
• restricting all sugared drinks including fruit juices, sugar-added foods, red meat, processed meats and fried foods
• avoiding smoke, alcohol and recreational drugs
• avoiding overweight
• keeping blood levels of hydroxy vitamin D above 20 ng/ml

SEPT 17

Exercise to Prevent a Heart Attack

The same training principles that improve athletic performance in competitive athletes also help to prevent heart attacks and prolong lives:
• The SUN Study on 18,737 middle-aged people showed that those who exercise intensely have half the rate of heart attacks as those who do the same amount of exercise less intensely (Am J of Cardiology, Sept 11, 2018)
• Vigorous exercise is associated with a much lower rate of metabolic syndrome and diabetes than low-intensity exercise (American J of Prev Med, April 2017;52(4):e95–e101)
• An extensive review of major articles shows that exercise helps to prevent heart attacks and strokes (J of Clinical and Preventive Cardiology, 2017;6(3):109-114)
• Even low doses of exercise, such as slow walking, are associated with reduced likelihood for heart attacks and strokes (Am J Lifestyle Med, Jul 1, 2009;3(1 Suppl):44S–49S)
• The amount of time teenagers spend exercising intensely predicts markers of arteriosclerosis and inflammation far more than how much time they spend sitting still (PLoS Medicine, Sept 2018;15(9):e1002649)
• A Mediterranean diet and regular exercise, individually and combined, are associated with reduced risk for heart attacks and strokes (Eur J of Prev, June 26, 2018)

How Intense Exercise Helps to Prevent Heart Attacks
Intense exercise makes muscles stronger, including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise also helps to stabilize plaques in arteries and widens heart arteries to help protect you from a heart attack.

Stress and Recover
If you try to exercise intensely every day, you are at high risk for injuries. To become stronger and faster and have greater endurance, you need to exercise on one day intensely enough to damage your muscle fibers and feel short of breath. Then you will feel sore on the next day and are supposed to exercise at a reduced intensity for as many days as it takes for your muscles to heal and the soreness to lessen or disappear. Only then should you take your next intense workout.
• You can tell you are exercising intensely enough to damage your muscles by a feeling of burning in your muscles when you exercise.• You will not improve your maximal ability to take in and use oxygen unless you exercise intensely enough to become short of breath.

Use Interval Training to Avoid Injuries
Adding interval workouts to an endurance training program specifically makes muscles stronger than continuous endurance training (Med & Sci in Sprts & Exe, June 2017;49(6):1126–1136). To use intervals in your exercise program, first you warm up for 10 or more minutes by going at a slow pace. Then you pick up the pace in your sport (such as running, skiing or cycling) until you start to feel a burning in your muscles or start breathing hard, usually after about 5-30 seconds. Then slow down. When you have completely recovered your breath and your muscles feel fresh again, start your next interval. Alternate picking up the pace and slowing down for full recovery until your muscles start to feel stiff or heavy, and then cool down by exercising at a slow pace for about 10-15 minutes. Most people will be able to do 5-20 short intervals of less than 30 seconds each in their early workouts and increase the number slightly as they keep on doing intervals two or three times a week. You can avoid injuries as long as you listen to your body when it tells you to reduce the intensity or to stop your workout.

Recovery Days
Most athletes in endurance and strength sports exercise on their recovery days and do not plan to take many days off. However, on recovery days, they work at a markedly reduced intensity to put minimal pressure on their muscles. If you develop pain anywhere that gets worse as you continue exercising, or doesn’t go away when you slow down, you are supposed to stop exercising for that day. Active recoveries on easy days at low intensity make muscles tougher and more fibrous so your muscles can withstand harder workouts on your intense days.

My Recommendations
• Before you start a program of interval training to improve your endurance, you should have exercised regularly for many months, be in good shape and not have any health conditions that can harm you.
• Try to set up your exercise program so that you take a hard workout that damages your muscles so they feel sore on the next day. Then take easy workouts until the soreness goes away, and then take your next hard workout.
• Immediately after an intense workout, eat whatever source of carbohydrates and protein you like best. I eat oranges and nuts immediately after I finish an intense workout to help me recover faster for my next workout. See Why You Should Eat Within One Hour After an Intense Workout.
• When you are training properly, your muscles may feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off. I do not recommend taking NSAIDs to Relieve Muscle Soreness; they can interfere with your strength gains.
• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately. Otherwise you are headed for an injury.

CAUTION:Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or make a sudden increase in the intensity of your existing program.

SEPT 13

How Soluble Fiber Helps to Prevent Heart Attacks

Forty percent of deaths in the United States are from heart disease, which kills more than 400,000 people each year. Soluble fiber (from beans, oats, peas, barley, nuts, fruits and vegetables) reduces high blood levels of Low-Density Cholesterol (LDL), one of the strongest predictors of heart attack risk (Curr Atheroscler Rep, Dec 2016;18(12):75). Soluble fiber also improves immune function and lowers other risk factors for heart attacks:
• high blood pressure,
• high blood sugar,
• high blood insulin,
• high triglycerides,
• excess body fat (particularly belly fat), and
• inflammatio

How Soluble Fiber Lowers Cholesterol
The intestinal tract of humans allows only single molecules to pass through to be absorbed into the bloodstream. You cannot absorb fiber into your bloodstream because it is a long chain of sugars bound end-to-end so tightly that the enzymes in your intestines are unable to separate them.

Fiber is classified into two main types: soluble and insoluble. Insoluble fiber cannot be broken down by humans, so it cannot be absorbed into your bloodstream and it passes from your body undigested. Soluble fiber can be dissolved in water, so although it cannot be absorbed from your upper intestinal tract, it can be broken down by bacteria in your colon into short chain fatty acids that are absorbed through your colon into your bloodstream (Appl Physiol Nutr Metab, June 2015;40(6):535-42).

Soluble fiber is a highly viscous gel that lowers blood cholesterol levels by sticking to bile acids in your intestines to prevent them from being absorbed into your bloodstream. When soluble fiber reaches your colon, it is broken down by bacteria there into short chain fatty acids that are absorbed into your bloodstream through your colon to travel through the bloodstream to your liver where they lower blood cholesterol by preventing the liver from making the bad LDL cholesterol, (Technical explanation: soluble fiber changes one bile acid, cholic acid, to another bile acid, chenodeoxycholic acid, that blocks 3-hydroxy 3 methylglutaryl CoA reductase, an enzyme that makes cholesterol).

How Soluble Fiber Lowers High Blood Sugar and Insulin
The viscous properties of soluble fiber bind to sugar in food to prevent some of the sugar from being absorbed in your upper intestinal tract (J Am Coll Nutr, Feb 2003;22(1):36-42). When soluble fiber reaches your colon, it is broken down by the enzymes from the bacteria there to release some of the sugar. Since blood sugar doesn’t rise very much when sugar is eaten with soluble fiber, the pancreas releases far less insulin.

Soluble Fiber Helps to Make You Feel Full
The gel-like properties of soluble fiber prevent many carbohydrates from being broken down and absorbed in your upper intestinal tract. When a meal contains a lot of soluble fiber, the liquid that passes through your intestines is so thick and viscous that it slows contractions of the small intestine to markedly delay digestion of the food in it. Slowed intestinal contractions decrease hunger (Nutr Rev, Feb 2016;74(2):131-47), so a meal that is high in soluble fiber suppresses appetite, increases satiety and reduces the number of calories that you take in (J Am Coll Nutr, 2016;35(1):41-9).

More Evidence of Soluble Fiber’s Benefits
The Doctors Study showed that high soluble fiber intake was associated with a 40 percent lower risk of heart attacks (JAMA, 1996;275:447-51), and The Nurses Study showed the same results (Am J Clin Nutr. 1999;69:30-42). Soluble fiber lowered all the markers of high blood sugar levels: blood sugar, insulin, blood pressure, excess weight, belly fat and triglycerides (Diabetes Care, 2004;27:538-46). A diet high in soluble fiber also reduced breast cancer risk (Pediatrics, Feb 2016:137(3);1-11).

How to Increase Soluble Fiber Intake
• All plants and plant parts contain both soluble and insoluble fiber in varying amounts. The more the food is processed, the less fiber it is likely to contain. Good sources of soluble fiber include beans, whole grains, nuts, legumes, snack seeds, fruits and vegetables.

• Eat whole fruits and vegetables instead of juices. Juicing removes most of the soluble fiber.

• Restrict foods made from flour such as bakery products and pastas. Most of the soluble fiber in whole grains is found in the outer coating that is usually milled away and discarded in the flour-making process. Even flour labeled “whole grain” or “whole wheat” is likely to have much of the fiber removed, since manufacturers can use the “whole” label as long as at least 51 percent of the grain is included. You have no way to know how much of the soluble fiber has been removed.

• Among the popular cooked cereals, oatmeal is the richest source of soluble fiber. Other cooked whole grain cereals are also good sources. Most of the dry breakfast cereals are highly refined and less likely to contain much soluble fiber.

SEPT 4

Exercise Really Does Help You

Researchers reviewed eight studies that used accelerometers to follow 36,383 adults, 40 years of age and older, for six years (Brit Med J, August 21, 2019). They found that exercising regularly, regardless of intensity, was associated with reduced risk for death during the study period, while sitting for more than nine hours a day was associated with increased risk of death.

The death rate dropped progressively as light physical activity increased up to five hours per day and moderate activity increased up to 24 minutes per day. Examples of light intensity included walking slowly, cooking and washing dishes. Moderate activity included brisk walking, vacuuming or mowing the lawn, while vigorous activity included jogging or carrying a heavy load. In another study, lack of physical activity doubled a person’s chances of suffering a heart attack, while a regular exercise program helped prevent it (Eur Heart J, 15 January 2019).

Not exercising regularly worsens diabetes (Cardiopulmonary Phys Ther J, 2013 Jun;24(2):27–34). Most cases of diabetes are caused primarily by excess fat in the liver and muscles, the only two places humans can store significant amounts of sugar. Excess fat in muscles and liver prevent these tissues from clearing excess sugar from the bloodstream. Most cases of diabetes can be cured by getting excess fat out of the liver, and the longer you exercise, the more fat you remove from muscles and liver and the less likely your blood sugar is to rise too high after you eat (Curr Cardiol Rep, Dec 2016;18(12):117).

Intense Exercise is Beneficial
Richard A. Winett of Virginia Tech has reviewed 106 journal articles to show that intense exercise can benefit health, prevent disease and prolong lives (Innovation in Aging, July 26, 2019;3(4):1–15). If you are trying to lose weight, intense interval exercise may help you to lose more weight than slower continuous exercise (Brit Med J, Feb 14, 2019). If you exercise intensely, you don’t have to spend as much time exercising to gain the same health benefits (J Am Coll Card, June 21, 2016;67(24):2910-2911).

A review of 41 studies involving 1115 people showed that people who have limited time to exercise will gain more health benefits from short bursts of intense exercise with short rests between each interval compared to continuous training (Brit J Sports Med, Feb 14, 2019;53(10)). Ideal sports for interval training include running, fast walking, cycling, swimming and weight lifting, but intense exercise can increase risk of injuries. Everyday opportunities for interval exercise include carrying heavy shopping bags up a few flights of stairs, running to catch a bus, walking fast from one place to another, pushing a lawn mower, or vacuuming your house with vigor.

My Recommendations
A key to prolonging your life and preventing disease is to keep on moving. Lying in bed for many hours each day is a certain way eventually to kill yourself. Your skeletal muscles circulate blood to your heart, and when you contract a muscle, it squeezes blood vessels near it to pump increased amounts of blood back to your heart. Your heart responds to the extra blood by contracting with greater force that makes it stronger. Each day that you spend not moving your muscles weakens your heart until you eventually die of heart failure.

Exercise will prolong your life. You do not have to have a specific exercise program, but you should keep on moving for a large part of each day. It is healthful to mow your lawn, wash your dishes, make your bed, vacuum your house, go out for walks and participate with your friends in activities in which you are moving your arms and legs. I recommend participating in groups for dancing, cycling, swimming, running, nature walks and so forth.

AUG 22

New Research on Intense Exercise

The more intensely you exercise, the less likely you are to suffer a heart attack, even though heart attacks can be caused by intense exercise in some people who already have irregular heartbeats or blocked arteries leading to their hearts.

• Researchers had 4582 men and women, average age 46, wear mechanical accelerometers to measure their intensity of exercise. After ten years, they found that the more they moved about and the less time they sat without moving around, the less likely they were to develop heart disease and the higher their blood levels of the good HDL cholesterol (Preventive Medicine, published online May 02, 2019). Also, the women who were even moderately active had lower total cholesterols.

• The HUNT study from Norway followed 26,163 healthy men and women, average age 55.7, for an average of 13 years and found that the more fit they were, the less likely they were to develop a first heart attack (Journal of the American Heart Association, April 19, 2019). They found that a high level of fitness was even more protective in the women than in the men.

• The SUN study from Spain followed 18,737 men and women, average age 38, for six years. The researchers found lower rates of heart attacks in those who exercised intensely as opposed to those who exercised at low intensity (American J of Cardiology, Dec 1, 2018;122(11):1871–1878). They used intensity of exercise per time spent exercising to show that those who exercise intensely had half the heart attack rate, compared to those who did the same amount of exercise less intensely.

Exercise to Prevent a Heart Attack
The association between a regular exercise program and improved health is unquestioned (J Clin Prev Cardiol, 2017;6:109-14; Am J Lifestyle Med, July 1, 2009;3(1 Suppl):44S–49S), and a healthful diet in addition to exercise helps even more to help prevent heart attacks and many other diseases (Eur J Prev Cardiol, Jul 2018 ;25(11):1186-1197).

Intensity makes all muscles stronger including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise stabilizes plaques in arteries and widens heart arteries to help protect you from a heart attack. Men with the highest ability to take in and use oxygen (VO2max) have the least high blood pressure, high HBA1C (a test for diabetes), high fasting blood sugar levels, obesity, coronary calcium scoring, abnormal treadmill exercise test, and calculated 10-year risk for heart attacks (American J of Cardiology, March 2012;109(6):839-843).

Preventing heart attacks involves both exercising and eating healthfully. Since exercise helps to stabilize plaques to help keep them from breaking off from arteries, exercise should be part of any heart-attack-prevention program. Dedicated exercisers who need to eat large amounts of food to meet their caloric needs should choose healthful, anti-inflammatory foods to avoid forming more plaques in their arteries. Check with your doctor if you have evidence of heart disease caused by a faulty diet: high blood pressure, high blood cholesterol, high triglycerides, high blood sugar, high CRP (c-reactive protein, a measure of inflammation), an abnormal EKG, or chest pain, particularly with exercise.

Can Intense Exercise Be Harmful?
Exercisers live longer and have far less heart damage than non-exercisers. However, elite athletes may be at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers with atrial fibrillation, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

My Recommendations
I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program.
• Before you try to increase the intensity of your exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that can harm you. Because intense exercise can cause heart attacks in susceptible people, you may want to check with your doctor before increasing the intensity of your workouts.
• Try to set up your exercise program so that you increase the pace enough on an intense day to feel mild muscle soreness on the next day. Then take easy workouts for as many days as it takes for the soreness to go away. Only then should you take your next hard workout.
• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off.
• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately for that day. Otherwise you are likely to be headed for an injury.

AUG 6

Alcohol Has No Health Benefits

A study from New Zealand shows that 30 per cent of alcohol–related deaths were from cancer, and 60 per cent of those deaths were from breast cancer. One third of these deaths were associated with an average of fewer than two drinks a day (Drug Alcohol Rev, June 16, 2016). However, the more you drink, the more likely you are to develop certain cancers. Alcohol increases risk for cancers of the oropharynx, larynx, esophagus, liver, colon, rectum, breast, cervix, vulva, vagina, skin, bladder, lung, stomach, skin, prostate and pancreas, and for leukemia and multiple myeloma. In the United States, the Center for Disease Control (CDC) estimates that alcohol kills more than 88,000 people each year and has shortened the lives of those who died by an average of 30 years (CDC Morbidity and Mortality Weekly Report, March 13, 2014). Alcohol also causes one in 10 deaths among working-age adults aged 20-64 years, and the health damage it causes costs $223.5 billion, or $1.90 per drink.

The Link Between Alcohol and Cancer
Alcohol is broken down only by your liver, which converts it to acetaldehyde, a substance that can damage cells’ genetic material called DNA to stop apoptosis, which can cause cancer. Alcohol and acetaldehyde can damage any living tissue they touch. The risk for cancer increases with the amount of alcohol that comes in contact with that tissue. Alcoholic beverages first touch the mouth and then the esophagus; therefore, these areas are at high risk for alcohol-induced cancers. Alcohol reaches the colon, rectum, and liver later so the link between these cancers and alcohol is not as strong.

Smoking Increases Cancer Risk from Alcohol
The risk for cancers of the mouth, throat, and esophagus is much higher if you drink and smoke than if you use either alcohol or tobacco alone. The more you drink and smoke, the greater your risk (Int J Cancer, 2011;128:533-540).

Definition of a Drink
In all of these studies, a “drink” is defined as the amount of alcohol that it takes an average person’s liver one hour to clear half of the alcohol from the bloodstream. That amount is 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol, which would be:
• 12 ounces of beer (5 percent alcohol content)
• 8 ounces of malt liquor (7 percent alcohol content)
• 5 ounces of wine (12 percent alcohol content)
• 1.5 ounces of 80-proof (40 percent alcohol content) liquor (e.g., gin, rum, vodka, whiskey)
However, the amount of alcohol a person’s liver can clear varies with body weight, sex, age, metabolic rate, recent food intake, the type and strength of the alcohol, and any medication you take, so your “drink” size may be different from the average.

One Alcoholic Drink per Day is Associated with Increased Cancer Risk
A review of 222 articles, following 92,000 light drinkers and 60,000 non-drinkers, showed that taking even one alcoholic drink a day is associated with increased risk for cancer of the mouth and throat, esophagus and breast (Annals of Oncology, Feb 2013; 24(2):301-308). Thirty-seven percent of North American adults take up to two drinks a day. Many have the mistaken belief that it is safe and even healthful for women to take up to one drink per day and for men to take up to two drinks per day. An additional 28 percent of North Americans drink more than that. See Any Amount of Alcohol Increases Cancer Risk

Moderate Drinking Has Not Been Shown to Prevent Heart Attacks
For many years, the wine, beer and alcoholic beverage industries have promoted studies showing that alcohol helps to prevent heart attacks. Their studies appeared to show that taking one to two drinks a day is associated with reduced risk for heart attacks. However, drinking alcohol regularly is associated with high blood pressure, heart failure, sudden death and stroke. Studies that compare “moderate drinkers” with “non-drinkers” are deceptive because more than half of the people who call themselves non-drinkers are recovering alcoholics or people who had been told to stop drinking because they already have health problems. Scientists reviewed 87 published studies on the effects of alcohol on death rates and found that all but 13 of these studies had a non-drinker group that included people who were told not to drink because they already had liver, heart or kidney disease, high blood pressure, heart attacks, certain cancers, alcoholism, stomach ulcers, or other major health problems (Journal of Studies on Alcohol and Drugs, March 2016;77(2):185–198). When people with alcohol-related diseases were removed from the abstainer group, moderate drinkers did not have a lower incidence of these diseases than the non-drinkers.

Researchers at the University of Victoria in British Columbia reviewed 54 studies and found that only seven of those studies corrected their non-drinking population for people who had been told to stop drinking for health reasons (Addiction Research and Theory, April 2006). The Canadian researchers re-analyzed 47 studies that associated wine or other alcohol with a longer life and decreased risk for heart attacks. When the studies were corrected to remove the people who had been ordered to stop drinking for health reasons, they found no benefit for the moderate drinkers compared to healthy non-drinkers. Another study, which followed 53,000 men and women ages 50 and older for six to ten years, found that alcohol has no demonstrable health benefits and does not prolong life (British Medical Journal, February 10, 2015).  Recent research shows that taking just one drink increases heart attack risk for the next hour (Circulation, March 4, 2016).

Alcohol Increases Stroke Risk
Drinking excessive amounts of alcohol increases a middle-aged person’s chances of suffering a stroke as much as high blood pressure or diabetes does. Those who take in more than two drinks a day have a 34 percent increased risk of stroke compared to those who take in less than half a drink (Stroke, Jan. 29, 2015). Those who take in more than two drinks a day in their 50s and 60s suffer strokes earlier in life than light drinkers or non-drinkers.

Alcohol Increases Risk of Permanent Liver Damage
Drinking alcohol regularly increases risk for permanent liver damage called cirrhosis (Journal of Hepatology, January 26, 2015). Wine is associated with a lower risk for liver damage than beer or liquor. The authors of this study warn that older drinkers are more likely to have health conditions affected by alcohol or to take medicines that impair their ability to metabolize alcohol.

Long-Term Health Risks from Alcohol
In addition to the immediate risks of harm from alcohol (accidents, violence, poor judgment), regular alcohol consumption increases risk for:
• High blood pressure, heart disease, stroke, liver disease, stomach ulcers
• Many types of cancer including breast, prostate, mouth, esophagus, stomach, liver and colon
• Learning and memory problems (dementia, poor work or school performance)
• Emotional problems, social problems and alcoholism

AUG 2

A Genetic Reason Why Humans Have More Heart Attacks than Other Mammals
 
Two to three million years ago, our pre-human ancestors had a single genetic mutation in their CMAH gene that protected them from a deadly form of malaria but set them up for risk for heart attacks that increases when they eat a lot of meat from any kind of mammal (PNAS, July 22, 2019). No other mammals developed this genetic mutation.Apes, gorillas, chimpanzees, and other human progenitors were dying from a type of malaria called Plasmodium reichenowi. Then along came a pre-human with a CMAH gene changed from making a cell surface sugar-protein called Neu5Gc to another molecule called Neu5Ac (Proc Natl Acad Sci USA, Sept 6, 2005;102(36): 12819–12824). That pre-human did not die from malaria like other apes, monkeys and gorillas, so his or her children lived and proliferated, and today all humans have Neu5Ac instead of Neu5Gc. Chimpanzees share more than 99 percent of their genes with modern humans, but the CMAH gene is one of the areas of difference. As often happens in nature, the malaria parasite then modified its genetic makeup into a variant called Plasmodium falciparum which can infect humans, but not chimpanzees, so today humans can be infected only with Plasmodium falciparum and chimpanzees can be infected only with Plasmodium reichenowi.

Neu5Gc, Neu5Ac and Heart Disease
Heart disease causes one-third of the deaths in North America, and while risk factors for heart attacks can include high blood cholesterol, high blood sugar, high blood pressure, obesity, smoking, or lack of exercise, 15 percent of people who suffer heart attacks have none of these risk factors (CDC, NCHS, Underlying Cause of Death, 1999-2013). Other mammals can suffer heart attacks when they have these risk factors (often caused by human lifestyle habits), but they seldom suffer heart attacks if they do not have these risk factors (Evol Appl, 2009 Feb; 2(1): 101–112).

Mice that have been genetically modified to have the same CMAH gene mutation that is found in humans have the same:
• high risk for heart disease and arteriosclerosis, and
• increased heart attack risk from eating mammal meat that humans have (PNAS, July 22, 2019). These CMAH gene-modified mice suffered double the risk of atherosclerosis compared to unmodified mice. Like humans, they were also at increased risk for inflammation, heart attacks, strokes, diabetes, and some types of cancers.

How This CMAH Gene Modification Can Harm
Your immune system recognizes invading germs by the surface proteins on cell membranes. If the surface proteins are different from your own surface proteins, your immune system makes:
• proteins called antibodies that attach to and kill the invading germs, and
• immune cells that eat and destroy germs.

All mammals except humans have a surface sugar-protein on their cells called Neu5Gc, while humans have a surface sugar-protein called Neu5Ac. When humans eat mammal meat, their immune systems make antibodies and cells that attack the Neu5Gc that they absorb into their bloodstreams, so people who eat mammal meat regularly are likely to have an immune system that is overactive all the time, called chronic inflammation (Proc Natl Acad Sci USA, Jan 13, 2015;112(2):542–547). An overactive immune system can use the same cells and proteins that it uses to kill germs to attack and destroy your own cells. It can punch holes in the inner linings of your arteries to form plaques, and break plaques off to cause heart attacks and strokes. Inflammation can also damage your DNA to cause cancers, and damage various tissues to cause arthritis, fatty liver, diabetes and so forth.

My Recommendations
The theory of Neu5Gc in mammal meat causing chronic inflammation is strong enough that I believe you should not eat mammal meat regularly. We have extensive data to show that regular meat eaters are at increased risk for heart attacks, strokes, diabetes, cancers (Genome Biol Evol, Jan 1, 2018;10(1):207-219). We do not have enough data to know if eating mammal meat on occasion is harmful. I recently reported on Neu5Gc and other theories that may help to explain the association between eating meat and heart attacks in Heart Attacks Again Linked to Red Meat

JULY 12

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592)

More New Studies on Muscle Growth for Older People
Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).
Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).
High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).
Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program
The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging
Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger
Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations
Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

JULY 4

Heat Stroke

Nobody should ever die of heat stroke, a rapid uncontrolled rise in body temperature that causes you to pass out. Your body sends you warning signals as your temperature rises.

In 1965, I almost died from heat stroke in an unimportant local race in Arlington, Virginia. I passed out during the race and lay unconscious for a while. I am still embarrassed by the stupidity that I showed when I ignored all the warning signs as my temperature continued to climb. First your muscles are affected, then your lungs and then your brain.
Muscles: As your temperature starts to rise, your muscles feel like a hot poker is pressing against them. It is normal for intense exercise to make your muscles burn, but hard exercise does not cause painful burning that feels like fire. Furthermore, the burning of hard exercise is relieved by slowing down, while the muscle burning of impending heat stroke does not go away when you slow down.
Lungs: As your temperature rises further, the air that you breathe feels like it is coming from a furnace and no matter how rapidly and deeply you try to breathe, you can’t take in enough air. When you exercise intensely, you can become very short of breath, but the air you breathe will not burn your lungs. Burning in your lungs, not relieved by slowing down, signals impending heat stroke. When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating and your temperature is rising rapidly. Your temperature is now over 104 degrees F. and continuing to exercise will raise your body temperature even further so it will start to cook your brain• Brain: When heat stroke begins to affect your brain, your head will start to hurt, you may hear a ringing in your ears, feel dizzy and have difficulty seeing. Then you will end up unconscious. Your temperature is now over 106 and your brain is being cooked just like the colorless portion of an egg that turns white when it hits a hot griddle.

Mechanism
During exercise, more than 70 percent of the energy used to drive your muscles is lost as heat, so your heart has to pump the heat in your bloodstream from your hot muscles to your skin where you sweat and the sweat evaporates to cool your skin to dissipate the heat. The harder you exercise, the more heat your muscles produce. Everyone who exercises, particularly in hot weather, has to sweat to keep their body temperatures from rising too high.

Risk for heat stroke is increased by:
• any pre-existing illness
• heart disease
• use of various recreational drugs such as cocaine, and some prescription drugs
• lack of fitness
• not drinking enough fluid
• exercising for extended periods without eating
• wearing excess clothing that traps heat in your body
• not listening to your body when you feel the warning signs described above

Many cases of heat stroke during exercise occur when a person suddenly increases the intensity of exercise, such as a sprint at the end of a long distance running or cycling race, or an intense run down the field in soccer.

Treatment
When a person passes out from heat stroke, get medical help immediately. Any delay in cooling can kill the person, and you may need an expert to help decide if the person has passed out from heat stroke or a heart attack.

Carry the victim rapidly into the shade and place him on his back with his head down and feet up so blood can circulate to his brain. Once it has been established that the person is not having a heart attack, he or she can be cooled by pouring on any liquids you can find. Evaporation of any liquid cools. As you cool him, he may suddenly wake up and talk to you and act like nothing has happened. Don’t stop cooling him, because while he’s sitting or lying there, his temperature can rise again and he can go into convulsions or pass out again. He must be watched for several hours after he is revived.

Prevention
When you exercise in hot weather, stop exercising when you start to feel any of the symptoms described above and find a shady spot to recover. Stay well hydrated, but realize that too much fluid (Hyponatremia) can also be harmful.

June 16

How to Get My Body in Shape at 60-Years-Old

SHARIN GRIFFIN

June 7

Osteoarthritis Linked to Inflammation

Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. Recent research suggests that osteoarthritis may be caused by inflammation, the same overactive immunity that causes heart attacks and auto-immune diseases. Your immunity is good for you because it kills germs that try to invade your body. However, after the germs are gone, your immunity is supposed to slow down. If your immunity remains active, it can use the same chemicals and cells that attack germs to attack any part of your body, and that includes destroying the cartilage in your joints. Here are some of the recent studies linking osteoarthritis with other diseases of inflammation:

• People with osteoarthritis have high blood levels of galectins that turn on a person’s immunity to cause inflammation, just as in rheumatoid arthritis and reactive arthritis (The Journal of Immunology, February 15, 2016;196(4):1910-1921).
• People who eat an anti-inflammatory Mediterranean-type diet (high in plants, low in red meat and other pro-inflammatory foods) are at reduced likelihood for getting osteoarthritis (Clin Nutr, Oct 8, 2016. S0261-5614(16)31279-1).
• Factors associated with increased diabetes risk are increased in people who have osteoarthritis (Br Med Bull. Sept 2015;115(1):111-21).
• Overweight women are at increased risk for osteoarthritis (Osteoarthritis Cartilage, Oct 27, 2015. S1063-4584(15)01364-3). See How Excess Weight Can Cause Arthritis.
• Taking sugared drinks increases risk for osteoarthritis and the more a person drinks, the greater the risk (BMJ Open, July 18, 2013;3(7):e002993).
• Osteoarthritis is associated with high cholesterol (Osteoarthritis and Cartilage, Feb 9, 2017).

Types of Arthritis
Doctors classify arthritis into several types, including:
• degenerative arthritis (following trauma. work-induced injury or repetitive motion injury)
• various kinds of reactive arthritis, such as rheumatoid arthritis, in which a person’s immunity is overactive
• infections in joints
• crystal diseases, such as gout, in which crystals form in joints
• osteoarthritis, by far the most common type, where cartilage is worn away and there is no history of trauma or other known explanation. When there is no known cause, treatments are just guesswork. Osteoarthritis is usually treated with non-steroidal drugs (NSAIDs) that help to block pain but do nothing to slow down the destruction of cartilage.

Symptoms of Osteoarthritis
People are usually diagnosed as having osteoarthritis if they:
• have gradually increasing pain in their knees, hips, hands or spine
• are age 40 or older
• have negative results in the standard blood tests for an overactive immunity
• have swelling of the knuckles and joints on the ends of the fingers next to the fingernails, not in the middle finger joints, and at the base of the thumb (Rheumatoid arthritis usually affects the middle joints of the fingers and the joints where the fingers attach to the hand)
• have pain that is usually worse in the morning when a person first gets up. In osteoarthritis, the pain usually lessens as the person keeps moving.

Exercise Treats Osteoarthritis
• A reviews of 55 studies showed that weight bearing exercise reduces pain and improves joint function in osteoarthritis (British Journal of Sports Medicine, September 24, 2015). Exercise helps to reduce inflammation.
• Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, 08/30/2016). No serious side effects occurred from the knee strength and conditioning program.
• A review of six studies of a total of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it did not make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203).
See Treat Osteoarthrits with Exercise
Exercise for Osteoarthrits

Little Evidence That Any Type of Surgery Helps to Treat Knee Osteoarthritis
Removing damaged attached cartilage offers little or no benefit (Br J Sports Med, 2016;50:1473-1480). Exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (British Medical Journal, July 20, 2016). Surgery has not been shown to be more effective than exercise in treating knee osteoarthritis (N Engl J Med, 2013;368:1675-84) and arthroscopic partial meniscectomy is not more effective than sham placebo surgery for a degenerative meniscal tear (N Engl J Med, 2013;369:2515-24). An editorial in the same issue of the journal states: “The surgery is a highly questionable practice without supporting evidence of even moderate quality . . . the latest nail into what should be a sealing coffin” (BMJ. July 20, 2016).

Why So Much Surgery?
In the United States, medicine is a business and the bottom line of a business is profit. Fifteen years ago, the first of many studies showed that arthroscopic partial meniscectomy is no more effective than a placebo (N Engl J Med, 2002;347:81-8). Yet arthroscopic partial meniscectomy to trim a torn knee meniscus is one of the most common surgical procedures, with more than 750,000 knee arthroscopies done in the United States each year.

My Recommendations
If your joints hurt, check with your doctor to see if you have a known cause. If you have sudden locking of a joint and it gets better but then recurs, you may have “joint mice”, loose pieces of cartilage that slip between the cartilage to cause horrible pain. Your doctor can usually fix this by removing the loose pieces by arthroscopy. If your doctor cannot find a cause for your pain, you will probably be told that you have osteoarthritis. Everything you can do to reduce inflammation will help you to combat the pain of osteoarthritis:

• Lose weight if you are overweight. I recommend Intermittent Fasting.
• Eat an anti-inflammatory diet that includes lots of fruits, vegetables, whole grains, beans, nuts and other seeds, and severely restrict red meat, all foods with added sugar, all sugared drinks including fruit juices, and fried foods.
• Keep blood levels of hydroxy vitamin D above 30.
• Exercise and keep moving. Osteoarthritis always worsens with inactivity. However, you must be guided by pain and stop when the pain worsens.
• Avoid sports that involve impact, since the force of your foot hitting the ground can break off cartilage. Do not run, jump or participate in exercise that involves impact of your feet hitting the ground. You can cycle since your feet never leave the pedals, so pedaling is not an impact sport. Swimming is also a good non-impact sport.
• Use non-steroidal anti-inflammatory drugs as needed to control pain, but realize that they do nothing to cure the problem. Take the lowest dose possible to relieve pain.
• If knee pain becomes so unbearable that it keeps you awake at night, you may want to consider a knee replacement. However, replacing your joint requires driving a spike into the middle of the bones of your knee and that pushes aside the shock-absorbing marrow and weakens the bone to increase your chances of breaking the bones if you fall. If that happens, the knee cannot be replaced again until the broken bones heal.

May 24

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program.  

MAY 21

Exercise Keeps You Younger

The decline in brain and body function with aging is caused more by inactivity than it is just by aging. A study of 85 male and 41 female fit amateur cyclists, aged 55 to 79, found that most of them were physically much younger than most people of the same age (The Journal of Physiology, published online January 6, 2015;593(1)). All rode their bikes for recreation and none were serious competitive athletes. The men had to be able to ride a metric century (62 miles)averaging only 10 miles per hour, and the women 60 kilometers (37 miles), averaging a slow 6.7 miles per hour.

The older bicyclists’ test results were close to those for younger people for:
• endurance,
• pedaling power,
• metabolic health (control of blood sugar levels),
• balance,
• memory function,
• bone density and
• reflexes.

The single best test that correlates with aging is called V02max, the maximal amount of oxygen that a person can take in and use during a given time period. Many population studies show that VO2max drops significantly with aging. In this group of older bicyclists, VO2max was just a little lower than the results in the younger ones.

Incredibly, the older cyclists had test results similar to younger cyclists for lung power and exercise capacity; and even more incredibly, the memory of the older cyclists was just as good as the memory of the younger cyclists. This confirms many other studies that show that a high level of regular exercise prevents your brain from deteriorating. Several thousand years ago, the Romans knew that when they greeted each other with “Mens sana in corpore sano” (a healthy mind in a healthy body).

Older Bicyclists Did Lose Strength
By studying only older men and women who are very active and ride bicycles most days, the authors were able to select a group of older people who are not like the general population in England. Thus this study shows that older people who exercise regularly have bodies and minds that are similar to those of much younger people. The conclusion is that the rapid decline in mind and body with aging is caused far more by inactivity than by aging.

The oldest cyclists were stronger than non-exercisers, but they had much smaller and weaker muscles than cyclists in their 50s and early 60s. This shows that aging makes you weaker, no matter how much you exercise. However, other studies show that while you lose strength rapidly with aging, you lose endurance and recovery time from intense exercise far more slowly.

What You Should Learn from This Study and Others Like It
If you want to be able to run, cycle or walk long distances fast as you grow older, you should try to exercise every day and try to go a little faster on some days. The majority of older people have chosen to be frail, weak and uncoordinated because of their lifestyles, not their ages.
• If you have never exercised, start now.
• If you exercise regularly, continue to do so.
• Find an exercise in which you can keep moving almost every day: dancing, walking, various exercise machines, cycling, skiing, and so forth.
• Those who choose to ride a bicycle should worry more about being hit by a car than about the disabilities associated with aging.
• In our modern societies, people are living longer and often spend many years suffering terrible disabilities of both mind and body. Most North Americans over 70 cannot walk fast. One in eight people over 70, and one in two over 85, suffer from dementia. Exercise helps to slow damage to your mind and body associated with aging.
• Lack of exercise is associated with increased risk for overweight, diabetes, heart attacks, strokes, many different cancers, and premature death.

Caution: People with blocked arteries leading to their hearts are at increased risk for heart attacks when they start to exercise or increase the speed or amount of exercise. Check with your doctor.

MAY 15

New Research on Intense Exercise
The more intensely you exercise, the less likely you are to suffer a heart attack, even though heart attacks can be caused by intense exercise in some people who already have irregular heartbeats or blocked arteries leading to their hearts.

• Researchers had 4582 men and women, average age 46, wear mechanical accelerometers to measure their intensity of exercise. After ten years, they found that the more they moved about and the less time they sat without moving around, the less likely they were to develop heart disease and the higher their blood levels of the good HDL cholesterol (Preventive Medicine, published online May 02, 2019). Also, the women who were even moderately active had lower total cholesterols.

• The HUNT study from Norway followed 26,163 healthy men and women, average age 55.7, for an average of 13 years and found that the more fit they were, the less likely they were to develop a first heart attack (Journal of the American Heart Association, April 19, 2019). They found that a high level of fitness was even more protective in the women than in the men.

• The SUN study from Spain followed 18,737 men and women, average age 38, for six years. The researchers found lower rates of heart attacks in those who exercised intensely as opposed to those who exercised at low intensity (American J of Cardiology, Dec 1, 2018;122(11):1871–1878). They used intensity of exercise per time spent exercising to show that those who exercise intensely had half the heart attack rate, compared to those who did the same amount of exercise less intensely.

Exercise to Prevent a Heart Attack
The association between a regular exercise program and improved health is unquestioned (J Clin Prev Cardiol, 2017;6:109-14; Am J Lifestyle Med, July 1, 2009;3(1 Suppl):44S–49S), and a healthful diet in addition to exercise helps even more to help prevent heart attacks and many other diseases (Eur J Prev Cardiol, Jul 2018 ;25(11):1186-1197).

Intensity makes all muscles stronger including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise stabilizes plaques in arteries and widens heart arteries to help protect you from a heart attack. Men with the highest ability to take in and use oxygen (VO2max) have the least high blood pressure, high HBA1C (a test for diabetes), high fasting blood sugar levels, obesity, coronary calcium scoring, abnormal treadmill exercise test, and calculated 10-year risk for heart attacks (American J of Cardiology, March 2012;109(6):839-843).

Preventing heart attacks involves both exercising and eating healthfully. Since exercise helps to stabilize plaques to help keep them from breaking off from arteries, exercise should be part of any heart-attack-prevention program. Dedicated exercisers who need to eat large amounts of food to meet their caloric needs should choose healthful, anti-inflammatory foods to avoid forming more plaques in their arteries. Check with your doctor if you have evidence of heart disease caused by a faulty diet: high blood pressure, high blood cholesterol, high triglycerides, high blood sugar, high CRP (c-reactive protein, a measure of inflammation), an abnormal EKG, or chest pain, particularly with exercise.

Can Intense Exercise Be Harmful?
Exercisers live longer and have far less heart damage than non-exercisers. However, elite athletes may be at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers with atrial fibrillation, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

My Recommendations
I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program.
• Before you try to increase the intensity of your exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that can harm you. Because intense exercise can cause heart attacks in susceptible people, you may want to check with your doctor before increasing the intensity of your workouts.
• Try to set up your exercise program so that you increase the pace enough on an intense day to feel mild muscle soreness on the next day. Then take easy workouts for as many days as it takes for the soreness to go away. Only then should you take your next hard workout.
• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off.
• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately for that day. Otherwise you are likely to be headed for an injury.

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or increase the intensity of your existing program.

APRIL 25

.Water-Based Exercises Help Relieve Arthritis Pain

Water exercise is a great option for painful joints and arthritis pain relief.

As a kid I loved to swim. In fact, you couldn’t keep me out of the water. The old swimming hole near my home was a summertime place of fun for me and my friends. Even in this day and age you still can’t keep most people out of the water. According to the Centers for Disease Control and Prevention, swimming is considered the fourth most common sports activity. It is also an excellent way to get in some aerobic exercise.

Many older people can certainly benefit from water-based exercises, such as swimming, or other water activities that require equipment. Besides the benefit to the joints and inflammatory pain, exercising in the water has been found to benefit those who are overweight or suffering from injuries or lower back pain. Water exercise can also improve muscular and cardiovascular strength.

Now that I’m getting older, jumping back in the swimming pool may not be such a bad idea, especially since I’m starting to develop joint and arthritis pain in my knees, hips, spine, and hands.

Water-Based Exercises Help Relieve Arthritis Pain

Osteoarthritis is an extremely common condition. In the U.S. it affects over 50 million people and 80% of those are over 50-years-old. Although autoimmune disorder rheumatoid arthritis is less common, it still affects two percent to three percent of the population at any age.

I’m starting to experience many of the common symptoms associated with arthritis, including morning stiffness, and painful and swollen joints. I also seem to have a restricted range of motion overall and I could benefit from losing a few pounds! Since activities like running and walking can also be painful on the joints, my physiotherapist recommended water exercises.

Water exercise eases arthritis pain and can actually help protect the joints. Some people with arthritis prefer swimming in cold water, whereas others find comfort in warmer water. Research is also very supportive of water exercise to treat arthritis relief. In a 1987 study published in the Scandinavian Journal of Rehabilitation Medicine, eight chronic rheumatoid arthritis patients performed water exercise therapy in a heated swimming pool. After two months of participating in the water exercise program, the patients’ maximal isometric and isokinetic quadriceps strength had increased by 38% and 16% respectively. A more recent review published in the journal Musculoskeletal Care in 2012 found that a warm water exercise called hydrotherapy reduced joint tenderness and pain in rheumatoid arthritis patients. It also increased grip strength and improved mood and overall wellbeing.

In regards to osteoarthritis, a 12-week study published in the Journal of Advanced Nursing in 2007 found that aquatic exercise could significantly improve knee and hip flexibility, strength and aerobic fitness in osteoarthritis patients. For the study, data was collected from 38 patients at the beginning of the study, and at weeks six and 12 during 2003 and 2004.

Getting Started With Water-Based Exercises and Relieving Joint Pain

Do you want to learn how exercise can reduce arthritis and joint pain? Water exercise for arthritis relief is a good place to start. It can be a simple exercise, such as water walking. Water is thought to provide 12 times the resistance of air. In other words, as you walk you are building and strengthening your muscles. Water walking as therapy helps relieve osteoarthritis pain and joint damage. The water’s buoyancy can also decrease the impact on your joints. There are a few key points to keep in mind when you are getting started with water-based exercises to treat joint pain:

  • It is important to start slow if you have arthritis but currently don’t exercise.
  • Use a flotation belt to stay upright when doing deep-water walking.
  • Avoid water exercises if you are experiencing a severe rheumatoid arthritis flare-up. Some downtime may be needed until the pain eases up. If your joint pain, stiffness, or swelling continues to increase, consult your doctor.
  • It is advised that people who experience heavy swelling related to knee osteoarthritis wait to attempt swimming or any other water exercise that would put the joints through a lot of movement.
  • An aquatic center or community center with pools will have programs geared toward people with arthritis.
  • Heated pools with temperatures that reach between 82 to 88 degrees Fahrenheit will help relieve arthritis pain.

Examples of Warm Water Exercises

It is important to relax and enjoy the soothing warm water from the pool when conducting the exercises, just make sure to choose a warm water exercise that best suits your capabilities and fitness level. The following are examples of warm water exercises that can reduce arthritis and joint pain:

  • Pool walking exercise or jogging: The water exercise eases arthritis and joint pain as well. You can try it for yourself. A good place to start is in chest high water. Walk about 10 to 20 steps forward and then about the same amount of steps backward. Eventually you will increase you speed and your difficulty level. Jogging will also increase your intensity. It is good practice to alternate between water walking and jogging for 30-second intervals for at least a five-minute period.
  • Water aerobics: Water aerobics (also known as waterobics, aquafit, or aquatic fitness) includes water yoga, aqua aerobics, or aqua Zumba. Water aerobics tend to be strenuous by nature. Examples of water aerobic exercises include strengthening or resistance exercises and range of motion workouts that prevent joint stress.
  • Hydrotherapy: Hydrotherapy is part of physiotherapy, occupational therapy, and naturopathic medicine. It is used to treat rheumatoid arthritis and osteoarthritis. This therapy is different from swimming since it involves water exercises in a warm water pool. The temperatures are usually warmer than a normal swimming pool at 33 to 36 degrees Celsius. The exercises tend to focus on slow and controlled movements and relaxation.
  • Side and forward lunges: Side and forward lunges are among the most effective pool exercises for joint pain. It is a great way to strengthen the muscles and improve the range of motion of joints. To perform the exercise, stand near the pool wall for support and take a large lunge forward; however, avoid letting the knee go past your toes. Return your leg to the starting position and then repeat on the other side. Side lunges are a little different. Face the pool wall and take a large step to your side with your toes facing forward. Repeat on the other side. Try doing three sets of 10 lunges and side steps.

Precautions to Take With Water Exercises

Water exercise is a great option for arthritis pain relief; however, there are a few precautions you should take before you perform water exercises for arthritis pain relief:

  • Consult with a doctor before participating in water-based exercises to make sure they are safe for you, especially if you have certain medical conditions such as diabetes, multiple sclerosis, thyroid disease, heart or lung disease, circulatory problems, low or high blood pressure, skin problems, or any other serious health condition.
  • Everyone reacts differently to heat. People who feel nauseous or lightheaded should get out of the pool immediately.
  • Avoid using pools or spas after drug or alcohol use. They may increase or reduce blood pressure, or cause drowsiness or sleepiness.

Sources for Today’s Article:

Danneskiold-Samsoe, B., et al., “The effect of water exercise therapy given to patients with rheumatoid arthritis,” Scandinavian Journal of Rehabilitation Medicine, 1987; 19(1): 31-35, http://www.ncbi.nlm.nih.gov/pubmed/3576139.

Al-Qubaeissy, K.Y., et al., “The Effectiveness of Hydrotherapy in the Management of Rheumatoid Arthritis: A Systematic Review,” Musculoskeletal Care, 2013; 11(1): 3-18, doi: 10.1002/msc.1028, http://www.ncbi.nlm.nih.gov/pubmed/22806987.

Wang, T.J., et al., “Effect of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee,” Journal of Advanced Nursing, 2007; 57(2): 141-152, http://www.ncbi.nlm.nih.gov/pubmed/17214750.

Noe Pagan, C., et al., “Water Walking 101,” Arthritis Foundation web site, http://www.arthritis.org/living-with-arthritis/exercise/workouts/simple-routines/water-walking.php, last accessed November 19, 2015.

“Exercises,” UW Medicine Orthopaedics and Sports Medicine web site, http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/water-exercises.html, last accessed November 19, 2015.

Balch, J., et al., Prescription for Natural Cures: A Self-Care Guide for Treating Health Problems with Natural Remedies Including Diet, Nutrition, Supplements, and Other Holistic Methods (Hoboken: John Wiley & Sons, Inc., 2004), 50-51.

Acosta S. J., “Water Exercise Eases Arthritis Pain,” EveryDay Health web site, http://www.everydayhealth.com/osteoarthritis/water-exercise-eases-arthritis-pain.aspx, last accessed November 19, 2015.

“Health Benefits of Water-based Exercise,” Centers for Disease Control and Prevention web site, last updated March 6, 2013; http://www.cdc.gov/healthywater/swimming/health_benefits_water_exercise.html, last accessed November 19, 2015.

“What is hydrotherapy?” Arthritis Research UK web site, http://www.arthritisresearchuk.org/arthritis-information/therapies/hydrotherapy/what-is-hydrotherapy.aspx, last accessed November 19, 2015.

APRIL 23

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People
Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).
Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).
High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).
Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program
The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging
Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger
Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations
Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION: People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

APRIL 14

A Little Vigorous Exercise Yields Big Fitness Gains

If you want to get in shape, you will become far more fit in far less time if you include some vigorous exercise. A new study showed that one intense exercise session plus four relaxed sessions per week improves fitness almost three times more than five relaxed exercise sessions per week (J Sports Sci Med, September 2014;13(3):702-7).

Twenty nine sedentary and out-of-shape men and women, average age 36 years, started a 12-week treadmill and stationary bicycle exercise program. They were put into one of three groups:
• Low Intensity: Five days a week of 30 minutes of exercise at 45-60 percent oxygen consumption reserve.
• High Plus Low Intensity: Four days a week of the above program plus one session of high-intensity intervals: 8 to 12 repeats of 60 second efforts at 100 percent of their maximum oxygen capacity (VO2max), with a 2.5 minute recovery between each interval.
• No Exercise at all.
In just twelve weeks the High Plus Low Intensity group increased their VO2max (the best measure of fitness) by more than 10 percent over the No Exercise group, and 3.9 percent more than the Low-Intensity group.

Why Intense Exercise Makes You More Fit than Just Exercising
To strengthen a muscle, you have to exercise intensely enough to damage it and when it heals, it will be stronger. To have greater speed and endurance, you have to increase your ability to take in and use oxygen. You do this only with intense exercise. Whatever your level of fitness, short bouts of working at YOUR maximum will do more to make you stronger and faster than any amount of casual exercise. Athletes call these repeated short bouts of vigorous effort “Intervals”.

Introducing Intervals in Your Exercise Program
Start out in your chosen activity by pedaling, walking or jogging at a slow pace for at least 10 minutes just to warm up. When you feel that your legs are ready, pick up the pace for 10 seconds and then slow down. It is irrelevant how long you take to recover for your next interval. Repeat these 10-second intervals until your legs start to feel heavy or hurt or you feel any discomfort whatever. Then quit for the day.

On the next day, you can go at a slow pace or take the day off if you are sore. The following day you can try intervals again provided that your legs feel fresh and are not sore. Repeat the 10 second intervals until your legs start to feel heavy or hurt. Continue this program of intervals and try to increase your intervals until you can sustain 30 seconds for each interval with any recovery time that feels comfortable to you. You will probably feel best with a 30-second interval followed by a one-to-two-minute recovery between each interval.

Doing intervals once a week will get you in great shape. You can do them more often but do not plan to do intervals more than every other day. Do not do intervals when your legs feel heavy or sore. Intense workouts when your muscles are sore markedly increase your chances of injuring yourself.

If You are Starting a New Exercise Program
If you have not exercised in a long time and are out-of-shape, or if you want to start a new sport, do what athletes call “Background before Peaking”. Take it very easy on the first day; muscle soreness does not show up for several hours. Go out and pedal on your bike or walk or jog at a very slow and comfortable pace until your legs start to feel tired or hurt. Then stop, even if you have only done a few minutes. Do that every day until you can exercise at a slow relaxed pace for 30 minutes. Most people will take six weeks or more of this background work to be able to do 30 minutes consistently. Then you are ready to start your intervals.

CAUTION! If you are out of shape, or if you are a regular exerciser but have never tried to exercise intensely, check with your doctor to make sure that you do not have a medical condition that will be aggravated by vigorous exercise. Heart attacks during exercise often occur in peop

APRIL 1 

How does exercise make bones stronger?

Bones are not static. Certain cells called osteoblasts constantly bring calcium into bones to make them stronger and osteoclasts take calcium from bones. Exercise increases the rate that osteoblasts strengthen bones. Inactivity slow osteoblastic activity to weaken bones. So any exercise that places force on a bone will strengthen that bone.

If they live long enough, every woman and most men will suffer from osteoporosis. Women who break their hips from osteoporosis must have a hip replacement immediately. Otherwise, they have a 20 percent chance of dying from complications within a year. A study from Australia shows that running strengthens the leg bones of both older and younger women (Medicine & Science in Sports & Exercise, October 2005.) However, the research shows that bones used in an exercise are the only bones that are strengthened by that activity. So running strengthens leg bones, rowing strengthens arms and back, and lifting weights strengthen bones that are used for each lift.

MARCH 30

Helicobacter and Stomach Ulcers
If you belch or have burning in your stomach or chest, particularly when your stomach is empty, you probably have either an infection, a tumor, or a condition called GERD (reflux or regurgitation). Infection with bacteria such as helicobacter pylori is by far the most common cause.

Your doctor will probably order an upper GI series X ray to rule out a tumor. That almost always comes back negative to tell you that you do not have tumor. Then you get a blood test for bacteria called Helicobacter pylori and you should be treated with antibiotics even if the blood test is negative, because there are at least 23 other species of bacteria that this test does not detect. Your gastroenterologist will want to put a tube down your mouth and into your stomach, but the biopsy that he will do to find the Helicobacter can often miss the germ even when it is there (11). If your doctor does not offer the antibiotic treatment (see below), you will be stuck with a diagnosis of regurgitation, called GERD, which means you have pain and no one can tell you why. You will need to take medication for the rest of your life.

An article in the medical journal GUT reported that at least 24 different bacteria have been shown to cause stomach ulcers (16). Since doctors do not have any way to check for all 24 different bacteria (10), all people with belching and burning in the stomach should be given a one-week course of antibiotics that are used to treat the most common cause of stomach ulcers, called Helicobacter Pylori.

Twenty years ago, stomach ulcers were treated by drinking cream. Today, almost everyone with belching and burning in the stomach should be treated with antibiotics. In 1983 they laughed at Dr. Barry Marshall when he reported that stomach ulcers were caused by infection with helicobacter pylori and could be cured with antibiotics. Fellow physicians were so mean to him that he responded by swallowing a vial of helicobacter and almost died. He recently received the Nobel Prize for his pioneering work.

Now almost every reasonable physician agrees that all people who have belching and burning in the stomach and a positive blood test for helicobacter pylori can be cured with antibiotics, but many gastroenterologists stubbornly refuse to treat patients with ulcer symptoms and a negative blood test or biopsy for that germ. They are clearly wrong because literature shows that at least 24 germs cause an irritation in the stomach (9), including H. helmannii (13), H. felis, H. rappini, H. cinaedi, H sp. Strain Mainz (14) H. fennelliae and H. pullorum, H. hepaticus, H. Billis, H. canis, H. Hills (15), cytomegalovirus and mycoplasma (1,2,3,4,5,6,7,), and Helicobacter mesocricetorum sp nov (12).

Helicobacter species have been isolated from the stomachs of dogs, cats, ferrets, pigs, monkeys and cheetahs, birds, mice, chickens. The standard treatment of one week of clarithromycin 500 mg twice a day, metronidazole 500 mg twice a day and omeperazole 20 mg once a day is safe and effective. These germs also grow in saliva, so they can be transmitted between family members and pets. So some doctors prescribe antibiotics to all people with belching and stomach burning, and check the other members of the household for symptoms.

At least 12 weeks later, you need a follow up blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with amoxacillin 500 mg four times a day, tetracycline 500 mg three times a day and omeperazole 20 mg once a day (1). If you still have symptoms, you may need to have a tube put down your throat by a gastroenterologist. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day. Some people who are not infected with helicobacter may benefit from taking clarithromycin or other antibiotic for a longer period of time.

Helicobacter may also cause liver disease, blood vessel diseases such as clotting and heart attacks, and certain skin conditions such as rosacea.

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2) JC Debongnie, M Donnay, J Mairesse, V Lamy, X Dekoninck, B Ramdani. Gastric ulcers and Helicobacter heilmannii. European Journal of Gastroenterology & Hepatology. 10: 3 (MAR 1998):251-254.

3) MA Stone, DB Barnett, JF Mayberry. Lack of correlation between self-reported symptoms of dyspepsia and infection with Helicobacter pylori, in a general population sample. European Journal of Gastroenterology & Hepatology. 10: 4 (1998):301-304.

4) 1) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

5) MJ Blaser. Heterogeneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.

6) C Seidl,V Grouls,HJ Schalk. Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.

7) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.

8) J Fox. Helicobacters: the next generation. Baillieres Clinical Infectious Diseases 4: 3(NOV 1997):449-471.

9)A Meining, G Kroher, M Stolte. Animal reservoirs in the transmission of Helicobacter heilmannii – Results of a questionnaire-based study. Scandinavian Journal of Gastroenterology 33: 8(AUG 1998):795-798. dogs, chickens cats, cattle, or pigs reservoirs in the transmission of H. heilmannii. J Fox. Helicobacters: the next generation. Baillieres Clinical Infectious Diseases 4: 3(NOV 1997):449-471. dogs, cats, ferrets, pigs, monkeys and cheetahs, other mammals, and birds. mice H. canis, H. rappini and H. pullorum isol To date, there are at least 19 formally named species of the new genus, Helicobacter.

10) Monkeys have so many different bacteria in their stomachs that nobody can tell what belongs there or is causing stomach symptoms . The bacteria that were found were susceptible to the following antibiotics: amikacin, ciprofloxacin, gentamicin, cefoperazone, tobramycin, imipenem, and trimethoprim/ sulfamethoxazole. SS KhanolkarGaitonde, GK Reubish, CK Lee, CTKH Stadtlander. Isolation of bacteria other than Helicobacter pylori from stomachs of squirrel monkeys (Saimiri spp.) with gastritis. Digestive Diseases and Sciences, 2000, Vol 45, Iss 2, pp 272-280.

11) R Colin, P Czernichow, V Baty, I Touze, F Brazier, JF Bretagne, I Berkelmans, P Barthelemy, J Hemet. Low sensitivity of invasive tests for the detection of Helicobacter pylori infection in patients with bleeding ulcer. Gastroenterologie Clinique et Biologique, 2000, Vol 24, Iss 1, pp 31-35.

12)Helicobacter mesocricetorum sp nov., a novel helicobacter isolated from the feces of Syrian hamsters. Journal of Clinical Microbiology, 2000, Vol 38, Iss 5, pp 1811-1817.

13) K Mention, L Michaud, D Guimber, EM DeLasalle, P Vincent, D Turck, F Gottrand. Characteristics and prevalence of Helicobacter heilmannii infection in children undergoing upper gastrointestinal endoscopy. Journal of Pediatric Gastroenterology and Nutrition, 1999, Vol 29, Iss 5, pp 533-539.

14) P Vandamme, CS Harrington, K Jalava, SLW On. Misidentifying helicobacters: the Helicobacter cinaedi example. Journal of Clinical Microbiology, 2000, Vol 38, Iss 6, pp 2261-2266.

15) P Ferenci. The importance of Helicobacter – Also beyond the stomach. Acta Medica Austriaca, 2000, Vol 27, Iss 4, pp 109-111.

16) The non-H pylori helicobacters: their expanding role in gastrointestinal and systemic diseases. Gut, 2002, Vol 50, Iss 2, pp 273-283. JG Fox. MIT, Div Comparat Med, 77 Massachusetts Ave, Bldg 16, Room 825C, Cambridge,MA 02139 USA

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19) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of Helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10(OCT 1994):1793-1796.

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21) Z Maratka. Endoscopic diagnosis of gastritis: Pros and Cons. Journal of Clinical Gastroenterology 20:2(MAR 1995):92-93. The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking, ”Endoscopic gastritis” does not correlate sufficiently with ”histologic gastritis” and the term ”gastritis” is to be limited to cases confirmed histologically.

22) CA Fallone, GE Wild, CA Goresky, AN Barkun. Evaluation of IgA and IgG serology for the detection of Helicobacter pylori infection. Canadian Journal of Gastroenterology 9: 2(MAR-APR 1995):105-111.

23) TU Kosunen. Antibody titres in Helicobacter pylori infection: Implications in the follow-up of antimicrobial therapy. Annals of Medicine 27: 5 (OCT 1995):605-607. Success in eradication is reflected in 40-50% decrease of antibody titres within 5-6 months. The decrease continues and most patients have normal titres within 2 years.

24) RJF Laheij, JBMJ Jansen, EH Vandelisdonk, ALM Verbeek. Review article: Symptom improvement through eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Alimentary Pharmacology & Therapeutics 10: 6(DEC 1996):843-850. 8)M Feldman, B Cryer, E Lee, WL Peterson. Role of seroconversion in confirming cure of Helicobacter pylori infection. JAMA, 280:4(JUL 22 1998):363-365

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30) S Khulusi, S Badve, P Patel, R Lloyd, JM Marrero, C Finlayson, MA Mendall, TC Northfield. Pathogenesis of gastric metaplasia of the human duodenum: Role of Helicobacter pylori, gastric acid, and ulceration. Gastroenterology 110: 2 (FEB 1996):452-458. This study shows that the extent of duodenal GM is unrelated to the presence or absence of ulceration but is partly due to H. pylori and partly due to acid.

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32) BJ Marshall. Managing acid peptic disease in the Helicobacter pylori era. Journal of Clinical Gastroenterology 21: Suppl. 1(1995):S155-S159. The advent of new diagnostic and therapeutic modalities for Helicobacter pylori allows any physician to offer curative antibiotic regimens to patients with peptic ulcer disease and gastritis. In the new strategy, patients with dyspepsia are investigated with serology to detect those with H. pylori and potentially curable peptic ulcers. Only those who are H. pylori-negative undergo endoscopy.

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35) AF Cutler, VM Prasad. Long-term follow-up of Helicobacter pylori serology after successful eradication. American Journal of Gastroenterology 91: 1 (JAN 1996):85-88. A 20% decline in IgG concentration has an overall sensitivity of 93 % for determining H. pylori eradication 12-21 months after H. pylori treatment.

36) PA Testoni, E Colombo, L Cattani, M Longhi, F Bagnolo, F Lella, M Buizza, R Scelsi. Helicobacter pylori serology in chronic gastritis with antral atrophy and negative histology for Helicobacter-like organisms. Journal of Clinical Gastroenterology 22: 3 (APR 1996):182-185.

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39) S Tefera, JG Hatlebakk, A Berstad.The effect of Helicobacter pylori eradication on gastro-oesophageal reflux. Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 915-920.Twelve weeks after H. Pylori eradication there was no consistent change in gastro-oesophageal acid reflux in patients with mild or moderate reflux oesophagitis.

40)FTM Peters, EJ Kuipers, S Ganesh, WJ Sluiter, EC KlinkenbergKnol, CBHW Lamers, JH Kleibeuker.The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 921-926.

41) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

42) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ”Helicobacter heilmannii” strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.

43) M Giladi, A Lembo, BL Johnson. Postural epigastric pain: A unique symptom of primary cytomegalovirus gastritis? Infection 26: 4 (JUL-AUG 1998):234-235.

44) RJ Owen. Helicobacter – species classification and identification. British Medical Bulletin 54: 1 (1998):17-30.

45) N Kitamoto, H Nakamoto, A Katai, N Takahara, H Nakata, H Tamaki, T Tanaka. Heterogeneity of protein profiles of Helicobacter pylori isolated from individual patients. Helicobacter 3: 3 (SEP 1998):152-162.

46) CF Li, TZ Ha, DA Ferguson, DS Chi, RG Zhao, NR Patel, G Krishnaswamy, E Thomas. A newly developed PCR assay of H-pylori in gastric biopsy, saliva, and feces: Evidence of high prevalence of H-pylori in saliva supports oral transmission. Digestive Diseases and Sciences 41: 11 (NOV 1996):2142-2149.

47) K Schutze, E Hentschel, B Dragosics, AM Hirschl. Helicobacter pylori reinfection with identical organisms: Transmission by the patients’ spouses. Gut 36: 6 (JUN 1995):831-833.

48) Infection and Immunity 1994;62:2367-74.

49) K Shankaran, HG Desai. Helicobacter pylori in dental plaque. Journal of Clinical Gastroenterology 21:2(SEP 1995):82-84.

50) F Parente, G Maconi, O Sangaletti, M Minguzzi, L Vago, E Rossi, GB Porro. Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer. Gut 39: 5 (NOV 1996):629-633.

51) SD Georgopoulos, AF Mentis, CA Spiliadis, LS Tzouvelekis, E Tzelepi, A Moshopoulos, N Skandalis. Helicobacter pylori infection in spouses of patients with duodenal ulcers and comparison of ribosomal RNA gene patterns. Gut 39: 5 (NOV 1996):634-638.

52) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ”Helicobacter heilmannii” strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.

53)Meining, G Kroher, M Stolte. Animal reservoirs in the transmission of Helicobacter heilmannii – Results of a questionnaire-based study. Scandinavian Journal of Gastroenterology 33: 8(AUG 1998):795-798.

54) N Chiba, ABR Thomson, P Sinclair. From bench to bedside to bug: An update of clinically relevant advances in the care of persons with Helicobacter pylori-associated diseases. Canadian Journal of Gastroenterology, 2000, Vol 14, Iss 3, pp 188-198.

55) NEJM, July 25, 1996

60) R Barretozuniga,M Maruyama,Y Kato, K Aizu, H Ohta, T Takekoshi, SF Bernal.Significance of Helicobacter pylori infection as a risk factor in gastric cancer:Serological and histological studies. Journal of Gastroenterology 32: 3 (JUN 1997):289-294.

56)JH Siman,A Forsgren,G Berglund,CH Floren.Association between Helicobacter pylori and gastric carcinoma in the city of Malmo, Sweden-A prospective study. Scandinavian Journal of Gastroenterology 32: 12(DEC 1997):1215-1221.

57) E Ierardi, R Francavilla, C Panella. Effect of Helicobacter pylori eradication on intestinal metaplasia and gastric epithelium proliferation. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):470-475.

58) S Tsuji, M Tsujii, WH Sun, ES Gunawan, H Murata, S Kawano, M Hori. Helicobacter pylori and gastric carcinogenesis. Journal of Clinical Gastroenterology. 25: Suppl. 1(1997):S186-S197.

59) R Cheli, M Crespi, G Testino, F Citarda. Gastric cancer and Helicobacter pylori: Biologic and epidemiologic inconsistencies. Journal of Clinical Gastroenterology 26: 1 (JAN 1998):3-6.

60) V Pasceri, G Cammarota, G Patti, L Cuoco, A Gasbarrini, RL Grillo, G Fedeli, G Gasbarrini, A Maseri. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation 97: 17 (MAY 5 1998):1675-1679.48-51. J Danesh. Helicobacter pylori infection and gastric cancer: systemic review of the epidemiological studies.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 851-856.

61) K Haruma, K Komoto, T Kamada, M Ito, Y Kitadai, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is a major risk factor for gastric carcinoma in young patients. Scandinavian Journal of Gastroenterology, 2000, Vol 35, Iss 3, pp 255-259.

62) JW Konturek, A Dembinski, SJ Konturek, J Stachura,W Domschke. Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology 114: 2 (FEB 1998):245-255.

63) RI Russell. Helicobacter pylori eradication may reduce the risk of gastroduodenal lesions in chronic NSAID users. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):465-469.

64) CY Wu, SK Poon, GH Chen. Is Helicobacter pylori a risk factor for NSAID- associated gastric ulcer bleeding? A sex- and age-matched case-control study. Advances in Therapy 15: 2 (MAR-APR 1998):85-91.

65) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

66) MJ Blaser. Hetero- geneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.

67) C Seidl,V Grouls,HJ Schalk.Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.

68) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.

69) D Scott, D Weeks, K Melchers, G Sachs. The life and death of Helicobacter pylori. Gut 43: Suppl. 1 (JUL 1998):S56-S60. In the absence of division, antibiotics such as clarithromycin and amoxycillin are ineffective. Proton pump inhibitors, by elevating gastric pH, would increase the population of dividing organisms and hence synergise with these antibiotics.

Checked 3/16/19

January 1st, 2015

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MARCH 22

Stress Fractures – Prevention and Treatment
 
If you are an exerciser and develop a sharp pain on a bone that hurts when you press directly on that spot and does not hurt to touch an inch away, you probably have a stress fracture. Stress fractures are very common injuries, particularly in runners. In one study, 69 percent of the stress fractures occurred in runners, eight percent in fitness class participants, five percent in racket sports, four percent in basketball players and the remainder from other activities (Clin Sports Med, 1997;16:179–196). Runners are at high risk for stress fractures of the lower legs because running fast causes the foot to hit the ground with tremendous force that can shatter bones.

X-rays Often Miss a Stress Fracture
A stress fracture is not a broken bone; it is a small crack on the surface of a bone, like a crack on an egg shell. Most of the time you do not need an X-ray or MRI to diagnose a stress fracture. X-rays usually are not sensitive enough to show the surface crack until you have had it for a week or more. After a couple weeks, an X-ray can pick up the callus that forms over the crack. An MRI (which is much more expensive) can usually pick up an early stress fracture.

Healing a Stress Fracture
Stress fractures usually start out as minor discomfort in the foot, lower leg or pelvis, and they often occur for the first time near the end of a long run. Usually the pain goes away as soon as you stop exercising. On the next day, it hurts in the same spot earlier in the run. Most of the time, you don’t need a cast or brace for a stress fracture to heal, but you should stop the exercise program that caused the problem until you can exercise without pain — usually three to six weeks. Meanwhile, you can probably switch to a non-impact exercise that does not hurt, such as cycling or swimming. If you are a competitive runner, you may be able to run in water, because the water absorbs most of the foot-strike force.

Risk Factors for Stress Fractures
• Small, thin bones: The largest bones are usually the strongest, so people with smaller bones are at increased risk for stress fractures.
• Smaller muscles: people with the largest muscles usually have the strongest bones, so people with small leg circumference at the calf muscles are more likely to suffer stress fractures.
• Weaker calf muscles: Women with stress fractures often have weaker calf muscles (Med & Sci in Sprts & Ex, December 2009). Having strong muscles can help to prevent stress fractures by absorbing more force from the foot hitting the ground during running. Distance runners often work to strengthen their calf muscles by running up hills no more than three times a week.
• Longer stride length: Taking long strides causes the greatest foot strike force, which increases stress fracture risk. Reducing stride length by ten percent reduces the force of the foot striking the ground and therefore reduces force on the lower leg bones. Shortening your stride usually will not slow you down. When your foot hits the ground, your Achilles tendon contracts to store up to 60 percent of your foot strike force. Then when you step off that foot, your Achilles tendon releases the stored energy to drive you forward. Over-striding deprives you of some of this stored energy. Since many runners take strides that are too long for them to be efficient, shortening stride length usually allows them to increase cadence, helps them to run faster and longer, and reduces risk for stress fractures.

My Recommendations
If you develop a pain anywhere in your body that does not go away when you slow down, stop exercising immediately. Most wear-and-tear injuries of any sort give you plenty of warning and become long-term only because you continued to exercise when your body was telling you to stop for that day.

Most runners who have had a stress fracture can resume running after they heal. Most will benefit from:
• taking shorter strides at an increased cadence,
• doing some hill training to make their muscles stronger, and
• stopping a workout when they develop pain in one spot that doesn’t go away when they slow down or stop.

People with recurrent stress fractures need to be evaluated for osteoporosis and its many causes. If a bone density test shows that you have osteoporosis, your doctor may recommend bone strengthening medication (Clin J Sports Medicine, Oct 1995;5(4):246-250).

People with recurrent stress fractures should also be evaluated for:
• Overtraining syndrome,
• Vitamin D insufficiency,
• Calorie insufficiency (not eating enough food),
• In females, the triad of irregular periods, weight loss and overtraining, and
• Other medical conditions (J Orthop Surg Res, 2016;11(1):98).
If pain persists for several months, or if stress fractures continue to recur, they may need to switch to a low-impact sport such as swimming or cycling. Cyclists usually do not suffer stress fractures but they can break bones if they get hit by a car or another cyclist.

MARCH 13

How Exercise Prolongs Your Life
Several recent studies show that exercise helps to prolong your life by:
• strengthening heart muscle,
• increasing the ability of the heart to pump increased amounts of oxygen through the body,
• reducing belly fat, and
• increasing the diversity of bacteria in your colon.

We have abundant data to show that people who exercise live longer than those who do not exercise. Now we have the Copenhagen City Heart Study which begins to examine which sports are associated with living the longest (Mayo Clinic Proceedings, Sept 2018;93(12)). People who played tennis lived an average 9.7 years longer than people who do not exercise, compared to badminton (6.2 years), soccer (4.7 years), cycling (3.7 years), swimming (3.4 years), jogging (3.2 years), calisthenics (3.1 years), and health club activities (1.5 years). This study followed 8,577 people for up to 25 years. Twelve percent were primarily sedentary while 66 percent reported exercising regularly. Those who exercised only occasionally were not included in the data.

Interestingly, longevity did not correlate with the amount of time spent exercising. Those who worked out in health clubs (treadmill, elliptical, stair-climber, stationary bikes, and weightlifting) averaged 2.5 hours per week, while the longest-living group, tennis players, played only 1.7 hours per week. Cyclists who averaged the most time exercising per week (6.4 hours) lived six years less than the tennis players.

The authors report that the sports that were associated with living the longest are the ones that require interval training of some sort: short bursts of exercise using large muscle groups and full body movement. Another factor associated with increased longevity appeared to be the amount of social interaction of group sports (tennis, badminton, and soccer) compared to more solitary exercise (jogging, swimming, and cycling).

Exercise Strengthens the Heart
Another study showed that older men who exercise have stronger and larger hearts that supply more oxygen to their bodies (Sports Medicine, February 2019;49(2):199-219). The authors reviewed 32 studies of men over 45 years of age, comparing 644 athletes to 582 non-exercising controls. Echocardiograms showed that the athletes’ hearts had far more muscle. The stronger and bigger hearts pumped more blood and oxygen with each beat and had more beneficial heart rhythms. The older athletes maintained these heart benefits as they aged. Having the ability to supply more oxygen to your heart muscle is a major factor that helps to prevent heart attacks.

Sedentary People Have More Belly Fat
Compared to people who exercise, those who do not exercise regularly have much higher levels of fat in their liver and that fat markedly increases risk for heart attacks, diabetes, certain cancers and premature death (Obesity, Dec 20, 2017). The authors used MRI scans on 124 participants to show that the more time a person spends sitting down, the more belly and liver fat he has. They used history and mechanical accelerometers to measure how much time a person spends sitting down. See my report on liver fat below.

Exercise Increases Bacterial Diversity in your Colon
Of 37 breast cancer survivors, those with the highest level of fitness (endurance and maximal ability to take in and use oxygen) had the most different types of bacteria in their colons (bacterial diversity), regardless of how much fat they had in their bodies (Exp Physiol, Feb 14, 2019). The authors suggest that exercising regularly and more intensely can increase the efficiency with which your heart transports oxygen to your tissues, which, in turn, encourages a greater diversity of bacteria to grow in your colon. Having more and different types of bacteria in your colon is associated with increased lifespan and freedom from diseases such as heart attacks and certain cancers (Int J Mol Sci, Apr 2015;16(4):7493-7519). Healthful bacteria turn soluble fiber into short chain fatty acids that lower high cholesterol and high blood pressure and reduce inflammation that can cause diabetes, heart attacks and certain cancers. The more different types of bacteria you have in your colon, the longer you can expect to live. The authors tested 37 non-metastatic breast cancer survivors who were at least one year post-treatment. Those who had the highest heart and lung fitness levels (most intense exercise capacity) had significantly greater numbers of different types of gut bacteria compared to less fit participants. This shows that the people who exercise at the most intense levels have more varied colon bacteria.

My Recommendations
Every week, studies are published that show that exercise prolongs lives, and now we are seeing studies that show the advantages of intense exercise over less-intense exercise. However, people with blocked arteries can suffer heart attacks with more intense exercise, so it is a good idea to check with your doctor before starting an exercise program or increasing the intensity of your present exercise program.

March 1 

Irregular Heartbeats in Lifelong Exercisers

Many studies show that a lifetime of vigorous exercise makes the heart stronger and healthier and does not harm it. However, as I reported last year, a few studies that got a lot of media attention suggested that chronic intense exercise can damage the heart to cause irregular heartbeats.

Now a new study of elite lifetime endurance athletes has found no evidence of irregular heartbeats from damage to the right ventricular heart chamber (Circulation, May 17, 2016;133(20):1927-35). Thirty-three world-class endurance athletes, 30 to 60 years old and training for more than 15 hours per week, received extensive heart function tests that were compared to the same number of healthy men who did not have a regular exercise program. Of course the athletes had larger and stronger right ventricles, and there was no evidence of damage or potentially harmful effects. Their hearts pumped more blood, beat at a much slower resting rate, and most importantly, had no evidence of irregular heartbeats called atrial fibrillation that had been reported in an earlier study. Note that the tests in this study were not done immediately after racing, while a previous study (see below) tested the athletes right after a race. This new study shows that athletes with lifelong high volumes of training seem to be very unlikely to suffer from heart disease.

Why the Earlier Studies May Not Show Heart Damage

Forty athletes were tested immediately after a three-to-11-hour cross country ski race and were found to have right ventricular abnormalities (Eur Heart J, Apr 2012;33(8):998-1006). However, the abnormalities returned to normal when the athletes were retested at a later date. This shows that the reported short-term heart muscle damage may really not have been heart damage at all. It could be the same changes that occur after vigorous exercise in all muscles that are exercised vigorously. Your skeletal muscles are supposed to feel sore after vigorous exercise because all muscles in your body show signs of damage after being vigorously exercised, and that can also apply to your heart muscle. All competitive athletes learn very quickly that to be competitive, they have to exercise very intensely. To make a muscle stronger, you have to exercise so intensely that you damage the z-lines that join the sarcomere blocks in muscle fibers. You can tell you are doing this when you feel a burning in muscles during exercise and delayed onset muscle soreness (DOMS) several hours afterwards. When the Z-lines in a muscle heal, the muscle is stronger.

More Evidence that Vigorous Exercise Strengthens the Heart

In another study, male participants in a 54 mile (90 km) cross-country skiing event were followed for several years. Those who skied faster and in more events had slow resting heart rates and had increased rates of atrial fibrillation (European Heart Journal, June 11, 2013;34(47):3624-3631). However, they were not at increased risk for the types of irregular heartbeats in the lower heart chambers that are more likely to kill them: ventricular tachycardia and ventricular fibrillation. Many other studies show that regular exercise is associated with a reduced risk of atrial fibrillation (Heart, 07/27/2015). Olympic endurance athletes, followed for up to 17 years, had no evidence of any damage whatever to the size, shape and function of their main pumping chambers (left ventricles) and suffered no evidence of heart damage or disease (J Am Coll Cardiol, 2010;55(15):1619-1625).

Lack of Exercise Increases Risk for Irregular Heartbeats

Not exercising is a risk factor for atrial fibrillation (Am J Cardiol, 2012 Aug 1;110(3):425-32). A slow resting heart rate in an athlete generally indicates a strong heart, but apparently healthy men who do not exercise and have slow resting heart rates are at increased risk for atrial fibrillation (Circ Arrhythm Electrophysiol, Aug, 2013;6(4):726-31). Obesity is also a major risk factor for atrial fibrillation (J Am Coll Cardiol, Jul 7, 2015 and JAMA, 2004 Nov 24;292(20):2471-7). Elite endurance athletes are virtually never obese and they are unlikely to have high blood pressure, which is a major risk factor for atrial fibrillation (J Am Soc Hypertens, Mar 2015;9(3):191-6).

Most Studies Associate Vigorous Exercise with Increased Longevity

A review of fourteen articles on the life spans and death rates of elite endurance athletes shows that they live longer than the general population, and suffer far less from heart disease (J of Sci and Med in Sport, July 2010;13(4):410–416). Another review of 174 studies shows that even activities such as gardening and household chores are associated with a lower risk of stroke, breast cancer, colon cancer, diabetes and heart disease. Larger risk reductions came with increasing intensity and duration of exercise (British Med J, August 9, 2016). However, one study reported that intense exercise could cause scarring in the heart that may increase the risk of death from heart disease (Mayo Clinic Proc, June 2012;87(6):587–595), and another article questioned the safety of exercising for more than an hour a day (Mayo Clinic Proc, 2014;89(9):1171-1175).

My Recommendations

The existing evidence is that intense exercise is good for you, provided that you have a normal heart and do not have any underlying disease. Of course, if you have chest pain or any questions about your health, you should check with your doctor.

Many different factors can damage your heart. While vigorous exercise can help to prevent heart disease and long-term heart damage, it does not guarantee protection against irregular heartbeats and heart damage.

FEB 26

Testosterone for Older Men

Medical journals have reported trials that examine the benefits and harms of taking testosterone for men over 65 with low blood levels of testosterone (less than 275 ng/dL). At 12 study sites across the country, a total of 790 participants were given testosterone gel or a placebo applied daily to the skin. Most of these men had low testosterone due to aging, not due to damage to the testicles or brain where testosterone levels are controlled. Over a year, investigators measured the effects of testosterone on:

• bone density and strength

• anemia

• heart health

• cognitive function

• sexual function

Bone Density and Strength: Testosterone increased bone density and strength in 200 older low-testosterone men (JAMA Intern Med, February 21, 2017). These increases were greater in the spine than in the hips.

Anemia: Testosterone raised hemoglobin levels by at least 1 g/dL in nearly 130 men with anemia (JAMA Internal Medicine, Feb 21, 2017).

Heart Health: Testosterone increased plaques significantly in the arteries leading to the heart likely to increase risk for heart attacks (JAMA, 2017;317(7):708-716). However, another study of more than 44,000 men with low testosterone showed that three years of testosterone gel reduced heart attack rate by 25 percent compared to those given placebos (JAMA Internal Medicine, Feb 21, 2017). The effects of testosterone on heart attack risk are controversial.

Cognitive Function: Testosterone did not improve memory or other brain functions including verbal memory, visual memory, executive function or spatial ability in 500 men with age-associated memory loss (JAMA, 2017;317(7):717-727).

Sexual Function: Improvement in sexual function is the benefit most strongly supported by research studies. However, having low testosterone levels does not determine whether a man will respond to erection-increasing drugs such as tadalafil in older men with enlarged prostates and erectile dysfunction (J Sex Med, May 2016;13(5):843-51).

A review of several other studies showed that testosterone gel can improve depression, bone mineral density, energy, libido, erectile function, muscle mass, insulin resistance, and lower urinary tract symptoms (Curr Opin Urol, Mar 2016;26(2):152-7). Testosterone treatment did not appear to increase a man’s risk of developing an enlarged prostate.

Testosterone Is Often Given to Men Who Will Not Benefit from its Use

A study from Baylor Medical School shows that more than 85 percent of men treated with testosterone do not have any disease caused by low testosterone. Most of the men suffer from adult-onset hypogonadism associated with chronic medical conditions such as diabetes, metabolic syndrome, arteriosclerosis and obesity. They do not have a deficiency of testosterone caused by damaged testicles or brain hypothalamic and pituitary glands that cause low testosterone. They should be treated for these conditions and not take testosterone, which may increase their risk for future heart attacks (Mayo Clinic Proceedings, June 24, 2016).

My Recommendations

• Men with normal blood levels of testosterone (>300) should not take testosterone since it may increase risk for heart attacks, liver damage and shutting down their own natural production of testosterone.

• Older men with normal testicles and brain hormones should not take testosterone unless their testosterone is very low (below 150).

• Usually men should take testosterone if they have low levels of the brain hormones that stimulate the testicles to produce testosterone or testicles that are damaged so they cannot make testosterone.

• Most men who suffer from poor sexual function because they have conditions that damage their sexuality, such as overweight, diabetes, arteriosclerosis or other life-shortening conditions that affect sexual function, should work to reverse those conditions rather than resorting to testosterone.

• Testosterone pills can damage the liver, so if a man chooses to take testosterone, the form of choice is a gel that is absorbed through the skin so it avoids the liver.

FEB 20

Even a 100-Year-Old Can Improve with Training

You can improve athletic performance at any age with proper training, even if you are over 100 years old. Traditional feeling among scientists is that aging is progressive and inevitable, and that your genetic programming causes you to age no matter what you do. This paper shows that physical training can reverse established markers of aging (J Appl Physiol, February 15, 2017).

I have reported on Robert Marchand, the 105-year-old cyclist who had improved his world record for how far he could ride a bicycle in one-hour from 15.07 miles (24.25 kilometers) at age 101 to 16.73 miles (26.92 kilometers) at age 103. That is an 11 percent improvement in a world record after just two years of serious training, an impressive accomplishment at any age.

Marchand’s Training Program

For two years, from age 101 to 103, Marchand trained by riding 3000 miles (5,000 km) per year, with 20 percent of his workouts doing hard, intense riding and 80 percent doing slow recovery riding. He spun his pedals at a cadence between 50 and 70 rotations per minute.

The newer study documents his training program and the improvements in his markers of aging. Athletes can run, ride, swim or ski faster if they improve their maximum ability to take in and use oxygen (VO2max) and their peak power output (strength). These same measurements are used by scientists to track aging in non-athletes. Marchand’s VO2max (maximal ability to take in and use oxygen) increased 13 percent, from 31 to 35 ml.kg-1.min-1, and his peak power output increased by 39 percent, from 90 to 125 watts.

These factors improved in Marchand because he was able to increase his maximal pedaling frequency by 30 percent, from 69 to 90 rotations per minute, and his ability to take in air through his lungs by 23 percent, from 57 to 70 liters per minute. His maximum heart rate and body weight did not change.

Training That Reduces Measures of Aging

Here is a program of training that is typical of the way competitive athletes in endurance sports work to become faster.

Muscle-sugar-depleting workout (one per week): You must exercise long enough to use up most of the sugar stored in your most-used muscles. Muscles use primarily fat and sugar for energy. You have an almost infinite amount of fat stored in your body, but only a very limited amount of sugar stored in the liver and muscles. Sugar requires less oxygen than fat to fuel your muscles, so when you run out of sugar stored in your muscles, you have to slow down. Exercising long enough to deplete muscles of their stored sugar supply increases the amount of sugar they can store and also increases your ability to move faster longer. The faster you move, the quicker you use up your muscles’ stored supply of sugar. The average runner can use up most of his stored muscle sugar supply while running fairly fast for two hours, and the average bicycle rider can use up his stored muscle sugar in three hours.

Intense oxygen deficit workout (two per week): The limiting factor to how fast you can move is the time it takes to move oxygen into muscles. You can increase your ability to take in and use oxygen by using interval workouts in which you run up severe oxygen debts and gasp for breath. You also have to damage muscles so that when they heal, they become stronger. To do this you must put great pressure on your muscles by moving very fast.

Type of Intervals: A short interval lasts less than 30 seconds. You can do lots of them in a single workout because in less than 30 seconds, you do not build up much lactic acid and do less muscle damage. A long interval lasts longer than two minutes and you should do only a limited number of these intervals because they cause considerable muscle damage and can take a long time for muscles to heal and recover.

Recovery workouts (at least four per week): Intense interval workouts cause considerable muscle damage, and it usually takes at least 48 hours for muscles to heal, so each intense workout requires easier workouts on the following day. If you are training twice a day, each intense workout is usually followed by three recovery workouts.

Example of a Weekly Training Program

Sunday: race or depletion workout

Monday: recovery workout

Tuesday: short intervals

Wednesday: recovery workout

Thursday: long intervals

Friday: recovery workout

Saturday: recovery workout

How to Apply These Concepts to an Ordinary Exercise Program

While exercisers who are not competing are likely to spend far less time in their sport, they can still benefit from following the same training principles. Increasing evidence shows that intense exercise is more effective than casual exercise, so plan to introduce at least some intense intervals into your program. You can gain the health benefits and help to prevent injuries if you:

• Plan to exercise every day

• Realize that if you are training properly, your legs are likely to feel sore every morning. If your legs do not feel fresh after a 5-to-10-minute warm up, take the day off.

• Stop your workout immediately if you feel a tightness, discomfort or pain in one area.

• As soon as your legs start to feel heavy during a workout, stop for the day.

Caution: People with blocked arteries leading to their hearts can be harmed by intense exercise, so check with your doctor if you have any questions.

FEB 14

Why Ice Delays Recovery

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).

Healing Requires Inflammation

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing

Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:

• cortisone-type drugs,

• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),

• immune suppressants that are often used to treat arthritis, cancer or psoriasis,

• applying cold packs or ice, and

• anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination

Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations

If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

FEB 12

Added Sugars Linked to High Blood Pressure

A review of studies on sugar-added foods shows that people who take in 10-25 percent of their calories from sugared beverages and foods suffer a 30 percent higher risk for heart attacks, compared with people who take less than ten percent of calories from added sugars (British Medical Journal: Open Heart, Dec. 11, 2014). The review also found that:

• higher added-sugar intake was associated with increases in systolic and diastolic blood pressure of 6.9 and 5.6 mm Hg.

• the more sugared foods you eat, the higher your bad LDL cholesterol.

• sugars occurring naturally in foods, such as fruit, did not appear to increase risk for high blood pressure or heart attacks.

Another review of twelve scientifically-dependable studies involving 409,707 participants showed that sugar-sweetened beverages are associated with increased risk for high blood pressure, a major risk factor for diabetes and heart attacks (The American Journal of Cardiology, February 2014).

What is High Blood Pressure?

You have high blood pressure if your systolic blood pressure is greater than 120 before you go to bed at night and just after you wake in the morning. That is when your blood pressure is at its lowest level. You may also have high blood pressure if your systolic pressure is greater than 140 after resting for 5 to 10 minutes during the day.

What Causes High Blood Pressure?

More than 90 percent of North Americans will develop high blood pressure. Kidney damage or an overactive adrenal gland can cause high blood pressure, but these causes occur so rarely that most doctors do not even order a renin level to look for kidney damage, or an aldosterone level to look for adrenal problems.

Many doctors believe that a high-salt diet is a major cause of high blood pressure, but low-salt diets reduce systolic blood pressure by less than 5 mm Hg in most adults with hypertension, and the average reduction in diastolic blood pressure associated with a low-salt diet among adults with high blood pressure is 2.5 mm Hg (JAMA Intern Med, 2014;174(4):516-524). Low-salt diets are associated with increased risk for death in people who also have diabetes.

The people who are most likely to get high blood pressure from taking in too much salt are those whose cells are insulin resistant. Their cells do not respond well to insulin (Hypertension, Jan 2013), so the pancreas keeps on releasing large amounts of insulin to try to lower high blood sugar levels. High levels of insulin constrict arteries to cause high blood pressure. People with high insulin levels are the ones who get high blood pressure when they take in too much salt (Am J Hypertens, 1998 (Apr);11(4 Pt 1):397-402). For them, a high salt intake increases blood pressure, insulin and blood sugar.

How Sugar-Added Foods Can Cause High Blood Pressure

More than 80 percent of people who have high blood pressure also have insulin resistance, an inability to respond normally to insulin. This means that when they eat or drink sugar-added foods, their blood sugar levels rise, causing their insulin levels to rise which constricts arteries to cause high blood pressure (British Medical Journal: Open Heart, Dec. 11, 2014).

How Can You Tell if You are Insulin Resistant?

People who are insulin insensitive usually have what is called metabolic syndrome. You probably have metabolic syndrome if you have any three of the following:

• storing fat primarily in your belly

• having small hips

• being overweight

• having blood triglycerides (>150)

• having blood HDL cholesterol (<40) • having high blood pressure • having a fatty liver • having a fasting blood sugar >100 (HbA1c> 5.7)

• having high insulin levels

Lifestyle Changes, Not Drugs, Can Cure High Blood Pressure

You cannot cure high blood pressure with drugs; you can only control it as long as you continue to take drugs (Hypertension, 2002;40(5):612-618). Most of the time, your blood pressure cannot be controlled with just one drug and most people end up with three or more drugs to treat their high blood pressure.

Lifestyle Changes to Lower Blood Pressure

• Restrict sugared drinks and sugar added to foods.

• Restrict refined carbohydrates. Whole grains are seeds with a fiber coating that forms a thick capsule which cannot be broken down efficiently in your intestines, so blood sugar and insulin levels barely rise after you eat them. However, when you grind whole grains into flour, you break the capsule so the starches can be absorbed quickly. Foods made from flour, such as bakery products or pasta, cause a high rise in blood sugar and insulin.

• Eat large amounts of fruits, vegetables and seeds. Unprocessed vegetables, whole grains, nuts, other seeds and most fruits contain complex carbohydrates and fats that are not released rapidly into the bloodstream. These nutrient-rich foods do not cause a high rise in blood sugar and insulin.

• Exercise. Resting muscles draw no sugar from the bloodstream. On the other hand, contracting muscles draw sugar rapidly from the bloodstream and don’t even need insulin to do so. The more intensely you exercise, the less insulin is needed by muscles to withdraw sugar from the blood and this effect lasts for up to 17 hours after you finish exercising.

• Avoid overweight. Your liver controls blood sugar levels. When blood sugar levels rise, insulin drives sugar from the bloodstream into the liver. However, the more fat you have stored in your liver the harder it is for sugar to enter liver cells in response to insulin. A fatty liver will raise blood sugar levels even higher by releasing stored sugar from its cells into the bloodstream.

• Avoid smoking. Smoking damages every cell in your body.

FEB 9

If you’ve been training for some time now and have gotten the body you want, keep moving forward and don’t give up.

I know how it is.

Life happens; marriage, kids, new career, the list goes on.

And you’re probably wondering what’s going to happen to your body and all your gains.

If you’re just starting out, you may be afraid and concerned to train hard because you’ve heard that the harder you train, you can’t stop or slow down as your muscles will turn into fat.

When you stop training, there are 3 main things that’s going to happen.

#1: Your muscles will start wasting away (atrophy) and will be covered in fat.

#2: If you’re eating well and you have high protein foods in every meal like fish, eggs, chicken breast, lean beef and you’re not taking any protein supplements, you’d probably still get muscle gains and a good body.

#3: If you keep taking protein shakes but you’re not having a good solid meal, and you don’t have enough of good protein sources for your body, the chances of maintaining and gaining muscles is very low.

FEB 1

Daily Aspirin May Not Save Lives
 
Just about everyone agrees that aspirin can help to prevent heart attacks by keeping clots from forming, but a major side effect of daily aspirin is increased risk for bleeding.  Almost all heart attacks are caused by clots blocking blood flow to the heart. However, a review of 13 studies on nearly 165,000 adults without heart disease and a mean age of 62, showed that five years of taking aspirin every day increased virtually the same percentage of major bleeding episodes as it reduced the incidence of heart attacks (JAMA, Jan 22, 2019;321(3):277-287).
This means that the number of lives that were saved by aspirin decreasing clotting that can cause heart attacks was no better than the number of lives that were lost by aspirin causing bleeding that can cause strokes and stomach bleeds.  The researchers showed that they would need to treat 265 people with daily aspirin to prevent one heart attack, while they needed to treat only 210 people with daily aspirin to cause a major bleed into the brain or gastro-intestinal tract.  The absolute risk reduction of fatal and non-fatal heart attacks and strokes was 0.38 percent, compared to the increased risk of 0.47 percent for a major bleeding into the brain or gastrointestinal tract.
Another study found that the number of diabetic lives saved from heart attacks and clotting strokes was offset by the number of diabetics who died from major bleeding into the brain, eyes, stomach, and other places (N Engl J Med,  Oct 18, 2018; 379:1529-1539).  Diabetes is among the strongest risk factors for suffering heart attacks in North America today, with more than 68 percent of diabetics, age 65 or older, dying from some form of heart disease and 16 percent dying of stroke.  The 15,480 adult diabetics who had no obvious heart disease were placed on either 100 mg of aspirin per day (a little more than one baby aspirin) or a placebo. Over the next 4.7 years, a heart attack or clotting stroke occurred in 8.5 percent of the aspirin group, compared to 9.6 percent of the placebo group. This appears to be a significant protection, but major bleeding occurred in 4.1 percent of the aspirin group, compared to 3.2 percent in the placebo group. This is a also a significant difference and shows that whatever advantage was gained by the anti-clotting benefit of aspirin was offset by the bleeding that aspirin can cause.

Data on Aspirin Preventing Heart Attacks

Taking aspirin daily for three years is associated with a small reduction in heart attacks only in people who have had previous heart attacks, but not in those who had not had a previous heart attack, and the people most likely to benefit from taking aspirin daily are those 50 to 70 years old (Clin Cardiol, May 2017; Am J Med, Feb 2015;128(2):137-43). The American Heart Association recommends that you take daily aspirin only if your chance of developing a heart attack in the next 10 years is greater than five percent (Ann Intern Med, June 21, 2016;164(12):826-35). They do not recommend that most people over 70 take aspirin regularly because of the increased risk for bleeding.

Factors that put you at high risk for a heart attack include:

• A previous heart attack or stroke

• Previous heart bypass surgery

• Angina (chest pain due to coronary artery disease)

• Diabetes and at least one other heart disease risk factor such as smoking or high blood pressure

• A stent in the arteries leading to your heart. Stents increase risk for clots for the rest of a person’s life. Almost all patients with stents are prescribed some type of anti-clotting medication.

How Aspirin May Help to Prevent Heart Attacks

A heart attack and most strokes are not caused by narrowed arteries. They are caused by a sudden complete blockage of blood flow to the heart or brain. First a plaque breaks off from the inner lining of an artery leading to your heart or brain. Then that spot bleeds and a clot forms. Then the clot extends to block completely all blood flow to the heart or brain. The heart muscle then suffers from lack of oxygen and dies. Aspirin helps to prevent blood clots from forming and therefore helps to prevent heart attacks and strokes. When a patient is at very high risk for forming clots, doctors often prescribe other drugs with aspirin such as clopidogrel, prasugrel or ticagrelor.

If you have sudden chest pain or headache and think that you may be having a heart attack or stroke, dial 911. You are likely to need far more treatment than just taking aspirin. Often emergency technicians do give aspirin while they are rushing you to a hospital or after you enter an emergency room with a suspected heart attack. If you are having a stroke, aspirin can harm you because some strokes are caused by bleeding and aspirin increases bleeding.

People Who Should Not Take Aspirin

You should not start aspirin therapy without first consulting your doctor. You should not take aspirin if:

• You are at increased risk for bleeding for any reason, particularly to the stomach, intestines or brain

• You drink alcohol regularly. Taking aspirin and drinking alcohol markedly increases risk for stomach and intestinal bleeding.

• You engage in activities in which you are at risk for banging your head, which could result in bleeding into your brain

• You are allergic to aspirin

Caution About Stopping Aspirin

Never stop taking aspirin suddenly. You can suffer rebound from stopping aspirin which increases risk for clots that can cause a heart attack. If you are going to stop taking aspirin after taking it for a while, your doctor will tell you how to gradually taper your dose of aspirin.

Lifestyle Factors that Decrease Risk for Clots

What you eat and what you do influence your susceptibility to forming clots. You can decrease your risk for clotting by:

• losing excess weight

• exercising

• avoiding smoking and smokers

• keeping diabetes well controlled

• lowering high blood pressure

• lowering high cholesterol

• limiting salt

• following a heart-healthy diet with plenty of vegetables, fruits, whole grains, beans, nuts and other seeds

JAN 16

Kettlebell fans love the heavy, round-shaped weights for a reason — kettlebell exercises combine cardio and strength training for a time-saving calorie burn. The amount of calories you can burn using kettlebells can be amazingly high: a study by the American Council on Exercise found that the average person burns 400 calories in 20 minutes when doing kettlebell exercises. More research has found that regularly exercising with kettlebells significantly reduces back, neck, and shoulder pain by strengthening core and upper body muscles

JAN 5

How Exercise Reduces Dementia Risk

Almost 50 percent of North Americans over 85 and 13 percent of those over 65 suffer from Alzheimer’s disease (Alzheimer’s Assoc Facts and Figures, 2018). We know that you lose brain cells as you age, and scientists used to think that you could not make new brain cells. However, an exciting new study from Columbia University suggests that you can make new brain cells as you age, and that loss of brain function may be caused by lack of adequate blood flow and nourishment of brain cells (Cell Stem Cell, April 5, 2018;22(4):589–599).

The authors found that all age groups, from young to old, have the same number of neural progenitor cells and immature neurons that make new nerve cells in the hippocampus, the part of the brain that governs memory. Contrary to a previous study that showed no new nerve growth with aging (Nature, March 2018), this new study suggests that the brains of older people have progressive loss of new blood vessels with aging and with that, the loss of ability of brain cells to connect with each other. If lack of blood flow to brain cells can cause dementia, its prevention should include exercise — the most effective way to increase growth of new blood vessels. Many previous studies show that exercise:

• increases blood flow to the brain, and

• reduces risk for diabetes and obesity which can damage the brain.

This new study suggests that anything that increases blood flow to the brain may stimulate growth of new blood vessels and brain cells.

Studies Showing that Exercise Reduces Risk for Dementia

A study of 1,462 women, ages 38 to 60, followed for 44 years, showed that those who exercised regularly were one tenth as likely to suffer dementia with aging as those who did not exercise (Neurology, March 14, 2018). In another study, 6500 older people wore exercise trackers. After three years, those who exercised regularly had a 36 percent lower risk of memory loss as well as better memory and executive function (Medicine & Science in Sports & Exercise, January 2017;49(1):47–53).

A third study of 81 older adults used VO2 max, a test of maximal ability to take in and use oxygen, to give a dependable measure of fitness. Those who were less fit had an increased rate of dementia and of losing the white matter in their brains that helps them to retain memory and make wise decisions (Journal of Alzheimer’s Disease, Dec 19, 2017;61(2):729-739). An earlier review of hundreds of articles showed that older people who exercise have far less loss of brain function with aging, less brain blood vessel damage, larger hippocampal brain size for better memory, less loss of brain tissue with aging, better spatial memory, better communication between brain nerves and improved ability to learn new facts (Mayo Clin Proc, 2011 Sep; 86(9): 876–884).

JAN 1 2019

How to Start an Exercise Program

If you want to become fit and use exercise to help prevent a heart attack, first check with your doctor to make sure that you do not have anything wrong with your heart or blood vessels. Intense exercise can increase your risk for a heart attack if you already have a damaged heart.

Pick any sport or activity that uses continuous motion (such as running, cycling, swimming, skating, rowing, dancing) that you think you might enjoy. Start out at a relaxed pace until your muscles feel heavy and then stop. For the first several days or weeks you may be able to exercise only for a few minutes. If your muscles feel sore the next day, take the day off. Increase the amount of time gradually until you can exercise 30 minutes a day at a relaxed pace and not feel sore. Then you are ready to begin your training for fitness. Try to increase the intensity of your exercise once a week. Do your jogging, cycling or whatever you have chosen as your sport at a slow pace to warm up. Then gradually increase the pace until you start to feel short of breath and your muscles start to feel sore, and then slow down. Then when you recover, pick up the pace again. Repeat these surges until your muscles start to stiffen and then quit for the day. Take the next day off and go easy the rest of the week. Then once a week, keep on making your one-day-a-week hard workout harder and harder. You will be continuously increasing your level of fitness.

The only way to strengthen any muscle is to contract the muscle against increasingly greater resistance. Your heart is a muscle, so the only way to make your heart stronger is to contract it against greater resistance. When you exercise, you alternately contract and relax your skeletal muscles. This alternate contraction and relaxation squeezes the veins near the muscles to pump blood toward the heart. Your heart is muscular balloon. The increased flow of blood returning to your heart goes inside the heart to stretch the balloon and the heart has to contract with greater force to pump the blood from inside the heart toward the body. The increased amount of blood inside the heart stretches the heart muscle to make it stronger.

The harder you contract your skeletal muscles, the more blood you pump toward your heart, the greater the stretch on the heart to make it stronger. So fitness is determined more by how hard you exercise than by how much you exercise because the harder you exercise, the stronger your heart muscle becomes. Going out and running 100 miles a week slowly does not make you very fit because you are not strengthening your heart very much with a little increase in circulation of blood, no matter how long you do it. Compare lifting a very light weight a thousand times in a row to lifting a very heavy weight 10 times in a row. The person lifting the heavy weight 10 times will become stronger than the person lifting a light weight a thousand times.

Caution: Exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program.

DEC 23

Listen to Your Body

The best way to achieve a high level of fitness without injuring yourself is to listen to your body. Don’t depend on heart rate monitors, fitness trackers or other gadgets. The most sophisticated fitness tracker and injury-avoider is your brain. Training to achieve a high level of fitness requires intense exercise and most exercise injuries are caused by continuing to exercise intensely when your body tells you to take the day off.

A fascinating study from Boston University showed how rats’ brains automatically record both time and distance. The researchers had rats run on treadmills with brain implants to measure brain function during exercise (Neuron, November, 2015). The treadmills forced the rats to run in the same place so they were not distracted by different visual effects. Their brains generated electrical impulses that fired off regularly at repeatable specific distances and times. Some repeatable electrical brain waves were recorded every eight seconds. Some were recorded every 400 centimeters. We can assume that the human brain functions in a similar way.

You Don’t Need Electronic Devices to Track Exercise

You can buy sophisticated gadgets to monitor your:

• heart rate,

• variability of heart rate,

• blood lactic acid, carbon dioxide, sugar and oxygen levels,

• speed or cadence,

• number of steps, breaths or arm motions that you take,

• stride length, and so forth.

However, these devices cannot tell you whether you are exercising intensely enough to gain your maximum improvement in ability to take in and use oxygen or to damage your muscles enough for maximum strength gain. Only your brain can tell you whether you are at your maximum, if you need to take off because you are about to injure yourself, or when you need to slow down because you are exhausted.  Fitness gadgets can help to motivate you and can be fun to use, but do not count on them to tell you how intensely you should exercise or when you are at the edge of an injury.

A report from Deakin University in Australia reviewed 56 studies that compared the way that electronic devices and your brain tell you when to slow down or stop exercising (Br J Sports Med, September 29, 2015). Half of these studies showed that the brain and sophisticated machines were equally effective in telling you that you are training too intensely and need to reduce your training. The other half of the studies showed that 85 percent of the time, the brain was a better gauge of over-training than sophisticated machines.

Your Brain Talks to You

Your brain can tell you when you are tired, short of breath and your muscles hurt. All you have to do is to ask, “How do I feel?” Researchers can measure signs of fatigue such as lactate levels, VO2max, heart rate, heart-rate variability, rapid morning heart rate, recovery heart rate, hormone levels (cortisol, testosterone, etc.), red cell counts (hemoglobin, hematocrit, red cell indices), immunity (white blood cells, interleukins, inflammation), muscle damage (creatine kinase, oxidative stress), blood pressure, and much more. But in the real world for athletes and regular exercisers, all you need to do is listen to your body.

For example, the test called VO2max measures the major limiting factor to how fast you can move over distance: the maximum amount of oxygen you can take in and use over time. However, you do not need to monitor VO2max with a machine; you can increase VO2max just by becoming short of breath in your training. To make muscles stronger, you have to exercise intensely enough to damage muscles so that when they heal, they will become stronger.

Stress and Recover

Almost all competitive athletes use the training principal of “stress and recover”:

• On one day they take an intense workout to damage their muscles.

• On the next day they feel sore and go less intensely to allow their muscles to heal.

• Then when their muscles feel fresh again, they take their next very intense workout.

Running causes tremendous muscle damage, so runners usually run very fast only two or three times a week, long once a week and have three or four slower recovery days, even if they are working out twice a day. Competitive swimmers are different. The water seems to protect their muscles so they usually try to take one hard and one easy workout every day. Pedaling causes less muscle damage than running, so bicycle racers do some fast riding on most days, and have to learn when to slow down.

Rules to Prevent Injuries

1. When you are training properly, your muscles will feel sore when you get up almost every morning. If you warm up for a workout and your muscles don’t recover and feel fresh after 10 minutes, take the day off or go very slow. It doesn’t matter what workout you have planned for that day.

2. If you are training and you feel a soreness or pain in one area that worsens as you continue to exercise, take the day off. You are headed for an injury. Wear-and-tear injuries are usually not symmetrical. One side of your body will feel far more uncomfortable than the other. Wear-and-tear injuries don’t just happen, they give you plenty of warning.

3. Stop your intense workouts immediately when your legs start to feel heavy or hurt.

4. You recover faster from workouts by eating food and drinking fluids immediately after you finish a workout and getting off your feet as much as possible. You recover faster by lying instead of sitting and sitting instead of standing.

What Does This 80-Year-Old Bicycle Rider Do for Training?

I spent my entire competitive running career injured because I thought that the runner who does the most miles is the best. Of course, that is ridiculous. It took me 60 years to learn when to take off and I have not been injured in the last six years. That means that I hope that I have finally learned when to take days off.

Remember, I am no longer a runner. Running causes so much muscle damage that runners must go much slower three or four days a week. Bicycle riding is done in a smooth rotary motion with no road shock, so cyclists can test their legs every day. Diana and I ride very fast in a tandem bicycle group of couples in their 40s to 80s. We usually ride about 30 miles on Tuesday, Thursday and Saturday. After these hard rides, my legs are always sore when I get up the next day. I take a very slow 10-minute warm up. If my legs still feel tired or stiff or I have localized pain after the warm up, I take the day off. If my legs recover during the warm up, I then do a series of standing 50-pedal-stroke intervals fast enough to make me short of breath each time, followed by a slow recovery of however long it takes to get my breath back and for my muscles to feel fresh again. I do not time recoveries, since starting an interval before full recovery would slow down my next interval. As soon as my legs start to feel heavy, I stop the interval workout and start my slow and short cool down.

See Rests Between Intervals Should Not Be Too Short

Interval Workout Rest Periods

I am riding about 125 miles a week (30-mile fast group ride three times a week plus about 12 miles of warm up and intervals three times a week). My 30 mile rides are close to as fast as I can go, depending on how I feel. Of course I go slower on some days. I do 21 to 24 fifty-pedal-stroke intervals on my average interval workout, which takes about 40 minutes. I always stop my interval workout when my legs start to feel heavy. I am usually forced to take off or go very slow at least one day and perhaps two days a week.

Caution: People who have narrowed arteries leading to the heart can suffer heart attacks when they exercise intensely. All vigorous exercisers must learn when to back off of training because not allowing enough time to recover from hard exercise can damage your heart muscle as well as your skeletal muscles. Check with your doctor before beginning an exercise program or making a sudden change in the intensity of your existing program.

DEC 20

NSAIDs Interfere with Exercise Training
To strengthen a muscle, you have to take an intense workout that damages muscle fibers to make them feel sore on the next day. This is called Delayed Onset Muscle Soreness (DOMS). Then you take easy workouts for as many days as it takes for the soreness to lessen before you take your next intense workout. Even if you do not compete in sports, you should use some form of “stress and recover” to strengthen your muscles and keep them strong. You can tell that you are damaging muscles when you exercise vigorously enough to feel burning during exercise and DOMS in those muscles 8-24 hours later (Str & Condit J, October 2013;35(5):16–21). Only when the soreness decreases should you take your next intense workout. The soreness is caused by injury to the muscle fibers themselves and when muscles heal, they are stronger than they were before the soreness occurred (J Strength Cond Res, Feb 2003;17(1):197–208).Non-Steroidal Pain Medications (NSAIDs)Some athletes and exercisers use pain medication, such as ibuprofin (Advil, Motrin) and other non-steroidal anti-inflammatory drugs (NSAIDs), because they think it will help them to recover faster from muscle soreness so they will be able to do more training and become better athletes. NSAIDs do not prevent DOMS (Brain Behav Immun, Nov 2006;20(6):578–84). Even if they did prevent DOMS, using them would increase your chance of injuring yourself because you should use DOMS as a signal to tell you when you can safely exercise intensely again (Clin J of Sprt Med, 2002;12(6):373-378). A review of 41 research papers showed a slight association between the use of NSAIDs and reduction of injuries, but the difference was nearly the same as what you would expect from use of placebos (Am J Sports Med, Mar 2017:363546517697957).Reasons for Not Taking NSAIDs for DOMSNSAIDs are supposed to reduce pain by blocking inflammation, and inflammation is unlikely to be a cause of DOMS since it does not decrease in any way after years of exercising (Front Physiol, 2015;6:424). Earlier studies have shown that NSAIDs:• do not significantly prevent DOMS (Brain Behav Immun, Nov 2006;20(6):578–84)• may not block DOMS at all (J Sports Sci, Mar 1999;17(3):197–203)• do not help muscles to recover faster (Appl Phys Nutr and Metab, 2008, 33(3): 470-475)• may delay muscle recovery (J Bone Joint Surg Am, 77:1510-1519, 1995)• may block some of the muscle growth that makes muscles stronger in the short term (American Journal of Physiology, 2002;282:E551-556; 2011;300:R655-662)• may cause short-term weakening of bones and tendons (J Bone Joint Surg Am, 77:1510-1519, 1995)What to Do When You Have DOMSYou can stop exercising when you have DOMS if you want, but you will become stronger if you take easy recovery workouts while your muscles are still sore. Athletes do not usually plan to take off workouts during recovery, even though resting when the muscles feel sore will allow muscles to heal faster than if you exercise at low intensity. Exercising at low intensity during recovery will cause your muscles to become more fibrous and resistant to injury when you stress them in your next intense bout of exercise. If you are a runner, run faster two or three times a week and much more slowly when you feel soreness on the days after running fast. If you are a weightlifter, lift heavy weights once or twice a week and much lighter ones on the following day or days when your muscles feel sore.What Does Not Decrease DOMS

• cryotherapy, homeopathy, ultrasound or electrical current devices (Sports Med, 2003;33(2):145–64; Phys Ther Sport, May 2012;13(2):101–14)

• glutamine or arginine supplements

• stretching (Cochrane Database Syst Rev, 2011;(7):CD004577)

• Epsom salts

• drinking extra water

• compression garments

• massage therapy (J Orthop Sports Phys Ther, Feb 1997;25(2):107–12)

• vitamin D supplementation, unless a deficiency needs to be corrected (hydroxy vitamin D below 20 ng/ml)

How to Prevent Injuries

Before you start an intense exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that might cause exercise to harm you.

• Try to set up your exercise program so that on one day, you take a hard workout that damages your muscles so they feel sore on the next day. Then take easy workouts for as many days as it takes for the soreness to go away, and then take your next hard workout.

• When you are training properly, your muscles will feel sore every morning. If they don’t feel better after a 10-minute warmup, take the day off.

• When your muscles start to feel heavy or hurt, stop the workout.

• If you develop a localized pain (one side only) that worsens as you exercise and does not go away when you slow down, stop the workout immediately.

Tips for Recovery from a Hard Workout

• Eat as soon as possible after an intense workout (J of Sports Science, Jan 2004). It doesn’t matter what you eat (Am J Clin Nutr, Jan 2017).

• Go to sleep for 1-3 hours as soon as possible after an intense workout. Muscles recover faster when you are asleep.

• Avoid NSAIDs; they may ease pain but will not help you to recover faster (PNAS, June 27, 2017;114(26):6675 – 6684).

See Recovery: The Key to Improvement in Your Sport

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or make a sudden increase in the intensity of your existing program.

DEC 15

Calculate Your Fitness Age

VO2max can be used to predict a person’s risk of premature death from a heart attack. Researchers at the Norwegian University of Science and Technology have developed a simple way to estimate a person’s VO2max, his maximal ability to take in and use oxygen (Med Sci Sports Exerc, November 2011;43(11):2024-30).

The researchers had 4637 healthy adults, average age near 50, run to exhaustion on a treadmill and measured their VO2max (a complicated test that measures oxygen and carbon dioxide concentrations). They then developed a formula that correlated very well with the subjects’ actual VO2max, based on their

* sex and age,

* exercise habits,

* resting heart rate and

* waist circumference.

VO2max Predicts Fitness Age

Now the researchers have figured out the average VO2 max for a healthy person at every age from 20 to 90 and used these numbers to calculate fitness age which predicts how long a person is expected to live. Their Fitness Calculator is available (free) at http://www.ntnu.edu/cerg/vo2max

Enter your answers to the simple questions: How often do you exercise? How long? How hard? Your age? Waistline? Resting heart rate?

The calculator quickly gives you your estimated VO2max and your fitness age.

How We Fared

Gabe at 78 had an 81 cm. abdominal circumference and a resting heart rate of 48. His estimated VO2max was 50 and fitness age was 35.

Diana at 71, had a 65 cm. abdominal circumference and a resting heart rate of 50. Her estimated VO2max was 50 and fitness age was 23.

Here is our exercise program: we exercise every day for two to three hours. On Tuesdays, Thursdays and Saturdays, we race flat out on a tandem bicycle for 25 miles. On the other four days Gabe does 30-second intervals with two-minute recoveries until his legs start to stiffen. Diana takes a longer ride with some intervals interspersed.  We cycle an average 150 miles per week and go to the gym 3-4 times a week to use the strength-training machines.

Vigorous Exercise Slows Aging

Studies from all over the world show that intense exercise maintains fitness. People who do not exercise lose 15 percent of their fitness per decade, those who exercise at low intensity lose nine percent, while those who exercise intensely barely lose any fitness at all.

Increasing intensity makes you more fit. If you go out and jog the same two miles at the same pace every day, you will not improve and you will not be very fit. However, if you go faster on one day, feel sore on the next day, go slowly until the soreness disappears, and then go fast again, you will become more fit on every measure of fitness, and also perform better on the tests that measure aging.

However, with increased intensity comes increased risk of injury. Before you start an intense exercise program, and before you start lifting heavier weights, running faster, jumping higher, throwing further, hitting a tennis ball harder, or doing anything that requires increased intensity, check with your doctor. The only problem with this recommendation is that the odds are overwhelming that your doctor won’t know very much about sports, training, or improving physical fitness. But you should at least check with him or her to see if you have any condition that could be aggravated by hard exercise.

DEC 12

Exercise Wins: Fit Seniors Can Have Hearts That Look 30 Years YoungerDecember 10, 2018 5:03 AM ET

Heard on Morning Edition

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PATTI NEIGHMOND

Twitter

The people who got caught up in the exercise boom of the 1970s and stuck with it into their senior years now have significantly healthier hearts and muscles than their sedentary counterparts.

David Trood/Getty Images

We know we need to exercise for our health, but a lifelong exercise habit may also help us feel younger and stay stronger well into our senior years. In fact, people in their 70s who have been exercising regularly for decades seem to have put a brake on the aging process, maintaining the heart, lung and muscle fitness of healthy people at least 30 years younger.

Take 74-year-old Susan Magrath, a retired nurse practitioner who lives in Muncie, Ind. Magrath has been running almost daily for 45 years. She often runs outdoors and describes it as addictive. “It’s just such a release, just a wonderful release,” she says. “I ran today and there were little snowflakes coming down, and I was down by the river and it’s just wonderful. And I think it’s become more of a contemplative meditative process for me.”

Magrath may be living proof that lifelong exercise helps with cardiovascular and muscle health. She recently took part in a study at the Human Performance Laboratory at Ball State University, also in Muncie, headed by exercise physiologist Scott Trappe. Trappe is among the first to study the enticing new population of lifelong exercisers.

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After the running and aerobic boom of the 1970s, large numbers of septuagenarians stuck with it and have been exercising regularly for the past 50 years. In this population, Trappe says, “We were interested in basically two questions: One, what was their cardiovascular health? And two, what was their skeletal muscle health?”

What he saw surprised him. “We saw that people who exercise regularly year after year have better overall health than their sedentary counterparts. These 75-year-olds — men and women — have similar cardiovascular health to a 40- to 45-year-old.”

” ‘Exercise wins’ is the take-home message,” he says.

In the study, Trappe divided 70 healthy participants into three groups. Those in the lifelong exercise group were on average 75 years old and primarily kept their heart rates up through running and cycling. They had a history of participating in structured exercise four to six days a week for a total of about seven hours a week.

The second group included individuals who were also, on average, 75 years old but did not engage in structured exercise regimens, although they might have participated in occasional leisure walking or golf.

The third group consisted of young exercisers who were, on average, 25 years old and worked out with the same frequency and length of time as the lifelong exercisers.

All participants were assessed in the Human Performance Laboratory at Ball State University. Cardiovascular health was gauged by having participants cycle on an indoor bike to determine VO2 max, also known as maximal oxygen uptake, which is the measurement of the maximum amount of oxygen a person can use during intense exercise and is an indicator of aerobic endurance. During the cycling test, which became increasingly challenging, individuals exhaled into a mouthpiece that measured oxygen and carbon dioxide levels.

The aerobic profile of the participants’ muscles was measured by taking a sample via a biopsy about the size of a pea, says Trappe. Then in the lab, researchers examined the micro vessels, or capillaries, that allow blood to flow through the muscle itself.

They also looked at specific enzymes that provide fuel to the working muscle and help break down carbohydrates and fats.

Although the study was relatively small, the findings, which were published in the Journal of Applied Physiology in August, suggest a dramatic benefit of lifelong exercise for both muscle health and the cardiovascular system.

“Lifelong exercisers had a cardiovascular system that looked 30 years younger,” says Trappe. This is noteworthy because, for the average adult, the ability to process oxygen declines by about 10 percent per decade after age 30.

“It’s kind of a slow decay over time that’s probably not so noticeable in your 30s or 40s,” says Trappe, but eventually as years go on, becomes apparent. People can get out of breath more easily and may have difficulty pushing themselves physically.

The age-related reduction in VO2 max is directly associated with an increasing risk of multiple chronic diseases, mortality and loss of independence. Maintaining a strong heart and lung system has been shown to decrease these health risks.

As for muscle health, the findings were even more significant, says Trappe. Trappe says researchers were surprised to find the 75-year-old muscles of lifelong exercisers were about the same as the muscles of the 25-year-olds. “If I showed you the muscle data that we have, you wouldn’t know it was from an older individual. You would think it’s from somebody that’s a young exerciser,” he says.

David Costill, 82, was not part of the study but is a former colleague of Trappe’s and professor emeritus of exercise science at Ball State University. As an exercise physiologist, he has always known about the benefits of exercise and has been committed since high school.

He says he has spent about “60 years actively exercising.” Costill ran marathons for about 20 years until his knees started to bother him, so he headed to the pool. “And I’ve been swimming for the last 35 years.”

When Costill looks at his friends, he says he finds he can do a lot more physically than they can. “If I’m out with a group of my peers, guys who are near 80, and we’re going someplace, it seems to me they’re all walking at half speed.”

Trappe says the findings are clear: 30 to 60 minutes of exercise a day may be the key to a healthy life. But you don’t have to run marathons or compete in cycling events. “If you want to do 30 to 45 minutes of walking a day, the amount of health benefit you are going to get is going to be significant and substantial,” he says. “Will it equal the person training for competitive performances? No. But it will outdo the couch potato.”

Unfortunately, couch potatoes are the norm. Federal guidelines recommend two hours and 30 minutes of moderate exercise a week, or one hour and 15 minutes of vigorous exercise per week. Yet 77 percent of Americans do not come close to getting that amount of exercise.

Dr. Clyde Yancy, spokesperson for the American Heart Association and chief of cardiology at Northwestern University Feinberg School of Medicine, says the findings suggest “a lifelong investment in health and fitness appears to be associated with a really sustainable benefit out until the outer limits of life.”

Since we are living longer, maintaining a good quality of life is more important than ever. While the study was small and the findings need to be confirmed, they present a “strong argument” for lifelong exercise that is inexpensive and accessible for everyone. “If you can swim, do yoga, cycle, or walk,” you can benefit,” Yancy says.

DEC 11

Inactivity Linked to Arthritis

The majority of people with arthritis are inactive, overweight, diabetic or pre-diabetic. The CDC Morbidity and Mortality Weekly Report (November 9, 2018; 67(44);1238–1241) found that 32 percent of adults with arthritis have pre-diabetes or diabetes, 56.5 percent are physically inactive and 50.1 percent are obese.

Osteoarthritis affects more than 30 million North Americans, making it the most common joint disease. Anything that causes inflammation can damage joints (Nature Medicine, published online Nov. 6, 2011), and inflammation is a more common cause of arthritis than wear-and-tear injuries (Bone, 2012;51:249–257). Everything that helps to reduce inflammation also helps to reduce pain and joint damage: lose excess weight, eat an anti-inflammatory diet, exercise, lower high blood sugar levels and so forth (Ther Adv Musculoskelet Dis, 2013 Apr; 5(2): 77–94).

Inflammation Harms Joints

Your immune system attacks and destroys germs that invade your body because it can tell that germs have different surface proteins than you do. However, if your immune system stays on all the time, it will use these same cells and chemicals to attack and destroy your own tissues. This is called inflammation and anything that causes your immune system to stay active all the time can damage the cartilage in your joints. See Osteoarthritis Linked to Inflammation

Osteoarthritis Probably Caused by Inflammation

Diabetes, Pre-Diabetes and Arthritis

A high rise in blood sugar can cause sugar to stick to the outer membranes of cells. Once there, sugar cannot get off and is eventually converted to sorbitol that destroys that cell. Your immune system responds to these damaged cells in exactly the same way it works to attack invading germs, so high blood sugar is a constant source of inflammation that specifically damages joints (Osteoarthritis Cartilage, Jun 2015;23(6):841–850).

Obesity and Arthritis

Obesity turns on your immune system to raise blood levels of cytokines that can damage joints (Clin Chem Lab Med, 2010;48:1141–1145), and high levels of these cytokines predict the onset and progression of osteoarthritis (Clin Immunol, 2012;144:228–236). More than 80 percent of obese people suffer some form of joint disease, most often because having muscles and liver full of fat is associated with inflammation that can damage every cell in your body including the cartilage in joints. Obesity is frequently associated with both osteoarthritis and rheumatoid arthritis, and losing excess weight can reduce joint damage and disability and improve quality of life (PMR, May 1, 2012;4(5 0):S59–S67).

• Obese people are seven times more likely than normal-weight people to suffer osteoarthritis of the knee (Joint Bone Spine, 2011; 78(2):150-5).

• The more overweight you are, the greater your chance of suffering from osteoarthritis of the knee and hip (Joint Bone Spine, 2012; 79(3):291-7).

• Obesity is a potent trigger to develop rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis (RMD Open, June 29, 2015;1(1): e000012).

• In just 16 weeks, weight loss lowered high markers of inflammation in people with osteoarthritis (Osteoarthritis Cartilage, 2014;22(11):1817–25) and losing weight markedly reduced pain and limitation of movement in patients with osteoarthritis (Arthritis Care Res, 2013;65(1):15–22).

Inactivity and Arthritis

You may believe that people with arthritis don’t exercise BECAUSE of the pain, but osteoarthritis always worsens with inactivity. If you have joint pain, keep on moving but be guided by the pain and slow down or stop when your pain worsens. Avoid sports that involve a lot of impact, because the force of your foot hitting the ground can break off cartilage. Good non-impact sports include cycling, swimming and water aerobics.

A study that followed more than 6500 women for 12 years showed that those who exercised regularly had far fewer complaints of joint pain than those who did not exercise or who exercised only a little bit (Arthritis Care & Research, Dec 5, 2017;69(12)). The women who were overweight and did not exercise had the highest incidence of joint pain. See Knee Osteoarthritis: Exercise Therapy More Effective than Surgery

NOV 30

Retaining Strength with Aging

If you don’t exercise regularly and vigorously, expect to lose a significant amount of muscle strength as you age, and expect that loss of strength to reduce the quality of your life. A 15-year follow-up study showed that older people who lift weights at least twice a week had a 46 percent lower death rate within the study period, a 41 percent lower death rate from heart attacks, and a 19 percent lower death rate from cancer, compared to the control group that did not lift weights (Preventive Medicine, June 2016;87:121-127).

• In one study, older people with the highest loss of muscle strength were four times more likely to be disabled, have difficulty walking and need walkers or other mechanical devices to help them walk (Am J Epidemiol, 1998; 147(8):755–763). The authors of this study said, “Exercise decreases body fat and obesity, increases muscle strength, improves balance, gait, and mobility, decreases likelihood of falling, improves psychological health and reduces arthritis pain, heart attacks, osteoporosis, cancer and diabetes.”

• Strength training can significantly reduce heart attack risk factors in older people (Clin Geriatr Med, Nov 2009;25(4):703-14).

• Just eight weeks of lifting weights increased muscle strength in a group of men 80 to 88 years old (Aging Clin Exp Res, April 2010;22(2):134-40).

Exercise Reduces Loss of Muscle

Muscles are made up of thousands of individual muscle fibers. Each muscle fiber is innervated by a single nerve. With aging, humans lose the nerves that innervate muscle fibers and with each nerve loss, they lose the associated muscle fiber. For example, the vastus medialis muscle in the front of your thigh contains approximately 800,000 muscle fibers when you are 20 years old, but by age 60, it will have only about 250,000 fibers. The average person loses about eight percent of muscle size in the decade between 40 and 50 years of age, and the rate of loss increases to 15 percent per decade after age 75 (J Am Geriatr Soc, March 2003;51(3):323-30). You can slow the loss of muscle fibers as you age and can enlarge the remaining muscle fibers by exercising against resistance, but you cannot increase the number of fibers once they are lost (The Journals of Gerontology, August 2012).

Resistance exercise increases muscle size and strength in older people (Med. Sci. Sports Exerc, 2011; 43 (2): 249–58), but with aging you need to work much harder to gain the amount of strength that a younger person would get with the same program. In older people, resistance training can enlarge the remaining muscle fibers, but it does not increase the number of fibers in a muscle (Med Sci Sports Exerc, July 2011;43(7):1177-87).

How to Grow Larger Muscles As You Age

The stimulus to enlarge a muscle is to exercise against resistance vigorously enough to damage your muscles. Muscles grow when they heal from muscle damage. You can tell that you are causing muscle damage because of the burning you will feel in muscles when you are exercising and the delayed onset muscle soreness (DOMS) that you feel 8 to 24 hours after you finish exercising. Then you take easier workouts until the soreness goes away, usually in 24 to 48 hours. If you take hard workouts when muscles are sore, you are likely to tear them and not be able to exercise again until your injuries heal.

Taking in extra protein without doing resistance exercise will not increase muscle size or strength; see my report on Extra Protein Does Not Enlarge Muscles.  However, eating foods that contain both protein and carbohydrates after a workout can help muscles to heal faster and grow stronger.

Lifting Lighter Weights with More Repetitions

In one study, older men gained more muscle strength by spending more time lifting lighter weights, whereas younger men gained more muscle strength by lifting heavier weights. In younger men, doubling exercise volume by spending more time lifting weights produced limited added muscle enlargement. In older men, it resulted in much larger muscles and far more strength (The Journals of Gerontology, August 2012).

Exercising as You Age Keeps More Fast-Twitch Fibers

Muscles are made up primarily of two types of fibers: fast twitch fibers that govern strength and speed, and slow twitch fibers that govern endurance. Inactivity causes a far greater loss of the fast twitch muscle fibers that govern strength and speed (J Cell Mol Med, Sep 2009;13(9B):3032-50), so exercise makes you stronger by causing your muscles to retain more fast twitch fibers.

Benefits of Life-long Exercise

Inactivity at any age causes tremendous loss of muscle size and strength. If you inactivate a leg by putting it in a cast, you lose a large amount of muscle size in just four days. However, if you make the inactivated leg muscles contract by stimulating them with an electric current, some of the loss of muscle size is prevented (Nutrition, Acta Physiol (Oxf), March 2014; 210(3):628-41).

Life-long competitive athletes over 50 who train four to five times per week do not lose as many of the nerves that innervate muscles, so they retain more muscle size and strength with aging (The Physician and Sportsmedicine, Sept 2011;39(3):172-8). Other studies show that life-long competitive runners over 60 had almost the same number of muscle fibers as 25-year-olds. If you are not a life-long exerciser, there is still plenty of benefit from exercise no matter when you start.

Join a Gym

First check with your doctor to make sure you do not have any condition that will be harmed by vigorous exercise. Then join a gym and ask for instructions on how to use the weight-training machines. As a general rule, on each machine, you will try to move a weight 10 times in a row, rest a minute, and then do two more sets of 10. In the beginning, you should lift very light weights and go home without sore muscles. After a few weeks of lifting weights three times a week, not on consecutive days, you can gradually try to add more weight on your machines. Older people are at increased risk for injuries, so always stop a lifting workout when you feel pain in one spot that worsens as you continue to lift a weight. 

NOV 9

Irregular Heartbeats in Senior Athletes and Exercisers

Virtually all doctors agree that exercise helps to keep you healthy and to prolong your life. People who exercise into later life live longer than non-exercisers and are at reduced risk for high blood pressure, heart attacks, premature death, diabetes, strokes and even some cancers. Endurance bicycle racers who participated in the Tour de France from 1947 to 2012 live an average of five years longer than their countrymen (European Heart Journal, 2013, 34 (40):3145-3150). Fit people are less likely to suffer a particular form of irregular heartbeat called atrial fibrillation, and a regular exercise program reduces a person’s chances of developing atrial fibrillation (Circulation, April 22, 2015). More than 36,000 middle-aged women were followed for 10 years, and those who exercised regularly were far less likely to develop atrial fibrillation (Heart, May 27, 2015).

However, extreme endurance exercisers such as bicycle racers, cross country skiers and long-distance runners who compete into their 40s and beyond may be at increased risk for atrial fibrillation (American Journal of Cardiology, October 15, 2014;114(8):1229–1233). The incidence of atrial fibrillation appears to be more common in older athletes than in the general population (J Am Coll Cardiol, 2005;46:690–6). Recent articles in the Wall Street Journal, the New York Times and other popular media have suggested that athletes who continue to do extensive fast mileage or train for extreme endurance events in later life may be doing more harm than good. I feel that these articles have caused a tremendous amount of harm in the exercising community.

What is Atrial Fibrillation?

Each heartbeat starts when a “battery” in the upper heart (atrium) sends an electrical impulse through the upper heart to make it contract to squeeze blood toward the lower heart (ventricle). Then the electrical impulse reaches another “battery” in the lower heart to make the lower heart squeeze blood forward. Atrial fibrillation means that the upper heart quivers and does not push blood forward, while the lower heart beats independently.

Some people with atrial fibrillation have no symptoms and do not know that they have this condition until it is discovered during a routine physical examination. Symptoms may include:

• Palpitations (a feeling that the heartbeat is racing, uncomfortable, or irregular)

• Muscle weakness

• Reduced ability to exercise

• Fatigue

• Lightheadedness

• Dizziness

• Confusion

• Shortness of breath

• Chest pain

These symptoms are usually harmless, but on rare occasions an irregular heartbeat can cause sudden death by stopping the heart from pushing blood through your body.

Atrial fibrillation is the most common irregular heartbeat. It occurs in 1.5 to 2 percent of the general population and risk increases with age. It affects 10 percent of 75-year-olds and 20 percent of those over 85, because aging increases the risk factors for atrial fibrillation such as blocked arteries, high blood pressure or diabetes.

How Atrial Fibrillation Can Harm You

When a person has an upper (atrial) heart that is fluttering, a clot can collect there and pass to the brain to cause a stroke, or to the lungs to block blood flow through the lungs. This is so dangerous that most doctors prescribe anti-clotting agents to everyone with atrial fibrillation. I believe that athletes with atrial fibrillation are far less likely to suffer clots that cause strokes than non-athletes with atrial fibrillation, but I have not seen any studies to support my belief. Healthy athletes can have occasional irregular heartbeats that will not harm them, but at this time, doctors treat atrial fibrillation in athletes the same way they treat their other patients.

Extreme Exercise May increase Atrial Fibrillation Risk

Two studies raised the concern about extreme amounts of exercise in older athletes. In the first study, 29 elite athletes were given MRIs to look for heart muscle scarring that increases risk of atrial fibrillation. They were Olympic or national team runners and rowers who had competed throughout their lives, including some who had completed more than 100 marathons. In the older group of 12 athletes ages 50 to 67, half showed some heart muscle scarring (J Appl Physiol, June 2011;110(6):1622-6). Those who had trained the longest and hardest had the most scarring. None of the 17 younger athletes (20-42) or the control group of 20 older non-athletes showed this heart muscle scarring.

In the second study, on rats, a 16-week program of daily one-hour treadmill running caused widening of the upper part of their hearts and scarring in the heart muscle that could increase risk for irregular heartbeats (J Am Coll Cardiol, July 2013;62(1):68-77). The scars in the upper heart remained after the rats stopped exercising.

Risk Factors for Atrial Fibrillation

• High blood pressure is the most significant risk factor for atrial fibrillation (Hypertension, 2012 Feb;59(2):198-204). Blood pressures greater than 140/90 significantly increased risk (J Am Soc Hypertens, 2015 Mar;9(3):191-6).

• Diabetes

• Overweight (J Am Coll Cardiol, Jul 7, 2015). A program getting people to reduce their excess body weight markedly reduced symptoms in patients who already had atrial fibrillation (JAMA, 2013;310(19):2050-206).

• Alcohol

• Smoking

• An over-active thyroid

• A very low heart rate, below 50 beats per minute (Circ Arrhythm Electrophysiol, 2013, Aug;6(4):726-31).

• Abnormal coronary artery calcium score, even with no heart symptoms (Am J Cardiol, 2014 Dec 1;114(11):1707-12). This test can be ordered by any doctor.

• Lack of exercise. Exercise helps to prevent atrial fibrillation; fit men had a 23 percent lower susceptibility for atrial fibrillation (Am J Cardiol, 2012 Aug 1;110(3):425-32).

• Aging. The older you are, the more likely you are to suffer atrial fibrillation. Walking or cycling is associated with a decreased risk in older people (Heart, 2014 Jul;100(13):1037-42).

• Possibly extreme ultra-endurance exercise.

My Recommendations

Exercise reduces the chances of a person developing atrial fibrillation. Nobody has shown that exercise in itself causes atrial fibrillation, and it is only extreme ultra-endurance exercise that some doctors believe may increase risk for atrial fibrillation. I think that nutrition, exposure to pollutants and other lifestyle factors are also important. I do not believe that just exercising will give you adequate protection from heart disease. To protect your heart, you should follow all of the rules that apply to everyone whether you compete in ultra-endurance events, exercise moderately or just sit on a couch.

• eat lots of fruits and vegetables

• severely restrict sugar-added foods and drinks

• restrict red meat and fried foods

• avoid smoking, second-hand smoke and third-hand smoke

• restrict alcohol

• avoid overweight

• exercise

However, some doctors disagree with me. Even if you are healthy and do not have any heart problems, your doctor may recommend that you avoid strenuous workouts. If you have atrial fibrillation or other heart problems, some doctors will even tell you to stop exercising altogether. After all, on rare occasions irregular heartbeats can kill you. If you already suffer from atrial fibrillation, or you already have blocked arteries leading to your heart, you have to depend on your doctor’s advice.

One Senior Athlete’s Exercise Program

I am 80 years old and do not have atrial fibrillation or known heart disease. I race with others 20 to 30 miles on my bike three times a week and know that I have to back off when my leg muscles start to feel stiff and heavy. I race for the sheer pleasure of riding fast. There are no trophies or financial rewards. On my other four days, I try to do controlled 50-pedal-stroke intervals until my legs feel heavy or hurt.

For most of my life, first as a marathon runner and then as a cyclist, I had exercise-induced injuries all the time. It took me more than 70 years to learn when to go slow and when to take a day off. Most mornings, my leg muscles feel heavy and ache from my previous day’s work out. If my legs do not feel better after riding my bike for 10 minutes, I take the day off or ride very slowly. I do not ever plan to do slow junk miles and I do not care how few miles I put down in my diary. I usually have to take off one day a week and go slowly one day a week. I also follow all of the rules I have listed for a healthful lifestyle.

NOV 6 ARE YOU OVER 40.50,60,or 70 GOOD WORKOUT 

NOV 05

Healthful Lifestyle Reduces Risk of Dying from Prostate Cancer

Almost all North American men will develop prostate cancer if they live long enough. However, fewer than five percent of men diagnosed with prostate cancer will die from that disease and the 15-year survival rate is 96 percent.

Data from the Health Professionals Follow-Up Study show that men who participated most frequently in vigorous exercise had a 30 percent reduced risk of developing advanced prostate cancer and 25 percent reduced risk of dying from prostate cancer than those who exercised the least (European Urology, October 22, 2018). Men in the highest group of intense exercisers did the equivalent of 25 minutes of running daily in various activities including bicycling, swimming, heavy outdoor work or playing sports such as tennis or racquetball.

Nearly 50,000 men, 40-75 years old, were followed for 26 years, during which 6,411 developed prostate cancer and 888 developed the aggressive type that can kill. Half of all prostate cancers contain the gene, TMPRSS2:ERG. If you have this gene, insulin, certain growth factors and other metabolic factors increase your risk for developing prostate cancer. This could explain the link between physical activity and reduced risk for developing or dying from prostate cancer. This genetically-driven prostate cancer now appears to be a metabolic disease and all the rules for preventing and treating diabetes and heart attacks also may help to prevent and treat these cases of prostate cancer.

The same group of researchers published a paper in the same journal issue showing that measuring PSA levels in mid-life can predict the likelihood to develop aggressive prostate cancer later on in African-American men (European Urology, October 22, 2018). The group reported earlier that PSA screening in mid-life can also be used to predict aggressive prostate cancer in Caucasian men.

Lifestyle Factors that Increase Risk for Prostate Cancer

• Most risk factors for diabetes and heart attacks are also risk factors for developing prostate cancer: high blood sugar, high insulin levels, high cholesterol, and diabetes (Horm Cancer, April 2016;7(2):75-83).

• Prostate cancer is six times more common in Western than non-Western countries and in countries that are richer rather than poorer (Eur Urol 2012, 61:1079-1092).

• Obesity is associated with increased death rate, more advanced stage disease, and higher Gleason scores once a man has prostate cancer (Int J Oncol, Mar 2006;28(3):737-45). Doctors look at prostate cancer cells under a microscope and use the characteristics of the cells, called the Gleason score, to predict how likely the cancer is to spread through the body.

• Full fat cells produce high levels of potential cancer causing leptin, interleukin-6 (IL-6), heparin-binding epidermal growth factor-like growth factor (HB-EGF), vascular endothelial growth factor (VEGF) and adiponectin that can cause cancer cells to spread through your body (Int J Oncol, Mar 2006;28(3):737-45 and J Clin Endocrinol Metab, Mar, 2001;86(3):1341-5).

• High blood sugar (fasting sugar over 100) in men diagnosed with prostate cancer markedly increases risk of them dying from prostate cancer (Prostate Cancer Prostatic Dis, June 2013;16(2):204-8).

• Eating a diet that has a high glycemic load (foods that cause a high rise in blood sugar) increases risk of developing prostate cancer by more than 26 percent (Ann Oncol, Jan 2013;24(1):245-51).

• Exercise is associated with reduced risk for both slow growing prostate cancer and the type that can kill (Journal of Urology, November 2009;182(5):2226-2231).

If You Already Have Prostate Cancer

After a man is diagnosed with prostate cancer, the same risk factors associated with the disease also increase risk for the prostate cancer progressing and being fatal. Men diagnosed with prostate cancer are less likely to have the prostate cancer spread and kill them if they:

• avoid smoking, maintain a healthy body weight, exercise regularly and intensely, and eat a high vegetable diet that includes tomato sauce (lycopene), cruciferous vegetables, non-saturated vegetable fats and coffee (World J Urol, 2017 Jun; 35(6): 867-874).

• restrict eggs, red meat and poultry (American Journal of Clinical Nutrition 2010; 91(3): 712-21; American Journal of Clinical Nutrition 2012; 96(4): 855-63; Cancer Prevention Research (Phila) 2011; 4(12): 2110-21). These foods are sources of choline that colon bacteria convert to TMAO, which is a carcinogen.

• restrict saturated fat in meat and eat polyunsaturated fats in vegetables (annual meeting of the American Association for Cancer Research. April 19, 2016).

My Recommendations

Most risk factors for heart attacks are also risk factors for prostate cancer (Journal of the American College of Cardiology: Cardiovascular Imaging, December 2015). I believe that the most beneficial diet to prevent and treat prostate cancer includes eating lots of fruits and vegetables, and restricting refined carbohydrates, red meat and processed meats, and fried foods (BMC Medicine, March 24, 2015;13:3). I also recommend that you try to exercise every day and work to lose excess weight if you are overweight.

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NOV  01

Exercises for Seniors to Improve Strength and Balance

In Canada and around North America, falls are one of the leading causes of injury and death for senior citizens. However, you don’t have to fall prey to slops & falls  By exercising, you can improve your balance and your strength, so you can stand tall and feel more confident when walking.

Read on to find 14 exercises seniors can do to improve their balance.

Exercise 1: Single Limb Stance

It’s best to start off with a simple balance exercise for seniors. Here’s how you do this one: stand behind a steady, solid chair (not one with wheels), and hold on to the back of it. Lift up your right foot and balance on your left foot. Hold that position for as long as you can, then switch feet.

The goal should be to stand on one foot without holding onto the chair and hold that pose for up to a minute.

Exercise 2: Walking Heel to Toe

You might read this and wonder, “How is walking an exercise to improve balance?” This exercise makes your legs stronger, which enables you to walk without falling.

Put your right foot in front of your left foot so that the heel of your right foot touches the top of the toes of your left foot. Move your left foot in front of your right, putting your weight on your heel. Then, shift your weight to your toes. Repeat the step with your left foot. Walk this way for 20 steps.

Exercise 3: Rock the Boat

Stand with your feet apart, so that the space between them is the same width as your hips. Make sure both feet are pressed into the ground firmly. Stand straight, with your head level. Then, transfer your weight to your right foot and slowly lift your left leg off the ground. Hold that position for as long as possible (but no more than 30 seconds).

Slowly put your foot back onto the ground, then transfer your weight to that foot. Slowly lift your opposite leg. Start by doing this exercise for balance five times per side, then work your way up to more repetitions.

Exercise 4: Clock Reach

You’ll need a chair for this exercise.

Imagine that you are standing in the centre of a clock. The number 12 is directly in front of you and the number 6 is directly behind you. Hold the chair with your left hand.

Lift your right leg and extend your right arm so it’s pointing to the number 12. Next, point your arm towards the number three, and finally, point it behind you at the number 6. Bring your arm back to the number three, and then to the number 12. Look straight ahead the whole time.

Repeat this exercise twice per side.

Exercise 5: Back Leg Raise

This strength training exercise for seniors makes your bottom and your lower back stronger.

Stand behind a chair. Slowly lift your right leg straight back – don’t bend your knees or point your toes. Hold that position for one second, then gently bring your leg back down. Repeat this ten to 15 times per leg.

Exercise 6: Single Limb Stance with Arm

This balance exercise for seniors improves your physical coordination.

Stand with your feet together and arms at your side next to a chair. Lift your left hand over your head. Then, slowly raise your left foot off the floor. Hold that position for ten seconds. Repeat the same action on the right side.

Exercise 7: Side Leg Raise

You’ll need a chair for this exercise to improve balance.

Stand behind the chair with your feet slightly apart. Slowly lift your right leg to the side. Keep your back straight, your toe facing forward, and stare straight ahead. Lower your right leg slowly. Repeat this exercise ten to 15 times per leg.

Exercise 8: Balancing Wand

This balance exercise for seniors can be performed while seated. You’ll need a cane or some kind of stick. A broomstick works well for this – just remove the broom’s head before you start.

Hold the bottom of the stick so that it’s flat on the palm of your hand. The goal of this exercise is to keep the stick upright for as long as possible. Change hands so that you work on your balance skills on both sides of your body.

Exercise 9: Wall Pushups

As long as you’ve got a wall, you can do this strength training exercise for seniors.

Stand an arm’s length in front of a wall that doesn’t have any paintings, decorations, windows or doors. Lean forward slightly and put your palms flat on the wall at the height and width of your shoulders. Keep your feet planted as you slowly bring your body towards the wall. Gently push yourself back so that your arms are straight. Do twenty of these.

Exercise 10: Marching in Place

Marching is a great balance exercise for seniors. If you need to hold onto something, do this exercise in front of a counter.

Standing straight, lift your right knee as high as you can. Lower it, then lift the left leg. Lift and lower your legs 20 times.

Exercise 11: Toe Lifts

This strength training exercise for seniors also improves balance. You’ll need a chair or a counter.

Stand straight and put your arms in front of you. Raise yourself up on your toes as high as you can go, then gently lower yourself. Don’t lean too far forward on the chair or counter. Lift and lower yourself 20 times.

Exercise 12: Shoulder Rolls

This is a simple exercise for seniors. You can do it seated or standing.

Rotate your shoulders gently up to the ceiling, then back and down. Next, do the same thing, but roll them forwards and then down.

Exercise 13: Hand and Finger Exercises

The following are exercises to improve flexibility. You don’t need to stand for these.

In the first exercise, pretend there’s a wall in front of you. Your fingers will climb the wall until they’re above your head. While holding your arms above your head, wiggle your fingers for ten seconds. Then, walk them back down.

During the second exercise, touch your hands while they’re behind your back. Reach for your left hand while your right hand is behind your back. Hold that position for ten seconds, then try with your other arm.

Exercise 14: Calf Stretches

These strength training exercises for seniors can be performed sitting or standing.

To do calf stretches while standing, find a wall with nothing on it. Stand facing the wall with your hands at eye level. Place your left leg behind your right leg. Keep your left heel on the floor and bend your right knee. Hold the stretch for 15 to 30 seconds. Repeat two to four times per leg.

If you want to stretch your calves while sitting, you’ll need a towel. Sit on the floor with your legs straight. Put the towel around the soles of your right foot and hold both ends. Pull the towel towards you while keeping your knee straight and hold it for 15 to 30 seconds. Repeat the exercise two to four times per leg.

OCT 30

You Can’t Exercise Too Much

Dramatic results in a new study from the Cleveland Clinic show that:

• You can’t exercise too much: Elite athletes who do tremendous amounts of exercise have a much lower risk of dying than non-athletes.

• Exercise is healthful: Not exercising is worse for your health than smoking, diabetes or heart disease. The vigorous exercisers had nearly a 500 percent reduced risk of death during the study period, compared to the non-exercisers (JAMA Network Open, Oct 19, 2018;1(6):e183605).

More than 120,000 patients, average age 53, were given an exercise stress treadmill test between 1991 and 2014 and were followed up at the Cleveland Clinic. The researchers used the stress test results to classify their fitness level as low (the bottom 25th percentile), below average (25th to 49th percentile), above average (50th to 74th percentile), high (75th to 97.6th percentile), and elite (above 97.7th percentile). By January 1, 2018, 13,637 of the participants had died.

The study results were overwhelming. The more fit a person was, the less likely he was to die. There was no limit to the increase in benefits from improving fitness to very high levels. The elite athletes had an 80 percent reduction in risk for death. The greatest differences were seen among patients who had high blood pressure in the high and elite groups compared to those in the low fitness group. The lead researcher concluded, “We found that there was no ceiling for benefit . . . with no toxicity at the higher end.”

Can Extreme Amounts of Exercise Be Harmful?

This new study counters the findings of earlier studies on elite athletes that suggested they are at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

Exercise Reduces Inflammation

Aging is associated with inflammation, an overactive immune system. Your immune system is supposed to kill germs when they attack you, but as soon as the germs are gone, your immunity is supposed to dampen down. However if your immunity stays active all the time, it attacks you in the same way that it kills germs. It can punch holes in arteries to cause plaques, break off the plaques to cause heart attacks, destroy your DNA to cause cancer, cause various auto-immune diseases and so forth. As you age, inflammation increases to cause loss of muscles and bone, osteoarthritis, loss of cell function associated with aging, and other harmful effects. Exercise helps to dampen down inflammation, and thus helps to prevent diseases and prolong life. One study of 111 women, ages 65 to 70, showed that replacing 30 minutes of sitting time with the same amount of time in light or moderate exercise very significantly reduced markers of inflammation (C-reactive protein and fibrinogen) and diabetes (Medicine & Science in Sports & Exercise, July 2018).

Intense Exercise is More Beneficial than Casual Exercise

This new study agrees with many earlier studies that have shown greater benefits from vigorous exercise than from low-intensity exercise:

• The SUN Study on 18,737 middle-aged people showed that those who exercise intensely have half the rate of heart attacks as those who did the same amount of exercise less intensely (Am J of Cardiology, Sept 11, 2018).

• Increased time spent exercising intensely gives adolescents a healthier metabolic profile than more time spent just exercising (PLOS Medicine, Sept 2018; 15 (9): e1002649).

• Vigorous exercise is associated with a much lower rate of metabolic syndrome and diabetes, compared to low-intensity exercise (American J of Prev Med, April 2017;52(4):e95–e101).

My Recommendations

I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program. Do not start an intense exercise program until you have spent several months exercising at a casual pace.

Socialization usually improves the length of time, intensity and enjoyment of exercise, so it is best to join a group, exercise with your mate, or do your exercise regularly with friends (Am J Alzheimer’s Dis Other Demen, June 2014; 29(4): 372–378).

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or make a sudden increase in the intensity of your existing program.

OCT25

Swimming May Slow Down Aging By Decades

From cradle to grave, swimming might just be the best exercise ever. Here, eight health benefits of taking a lap or two. 

Swimming is good for just about everyone. It accommodates all ages, stages, abilities and disabilities.

There’s also evidence it can slow down the aging process.

A long-term study at Indiana University Bloomington’s Counsilman Center for the Science of Swimming found that Masters Swimmers (over age 35) who swam roughly 3,200 to 4,500 metres (about 3.2 to 4.8 kilometres) three to five times a week, postponed the aging process. And not just for a few years but for decades, according to traditional age markers like muscle mass blood pressure and lung function.

But you don’t have to be a Masters Swimmer to benefit from swimming. Far from it.

“The health and well-being benefits start with a minimal amount of swimming,” Counsilman Centre Director Joel Stager is quoted as saying in the university’s newsletter. “If you want the fitness effect, you’ll need to look at getting your heart rate up and boosting the intensity.”

Another study, by Dr. Steven Blair at the University of South Carolina, has shown swimming dramatically reduces the risk of dying. The study spanned 32 years and followed 40,000 men, aged 20 to 90. Those who swam had a 50 per cent lower death rate than runners, walkers and those who didn’t exercise at all.

Here are some other known benefits to swimming:

1. It’s kind to your joints and improves flexibility: “Swimming is a form of exercise that’s suitable to people of all ages because it’s so easy on the joints,” says Belgium-based Christophe Keller, who so loves the sport he created a website solely devoted to it, called enjoy-swimming.com. “The water supports the body so only a fraction of your weight has to be supported by your limbs. It also favours smooth circular movements rather than quick jerky movements that can strain joints.”

2. Helps you lose weight: Swimming for half an hour can burn as much as 250 calories. Even a gentle swim can burn 200 calories. Since water is about 800 times denser than air, your body has to work harder in the pool, even though it might not feel like it is. Gliding through the water can be a glorious feeling.

3. Improves mental health: The British website swimming.org reports that swimming promotes feelings of well being, something the Centres for Disease Control and Prevention confirms. “For people with fibromyalgia it can decrease anxiety, and exercise therapy in warm water can decrease depression and improve mood.”

Article Continued Below

4. It’s a great aerobic exercise: Swimming increases your lung capacity and gives them a solid work-out. It’s also been identified as a good form of exercise for people with asthma.

5. Choose where you want to tone up: Since swimming involves a variety of strokes that use different muscles, you can target the areas you most want to tone – be it legs, upper arms, or stomach muscles. Keller’s website includes techniques for doing each stroke.

6. It’s cheap: Unlike some sports which require a lot of equipment, swimming just requires a swim suit, bathing cap and a pair of decent goggles and of course a pool, which most cities and mid-size communities have. It’s also a great summer exercise since you can cool down and work out at the same time.

7. Suitable for all ages: That’s why they say swimming is ‘cradle to grave.’ You simply adjust the pace to your age and ability.

8. It’s social: “If you swim regularly you’ll most likely make new friends of all ages,” says Keller, “since people not only swim at the pool but also like to relax, socialize and talk. My impression is that swimmers are usually positive and in a good mood.”

If you aren’t already a swimmer, but think you might like to start, first check with your doctor to make sure there aren’t any health issues to take into account. You might even want to enroll in swim lessons. An instructor can not only help build swimming skills, but alleviate any fears you might have about the water.

“Take it slow in the beginning and progress at your own pace,” suggests Keller. “Don’t try to measure up to a 20-year-old speeding through the water. Instead, enjoy the experience of swimming – of floating and moving through the water.”

OCT 18

Cooling Down After Intense Exercise

“Cooling down” means that after you exercise intensely, you slow down and exercise at low intensity for a while before you stop exercising for that session. The scientific literature is controversial on whether cooling down helps to reduce next-day muscle soreness to help muscles to recover faster. I believe that cooling down may help you to heal faster from muscle soreness after intense exercise, which allows you to recover faster from intense workouts. There is some evidence that cooling down augments your immune system response to help muscles fibers heal faster from the Z-line damage caused by hard exercise (Sports Med, July 2018;48(7):1575-1595; Nat Rev Immunol, 2011;11:607-615).

You can tell you are damaging muscles when you exercise vigorously enough to feel burning during exercise and when you get soreness in those muscles that develops 8-24 hours later (Strength & Conditioning Journal, October 2013;35(5):16-21). This is called Delayed Onset Muscle Soreness (DOMS); see my report on DOMS below. The old explanation that cooling down helps muscles recover faster by ridding them of lactic acid does not adequately explain any improvement in recovery time after intense exercise. Lactic acid build-up from intense exercise lasts, at most, for only a few minutes even if you do not cool down. Muscle soreness that starts more than four hours after stopping exercise is not caused by lactic acid accumulating in muscles; it is caused by damage in the muscle fibers.

Cooling Down May Help You Recover Faster

Many coaches and athletes believe that cooling down helps muscles heal so the athlete can resume intense workouts sooner and thus become a stronger athlete. However, there is conflicting scientific evidence whether cooling down helps to prevent DOMS. There is some evidence that cooling down does help to relieve DOMS three days after intense exercise (J Strength Cond Res, Oct, 2012;26(10):2777-82), but smaller studies on non-competing athletes fail to show that cooling down reduces next-day muscle soreness (J Hum Kinet, Dec 2012;35:59-68; Aust J Physiother, 2007;53(2):91-5), or helps athletes to recover faster (J Hum Kinet, Mar 2012;31:121-9). There is data to show that cooling down reduced pain when pressure was applied to muscles with DOMS 48 hours after intense exercise, more so than on the muscles of those who did not cool down (J of Human kinetics, Jan 26, 2013;35(1):59-68). A recent review of the scientific literature concluded that cooling down does not enhance same-day or next-day sports performance, even though it may help to clear lactic acid in blood faster, but cooling down may partially prevent immune system depression and promote faster recovery of the heart and lungs (Sports Med, Jul 2018;48(7):1575-1595).

Known Benefits of Cooling Down

• Cooling down can help to keep you from feeling dizzy or passing out after very vigorous exercise (Medicine and Science in Sports and Exercise, Sept 1994;26(9):1095-1101). Most people who pass out in races do so after they stop running suddenly at the finish line. In one study, all of the runners who collapsed had an excessive drop in blood pressure when they went from lying to standing, and the few cases of collapse away from the finish line were far more serious and were often caused by diseases such as asthma, heart damage or heat stroke (Physician and Sportsmedicine, 2003;31(3):23-29).

• Cooling down can help to clear lactic acid and relieve oxygen debt after intense running (J of Applied Physiol, Nov 6, 1966;21(6):1767-1772).

Cooling down has NOT been shown to improve fitness level, make you stronger (J Strength Cond Res, Nov 2012;26(11):3081-8), or to prevent injuries.

My Recommendations for Recovery After an Intense Workout

• Before every intense workout, warm up by going slowly until your muscles feel fresh.

• After every intense workout, do a prolonged cool down of at least 10 minutes (Sports Science Exchange, 87:15, 2002; J Sports Sci Med, 2004 Sep; 3(3):131-138).

• Drink fluids for a faster recovery (Journal of Sports Sciences, January 2004).

• Add salt on hot days if your muscles feel excessively fatigued or if you develop cramps (Can J Appl Physiol, 2001;26 Suppl:S236-45).

• Eat as soon as you finish your intense workout (J Sports Sci Med, 2004 Sep; 3(3): 131–138). It doesn’t matter what you eat in your post-intense-workout meal, as long as it contains lots of protein and carbohydrates (Am J Clin Nutr, Jan 2017; Med Sci Sports Exerc, Oct 2008;40(10):1789-94). In one study, fast foods such as French fries, hash browns and hamburgers helped athletes recover just as quickly from hard workouts as sports nutrition products such as Gatorade, PowerBars and Clif Bars (International Journal of Sport Nutrition and Exercise Metabolism, March 26, 2015).

• After each intense workout, get off your feet and do as little walking as possible.

• Try to sleep within a few hours after your intense workout as you may recover faster by sleeping than remaining awake (South African J Research in Sport, Physical Education and Recreation, Jan 2012;34(1):167 – 184). Loss of sleep can impair exercise performance (European Journal of Applied Physiology, April 2017;117(4):699-712).

• Do not take non-steroidal anti-inflammatory drugs (NSAIDs) to relieve muscle soreness. NSAIDs can block gains in strength and endurance (

OCT 11

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592)

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging

Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

OCT 1

Should You Breathe Through Your Nose?

People who exercise with their mouths closed aren’t working very hard. You can’t get enough air through your nose to meet your needs for oxygen when you exercise vigorously. The cross sectional area of the openings in your nose is less than one tenth the opening in the back of your mouth. That space is so narrow that when you pick up the pace, you could turn blue.

You don’t need to breath through your nose when you exercise in very cold weather. Your nose warms the air much more than your mouth does, but exercise causes your body to produce such large amounts of heat that air taken through your mouth at 40 degrees below zero Fahrenheit during exercise will be warmed almost 100 degrees before it reaches your lungs. Breathing air that cold hurts so much that you lose interest in exercising and seek shelter.

Your nose clears pollutants far more efficiently than your mouth does, but people with healthy lungs can exercise safely on polluted days. Pollutants that you breathe in through your mouth can be quickly cleared from your lungs. Your air tubes are lined with small hairs, called cilia, that sweep pollutants towards your mouth where you swallow them with your saliva and they pass from your body.

Lifter-for-life-1

SEPT 22

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program. 

SEPT 20

Exercise for Arthritis

When you have arthritis, your joints hurt every time you move. When you wake up, your muscles and tendons are so stiff that you can barely get out of bed, but you force yourself to get up and as you keep on moving, the pain lessens and you can move a little faster.

Is your body trying to tell you something when you muscles and joints feel better after you start to move? Dr. Ronenn Roubenoff of Tufts University Medical School published a paper in the Journal of Rheumatology showing that rest worsens arthritis, and strength training helps to control the pain of arthritis.

Most people think that when they have arthritis, they are supposed to rest their muscles and joints, but resting is the worst thing that a person with arthritis can do. Arthritis means that the gears that are formed by cartilage in your joints are damaged, causing your joints to hurt. Resting weakens your muscles and makes your joints wobble even more when you walk. Your car works in a similar fashion. When your car goes over a bumpy road, the shock absorbers dampen the shock of each bump. When you walk or run, the cartilage in your joints act like rubber to absorb the shock. Resting weakens cartilage and increases its likelihood to break. Resting weakens muscles so they can’t control the joint, allowing more wobble of the joints with each movement and therefore increasing cartilaginous damage.

People with arthritis should exercise, but they should not walk fast or run. When you walk or run, your foot stops moving suddenly when it hits the ground with a force that is transmitted up your leg to your knees and hips. This force can break cartilage. So people with arthritis should not run, walk fast, jump, or play tennis or basketball because the jarring breaks joints. On the other hand, these people can pedal a bicycle because pedaling is done in a smooth rotary motion that does not stop suddenly to jar and break the cartilage in joints.

People with arthritis should also lift weights because this strengthens muscles to stabilize joints, and strengthens cartilage to protect it from breaking. Ideally, everyone with arthritis should gain access to weight machines and be taught how to lift weights with proper form, in sets of ten, two or three times week. They should also pedal a bicycle several times a week. The combination of smooth continuous exercise on a bicycle and supervised weight lifting on a machine can help protect people with arthritis from further joint damage and reduce pain. Swimming, rowing or any other activities that use smooth motions can be substituted for cycling.

SEPT 5

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone 

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION:People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

AUG 31

Even a 100-Year-Old Can Improve with Training

A new research report shows that you can improve athletic performance with proper training, even if you are over 100 years old. Traditional feeling among scientists is that aging is progressive and inevitable, and that your genetic programming causes you to age no matter what you do. This paper shows that physical training can reverse established markers of aging (J Appl Physiol, February 15, 2017).

A few weeks ago I reported on Robert Marchand, the 105-year-old cyclist who had improved his world record for how far he could ride a bicycle in one-hour from 15.07 miles (24.25 kilometers) at age 101 to 16.73 miles (26.92 kilometers) at age 103. That is an 11 percent improvement in a world record after just two years of serious training, an impressive accomplishment at any age.

Marchand’s Training Program

For two years, from age 101 to 103, Marchand trained by riding 3000 miles (5,000 km) per year, with 20 percent of his workouts doing hard, intense riding and 80 percent doing slow recovery riding. He spun his pedals at a cadence between 50 and 70 rotations per minute.

This new study documents his training program and the improvements in his markers of aging. Athletes can run, ride, swim or ski faster if they improve their maximum ability to take in and use oxygen (VO2max) and their peak power output (strength). These same measurements are used by scientists to track aging in non-athletes. Marchand’s VO2max (maximal ability to take in and use oxygen) increased 13 percent, from 31 to 35 ml.kg-1.min-1, and his peak power output increased by 39 percent, from 90 to 125 watts.

These factors improved in Marchand because he was able to increase his maximal pedaling frequency by 30 percent, from 69 to 90 rotations per minute, and his ability to take in air through his lungs by 23 percent, from 57 to 70 liters per minute. His maximum heart rate and body weight did not change.

Training That Reduces Measures of Aging

Here is a program of training that is typical of the way competitive athletes in endurance sports work to become faster.

Muscle-sugar-depleting workout (one per week): You must exercise long enough to use up most of the sugar stored in your most-used muscles. Muscles use primarily fat and sugar for energy. You have an almost infinite amount of fat stored in your body, but only a very limited amount of sugar stored in the liver and muscles. Sugar requires less oxygen than fat to fuel your muscles, so when you run out of sugar stored in your muscles, you have to slow down. Exercising long enough to deplete muscles of their stored sugar supply increases the amount of sugar they can store and also increases your ability to move faster longer. The faster you move, the quicker you use up your muscles’ stored supply of sugar. The average runner can use up most of his stored muscle sugar supply while running fairly fast for two hours, and the average bicycle rider can use up his stored muscle sugar in three hours.

Intense oxygen deficit workout (two per week): The limiting factor to how fast you can move is the time it takes to move oxygen into muscles. You can increase your ability to take in and use oxygen by using interval workouts in which you run up severe oxygen debts and gasp for breath. You also have to damage muscles so that when they heal, they become stronger. To do this you must put great pressure on your muscles by moving very fast.

Type of Intervals: A short interval lasts less than 30 seconds. You can do lots of them in a single workout because in less than 30 seconds, you do not build up much lactic acid and do less muscle damage. A long interval lasts longer than two minutes and you should do only a limited number of these intervals because they cause considerable muscle damage and can take a long time for muscles to heal and recover.

Recovery workouts (at least four per week): Intense interval workouts cause considerable muscle damage, and it usually takes at least 48 hours for muscles to heal, so each intense workout requires easier workouts on the following day. If you are training twice a day, each intense workout is usually followed by three recovery workouts.

Example of a Weekly Training Program

Sunday: race or depletion workout

Monday: recovery workout

Tuesday: short intervals

Wednesday: recovery workout

Thursday: long intervals

Friday: recovery workout

Saturday: recovery workout

How to Apply These Concepts to an Ordinary Exercise Program

While exercisers who are not competing are likely to spend far less time in their sport, they can still benefit from following the same training principles. Increasing evidence shows that intense exercise is more effective than casual exercise, so plan to introduce at least some intense intervals into your program. You can gain the health benefits and help to prevent injuries if you:

• Plan to exercise every day

• Realize that if you are training properly, your legs are likely to feel sore every morning. If your legs do not feel fresh after a 5-to-10-minute warm up, take the day off.

• Stop your workout immediately if you feel a tightness, discomfort or pain in one area.

• As soon as your legs start to feel heavy during a workout, stop for the day.

Caution: People with blocked arteries leading to their hearts can be harmed by intense exercise, so check with your doctor if you have any questions.

AUG 11

Exercise Keeps You Younger

The decline in brain and body function with aging is caused more by inactivity than it is just by aging. A new study of 85 male and 41 female fit amateur cyclists, aged 55 to 79, found that most of them were physically much younger than most people of the same age (The Journal of Physiology, published online January 6, 2015;593(1)). All rode their bikes for recreation and none were serious competitive athletes. The men had to be able to ride a metric century (62 miles)averaging only 10 miles per hour, and the women 60 kilometers (37 miles), averaging a slow 6.7 miles per hour.

The older bicyclists’ test results were close to those for younger people for:

• endurance,

• pedaling power,

• metabolic health (control of blood sugar levels),

• balance,

• memory function,

• bone density and

• reflexes.

The single best test that correlates with aging is called V02max, the maximal amount of oxygen that a person can take in and use during a given time period. Many population studies show that VO2max drops significantly with aging. In this group of older bicyclists, VO2max was just a little lower than the results in the younger ones.

Incredibly, the older cyclists had test results similar to younger cyclists for lung power and exercise capacity; and even more incredibly, the memory of the older cyclists was just as good as the memory of the younger cyclists. This confirms many other studies that show that a high level of regular exercise prevents your brain from deteriorating. Several thousand years ago, the Romans knew that when they greeted each other with “Mens sana in corpore sano” (a healthy mind in a healthy body).

Older Bicyclists Did Lose Strength

By studying only older men and women who are very active and ride bicycles most days, the authors were able to select a group of older people who are not like the general population in England. Thus this study shows that older people who exercise regularly have bodies and minds that are similar to those of much younger people. The conclusion is that the rapid decline in mind and body with aging is caused far more by inactivity than by aging.

The oldest cyclists were stronger than non-exercisers, but they had much smaller and weaker muscles than cyclists in their 50s and early 60s. This shows that aging makes you weaker, no matter how much you exercise. However, other studies show that while you lose strength rapidly with aging, you lose endurance and recovery time from intense exercise far more slowly.

What You Should Learn from This Study and Others Like It

If you want to be able to run, cycle or walk long distances fast as you grow older, you should try to exercise every day and try to go a little faster on some days. The majority of older people have chosen to be frail, weak and uncoordinated because of their lifestyles, not their ages.

• If you have never exercised, start now.

• If you exercise regularly, continue to do so.

• Find an exercise in which you can keep moving almost every day: dancing, walking, various exercise machines, cycling, skiing, and so forth.

• Those who choose to ride a bicycle should worry more about being hit by a car than about the disabilities associated with aging.

• In our modern societies, people are living longer and often spend many years suffering terrible disabilities of both mind and body. Most North Americans over 70 cannot walk fast. One in eight people over 70, and one in two over 85, suffer from dementia. Exercise helps to slow damage to your mind and body associated with aging.

• Lack of exercise is associated with increased risk for overweight, diabetes, heart attacks, strokes, many different cancers, and premature death.

Caution: People with blocked arteries leading to their hearts are at increased risk for heart attacks when they start to exercise or increase the speed or amount of exercise. Check with your doctor.

AUG 4

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program.  

AUG 2

Weak Muscles Increase Risk for Dementia

Many studies show that having excess fat in your belly is associated with increased risk for dementia, but a new study shows that as a person ages, lack of muscle size and strength appears to be an even stronger predictor of dementia than having excess belly fat (Clinical Interventions in Aging, July 5, 2018;13).

The authors followed 353 men and women, average age 69, and found that those who had both excess body fat and small, weak muscles had the worst memory, speed in answering questions and executive function such as making intelligent decisions. Those who had the weakest and smallest muscles had even worse mental function than those who were just obese and did not have excessive muscle weakness. Another well-performed study of more than 5000 people, with an average age over 70, also found that low muscle size is associated with increased risk for dementia (Age and Ageing, March 2017;469(2):250–257).

Significance of “Skinny Fat”

This new study found that many people who do not have conventional measures of obesity such as excess weight or a high BMI (Body Mass Index) can still be at high risk for obesity-related diseases such as dementia, heart attacks, strokes, diabetes, certain cancers and premature death. The authors call this “skinny fat,” a combination of low muscle size and strength and high fat mass that significantly increases risk for dementia. Sarcopenia (loss of muscle size and strength) and obesity are part of the aging process for many people, and can both be used to predict potential mental decline, dementia, and diseases associated with aging. These conditions can be caused by sedentary behavior, weight gain and an unhealthful diet.

Testing and Treating People with “Skinny Fat”

Strength testing can be as simple as measuring a person’s grip strength with a simple inexpensive hand-held dynamometer. Excess fat can be measured with belly circumference or thickness of the fat layer underneath the skin near the belly button. An MRI of the body will be more accurate but is far more expensive and time consuming. People with weak grip strength or high belly fat are at increased risk for dementia with aging, even if they appear otherwise to be thin and healthy. An earlier study showed that a program of strength training and aerobic exercise and a healthful diet can help slow the frightening loss of muscle size and strength and increase in body fat in people as they age (Clinical Interventions in Aging, August 6, 2015;1267—1282). A recent review of many studies showed that the typical Western diet (high in sugar, red meat, processed meat and fried foods) is associated with a marked increase in the incidence of mental decline and dementia throughout the world (presented at the 2018 Alzheimer’s Association International Conference, July 22, 2018 in Chicago, Illinois). Another study of 2200 people, presented at this same conference, shows that people who consume the equivalent of two-and-a-half teaspoons or more of added sugar a day have a 54 per cent increased risk for developing Alzheimer’s disease. A high rise in blood sugar can damage every cell in your body, particularly your brain.

To prevent blood sugar levels from rising too high, your pancreas releases insulin which lowers blood sugar by driving sugar from the bloodstream into the liver. However, if you have a lot of belly fat, you are also likely to have a liver full of fat, and a fat-filled liver cannot accept sugar from the bloodstream. Contracting muscles can lower blood sugar just by pulling sugar from the bloodstream without even needing insulin. A single bout of exercise will allow your muscles to pull sugar out of your bloodstream without needing insulin for up to 17 hours after you finish exercising. Lack of exercise and low muscle size are associated with high blood sugar levels and increased risk for both diabetes and dementia.

My Recommendations

A high rise in blood sugar after meals is a major risk factor for dementia. You will help to prevent dementia by preventing high rises in blood sugar if you:

• grow larger and stronger muscles

• avoid foods that cause high rises in blood sugar

• avoid having excess belly fat that specifically causes high rises in blood sugar

july 30

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). 

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION:People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

JULY 18

Update on Aging

By Dr. Phil Maffetone

It’s more than immunity and hormones, posture and gait play key roles too.

The ageless Hall of Fame baseball pitcher Satchel Paige said it best: “How old would you be if you didn’t know how old you were?” Too many people would say they feel or look older than they are. If that is the case, change it!

We can all update our age, and always strive to be younger. While we know that most debilitating chronic illnesses are preventable, including heart disease, cancer and Alzheimer’s, so is poor aging. Large numbers of today’s elderly are living longer through heroic measures such as heart, lung and liver transplants, around the clock care and other medical means. For most, those ‘extra years’ come at the end of the lifespan, unfortunately, when life is less vigorous and productive. But we can significantly control what may be the most important factor of aging—quality of life. And the sooner we start the better.

All humans do it. The months and years pass and we get less efficient with our bodies and brains. We slow down, and it happens whether we are couch potatoes or Olympians. There is no stopping it—anti-aging is a myth. We can, however, significantly control the pace at which aging occurs by being healthier and more fit. The difference is physiological versus chronological aging.

A normal, healthy life includes aging. And while some illness and death may come from factors beyond our control, most unhealthy conditions that slow people down, or kill them at too early an age, are avoidable. This means we control aging to a great degree by choosing a lifestyle that allows us to be more like an average 40-year old even if we were born 50 years earlier, or a 45-year old even though our driver’s license says 1953.

Chronological age refers to the years that have passed. But when we are healthier and more fit, we function like someone younger. That is our physiological age. It’s related to better blood sugar regulation, brainpower, endurance and strength, and other lifestyle features we influence. This also includes our posture, gait and how we physically move.

While the whole body plays a role in graceful aging, three areas in particular do much of the work: the brain and neuromuscular mechanism, hormones, and the immune system. These areas of the body are continuously repairing and replacing themselves, relying on raw materials from the foods we eat. Adelle Davis’ 1950s mantra, “you are what you eat” still holds true today.

These and other aging factors are so integrated into our whole body that it is difficult to discuss each one in isolation. For example, hormones are an essential part of immunity, and muscle function reflects physical, chemical and mental health. In particular, one of the most common images of aging—posture and gait—is also a sign of how well we are doing it.

The Bent Spine Syndrome

Among the most common images of poor aging are people who do not stand erect. On closer examination, they don’t sit or move that way either, especially when walking. Their lower (lumbar) spine is flexed, and they are “bent” forward having lost their natural spinal curve, which usually helps maintain a healthy-looking upright posture. With a “bent” spine, individuals become shorter. While this typically occurs in the elderly, younger people can begin developing it too. This condition is well recognized by clinicians and researchers, and is called the bent spine syndrome, BSS, originally referred to as camptocormia, derived from the Greek camptos (bent) and kormos (trunk). (See “Camptocormia: the bent spine syndrome, an update.” European Spine Journal. 2010 Aug;19(8):1229-37.)

The BSS is a spectrum disorder, going from mild and moderate to a more severe condition depending on a person’s level of health. Two common causes of BSS include muscle imbalances, often a reflection of various neurological and biochemical problems, and psychological disorders.

The BSS affects the whole body, not just the spine. An example is how proper spinal function can help balance a key component of the body, the autonomic nervous system, which regulates many aspects of health from blood pressure, heart beat and breathing, to gut function, sexual arousal and controlling all stress.

As a functional problem for most individuals, BSS is rarely due to permanent changes in the bones or discs of the spinal column. This is evident when lying down—in this relaxed position people with BSS have relatively straight spines.

In addition, BSS may or may not be associated with pain, but the posture and gait are typically irregular, with related body-wide function that can be significantly reduced. The result is poor aging.

Physical and Chemical Causes

There are a number of physical causes of BSS, perhaps the most common one being muscle imbalance (muscles directly control the skeleton, especially the spine). In most cases, these imbalances are due to some type of neurological dysfunction between the brain and muscle. These weaknesses are not only in muscles directly controlling the spine, but throughout the body too, including those in the feet, pelvis, abdomen, and neck—areas that can significantly affect spinal posture and movement.

Another aspect of muscle dysfunction is reduced energy due to chemical imbalance. Muscle fatigue develops quickly in those with BSS during standing, walking, and even easy physical activities. This is typically due to poor aerobic metabolism.

Other biochemical factors include abnormally high levels of fat found in the muscles of those with BSS. The cause of this may be of hormonal, primarily high insulin due to the ingestion of too much refined carbohydrate. Higher levels of the stress hormone cortisol also can influence the brain, often significantly. This is typically due to the combination of physical, chemical and mental stressors, which, in turn, can affect muscle balance.

At any age, BSS is associated with, often caused by, other chemical disorders that include chronic inflammation. This is usually directly associated with the balance of fat in the diet. The ongoing inflammatory disorder is the first stage of many chronic diseases.

Other hormonal imbalance can play a role too. Especially important are conditions of low testosterone and low thyroid function—both can occur in men and women. In addition, low levels of vitamin D, typically from inadequate sun exposure, and sarcopenia, the loss of muscle during aging, are both very common problems of epidemic proportion that can speed up the aging process.

More severe cases of BSS are often seen in patients with Parkinson’s disease, multiple sclerosis, or other neurological diseases.

Psychology

It has long been know that posture and gait, in addition to being a manifestation of physical and chemical dysfunction affecting muscle contraction, can also reflect ones psychological state. Bent spine syndrome was first observed and researched in young soldiers psychologically affected by war. Whether old or young, images of an aging spine can reflect mental and emotional states.

Growing Younger

Just being aware of ones posture is the first step to improved function. By avoiding the common age- or fatigue-related slumping and making sure the lower spine is not slowly losing its natural curve, one can keep the body healthier and not only more youthful looking, but physiologically younger. By simply sitting up straight, standing, walking and running more erect, we can maintain better balance, and our bodies will function better.

In addition, yoga, tai chi, respiratory biofeedback and other self-therapies can be very effective in maintaining good posture when practiced properly.

Regardless of how much or little you run, bike or lift weights, walking can also do wonders to help train the brain to better maintain proper postures. Walking erect is part of an optimal walking gait. In order to do this effectively, the knees must be gently locked as you land more on the front of your heels. This is different from the running (or jogging) gait, where knees should never lock and landing on the foot is farther forward. (By striking on the back of the heels, often encouraged by wearing thicker shoes, many runners do lock their knees, which can directly cause knee and other physical impairments, poor gait, and wasted energy.)

While most of us are too familiar with the images of aging, we sometimes don’t see it in ourselves. We can control the process significantly. With increased health and fitness we can age more gracefully and have additional active years at the end of our natural lifespan.

july 13

Knee Cap Pain

The most common long-term running injury is called runner’s knee. It is caused by the back of the knee cap rubbing against the femur, the long bone behind it.

When you suffer from runner’s knee, the back of the kneecap hurts when you walk or run, particularly when you walk down stairs. It usually does not hurt to pedal a bicycle. If it hurts to push the kneecap against the bone behind it, you have runner’s knee.

The back of the kneecap is shaped like a triangle with the point fitting in a grove in the lower part of the bone behind it. During running, the knee cap is supposed to move up and down. If it moves from side to side, the back of the kneecap will rub against the front of the bone behind it and hurt. Treatment is to stop the kneecap from touching the bone behind it which is usually caused by the knee cap being pulled toward the outside (laterally), while the lower leg twists the bone behind it inward (medially). When you run, you land on the lateral bottom of your foot and roll inward, causing the lower leg to twist inward. At the same time, three of the four quad muscles attached to the kneecap pull the kneecap outward and cause the knee cap to rub against the bone behind it.

People with runner’s knee usually can pedal a bicycle with their seats set lower than normal to prevent their knees from straightening completely. Orthotics, custom- fitted inserts in the shoes that restrict pronation, may help. They can also use special exercises that strengthen the vastus medialis muscle above the kneecap that pulls the knee cap inward when they run or pedal. Running backward may also help (1).

july 11

Repairing Damaged Knee Cartilage

The ends of bones are soft, so they must be covered with a thick white gristle called cartilage. Once damaged, cartilage can never heal. When knee cartilage is damaged, the person spends the rest of his life losing more cartilage until it is completely gone and the knee hurts 24 hours a day.

If only a small area of the cartilage is damaged, it may be treated with cartilage extracted from your own body. (If cartilage is taken from someone else, your immunity will try to kill it, but it does not try to kill your own cartilage.) Your extracted cartilage is grown in special culture dishes and then injected into a hole in your own cartilage and secured in place. This procedure works very well if you have only a small piece of cartilage missing. The doctors just fill the hole. However, unless they can enclose the entire area for the donor site, the cartilage will not stay where it was put and will not be beneficial. That is why this procedure cannot be used to treat a cracked cartilage in the knee. Remember they have to cover the articular surface that meets the cartilage from the other side of a joint.

When all the cartilage in your knee is gone, the only effective treatment is to replace the whole knee. Knee replacements are now lasting for twelve to twenty years or more, and most remain pain-free.

If you have damaged cartilage in your knee, you should protect that knee for the rest of your life. Running, fast walking and jumping cause further damage, while pedaling and swimming usually do not. When the knee hurts all the time, your doctor will check to see how much cartilage is left. If it’s gone, you will probably be told that you need a knee replacement.

JULY 11

Strengthen Quad Muscles to Help Your Knees

Doctors have known for many years that having weak quad muscles (in the front of your upper legs) increases risk for damage to the cartilage in your knees. A study from Purdue University showed that strengthening these muscles slows down knee cartilage damage and may even improve knee function (Arthritis & Rheumatism, October 2006). The researchers placed 221 adults in their sixties and seventies either on a program of strengthening their muscles in their upper legs or just moving their knees in a series of range-of- motion exercises. The subjects exercised three times per week (twice at a fitness facility and once at home) for 12 weeks. This program was followed by a transition to home-based exercise for 12 months. Older people weaken naturally with aging, but the range of motion exercisers lost more strength than those who exercised against progressive resistance. The strength training helped retain joint space, signifying that this group had less loss of cartilage.

The knee is like two sticks held together by four bands called ligaments. Strength training stabilizes the muscles that support the knee and helps to prevent loss of cartilage with aging. People with knee pain should get a diagnosis from their doctors. Most will be advised to do exercises that strengthen the knee, such as pedaling a bicycle or performing knee strengthening exercises that involve bending and straightening the knees against resistance. People with knee pain should avoid exercises that jar the joints, such as jumping or running.

july 1

Kettlebells Build Hard Bodies

Kettlebells (or girva, as they are called in Russian) are traditional Russian cast-iron weights that look like a cannonball with a handle. They have become a popular exercise tool in the United States largely because of the enthusiasm and effective marketing by strength and flexibility coach Pavel Tsatsouline and kettlebell lifting record holder Valery Fedorenko.

Though kettlebell lifting competitions are relatively new in the United States, they have historical significance in other parts of the world. Recently, kettlebell training has been “discovered” by U.S. athletes and particularly mixed martial arts fighters.

Kettlebell workouts are designed to increase strength, endurance, agility, and balance. Both the muscle and cardiovascular systems are challenged through dynamic total-body movements. They are used by both men and women.

Commonly asked questions are . . .

What makes kettlebells different than dumbbells or barbells?

Why has kettlebell training become so popular with women?

Are they safe?

Are kettlebells appropriate for seniors?

What sizes do they come in?

What weight should a beginner buy?

What is good kettlebell design?

What makes kettlebells different than dumbbells or barbells?

All are free-weights used for strength training, muscle building, and all-around fitness. However, since practically any KB exercise can also be executed with a dumbbell, it is reasonable to ask why you should use a kettlebell instead?

The kettlebell shape (remember the “cannonball with a handle” description) makes the weight displacement different from a dumbbell’s. The off-center weight of a kettlebell makes it more unwieldy, requiring the use of more stabilizing muscles to control it. By the nature of their design, nearly all kettlebell lifts are compound movements that work the body as a whole, rather than isolating muscles. Common kettlebell lifts also tend to work muscles through a longer range of motion, which improves flexibility.

So while barbells and dumbbells are certainly good free-weights, keep in mind that the unique unwieldiness of kettlebell training is precisely the reason many athletes use them today. When comparing dumbbells to kettlebells, it really comes down to being a matter of personal preference.

Why has kettlebell training become so popular with women?

Many of the most common kettlebell exercises, such as swings, cleans, windmills, and snatches, really work the hips, hamstrings, glutes, and waistline. And when done in higher repetitions they are great cardiovascular exercise. Combined with proper nutrition, KB workouts will burn off fat better than almost anything you can think of. And they are fun to use.

Are they safe?

Get some instruction from a good DVD video or coach/teacher. Kettlebell lifting is somewhat different than lifting other free-weights. I am not aware of any reported serious injuries, but you sure wouldn’t want to bonk yourself on the head or drop one on your foot. Ideally, some sessions with a competent instructor is a good way to go, although I’ve seen some excellent video instruction, too. Either way, once you know and practice proper form, kettlebells are certainly no riskier than lifting other free weights such as barbells and dumbbells.

Are they appropriate for seniors?

 

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Used properly, all free weights are senior friendly. Good judgment is the key to safe, successful kettlebell training, just as it is with barbells and dumbbells. But always consult with your doctor before starting any exercise/fitness program. Then begin with modest efforts, perfect your form, and gradually work up. If a particular lift or exercise irritates an existing problem area – don’t do that exercise. It is really a common sense issue.

What sizes do they come in?

The common kettlebell weights follow:

8 lbs

12 lbs

18 lbs

26 lbs

35 lbs

44 lbs

53 lbs

70 lbs

80 lbs

88 lbs

97 lbs

105 lbs

What weight should a beginner buy?

Most kettlebell exercises can be done with a single bell. Or they can be done with a pair of bells of the same weight. Most people start with a single KB and many continue lifting singles.

Next, you must consider your present strength and fitness level when deciding what weight to start with. A rule of thumb is that handling a kettlebell will be more challenging than a dumbbell of the same weight. Most of the companies selling KBs offer beginner guidelines for what weight(s) to buy. I would rely on their advice.

As your strength grows you can buy a heavier bell and sell the lighter one or keep it for higher repetition work.

Best of all, if you can attend a KB training workshop before you buy, or find a trainer nearby, you can try out different weights at the same time you are receiving some coaching.

JUNE25

Senior Exercises for Slenderizing the Waistline

The best approach for you to slenderize their waistline is a healthy diet, 150 minutes of cardio and two strength training sessions each week. Including abdominal exercises in strength training sessions will tone the stomach muscles, which will become visible after overall weight loss occurs. A strong core contributes to good posture and eases the challenge of standing for extended periods of time. In addition, becoming physically fit can make daily tasks, such as showering or carrying objects, easier for older adults. You should consult with your physician before starting an exercise program.

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Burn Calories

Burning calories and expending more than you consume is the only way to lose weight. Mowing the lawn, climbing stairs or going on a walk with friends are all examples of cardio exercises that contribute to weight loss, including the stomach area. The treadmill, elliptical and recumbent bike are all cardio machines available at most gyms. The rowing machine is a good option if you want to challenge your midsection while doing your cardio. Water aerobics and swimming are non-weight bearing cardio workouts that don’t strain the joints, making them a good option if you have joint problems or arthritis. Complete at least 10 minutes of cardio exercise during a session to ensure benefits and contribute to your weekly goal of 150 minutes.

Make a Bridge

The bridge is an abdominal exercise that strengthens the glutes, lower back and stomach muscles. Lie on your back, bend your legs and place your feet on the floor, directly under your knees. Tighten your abdominal muscles and rest your arms on the floor, next to your hips. Push through your heels and lift your hips and lower back off the floor. Align your knees, hips and shoulders. Squeeze your glutes and hold this position for 20 to 60 seconds.

Twist and Turn

Trunk rotations tone the abs while strengthening the arms. Hold a light weight with both hands. Stand up straight, bend your knees and position your feet shoulder-width apart. Lift the weight in front of your waist, straighten your arms, then slightly bend your elbows. Tighten your stomach muscles. Twist your torso and rotate your trunk and arms to your right. Do this without moving your hips or lowering your arms. Twist back to the center, pause, then rotate to your left to complete your first repetition. Complete eight to 10 reps, stopping when your stomach and arms fatigue.

Tighten Your Abs

Pelvic tilts tighten and tone the abdominal muscles. Lie on your back, bend your legs and place your feet on the floor, under your knees. Squeeze your stomach muscles. Throughout the exercise, imagine that you are trying to balance a grape in your belly button. This will help you maintain the contraction. Simultaneously, push your lower back against the floor and slightly lift your hips off the floor. Hold for six to 10 seconds, then release. Complete eight to 10 repetitions.

JUNE 23

The Best Kettlebell Workout for Women Over 50

Women in their 50s often gain weight, experience changes in posture, and lose muscle mass because of menopause. Doing two to three kettlebell sessions a week can help combat some of those physiological changes. Kettlebells increase muscular strength and endurance, and improve balance, core strength, coordination and posture. The workout has cardiovascular benefits as well. Most of the exercises are functional and incorporate the entire body, which makes the workout more efficient and less time consuming than traditional strength training with free weights.

Program Design

Pay careful attention to form and technique when learning how to use kettlebells. It is better to begin with a light weight to master form to prevent injury to the back, shoulders and knees. If you work out regularly, begin with a 10- to 15-pound kettlebell. Try a routine two to three days a week that consists of two to three sets of eight to 10 exercises. Cross train on alternate days with Pilates, yoga or a moderate-intensity cardiovascular activity.

Short Circuit

A circuit kettlebell routine can help banish the excess adipose tissue that accumulates around the midsection during menopause. Include two to three sets of 10 to 15 squats, deadlifts, snatches and swings. Rest 30 to 60 seconds between each exercise before continuing. Finish with two to three bodyweight planks before you stretch. The moves can help you burn calories, aiding in fat loss and increased lean muscle mass.

Muscle Up

You may be dismayed as you progress through your 50s to realize that you are losing tone in your lower body, particularly in the derrière. A kettlebell routine that targets the lower body can prevent things from going further south. Warm up with joint mobility exercises. Perform two to three sets of walking lunges, single-leg squats, figure eights between the legs, single-leg deadlifts and single-arm swings for 15 to 60 seconds. Rest 30 to 60 seconds between exercises.

Upper Body Training

Banish batwing arms with upper-body exercises involving 5- to 8-pound kettlebells, such as snatches, high pulls, bentover rows, alternating shoulder presses, farmer’s walks and overhead triceps extensions. Consult a certified fitness professional to watch your form when you are learning how to use kettlebells.

june 19

Kettlebell Exercises for Seniors

Kettlebells are traditional Russian weights that look like a cast-iron cannonball with a handle. Used properly, they are senior friendly and can be used for maintaining and increasing muscle strength and bone density, and for a cardiovascular workout. They are available in weights from 2 lbs to over 100 lbs. Women should start with about 8 lbs, while men can begin at 16 lbs. Use common sense: If a particular exercise aggravates an existing problem or injury, don’t do that exercise.

Two-Arm Swing

The two-arm swing is the most basic kettlebell exercise and should be mastered before moving to other exercises. Use an overhand grip with both hands on the handle and allow it to hang between your legs. Stand with feet slightly wider than hip-width apart. Start swinging by rocking your hips rather than using your shoulders and use momentum to raise the bell so that it swings to about shoulder height, then back between your legs. Perform for at least one minute, or for a desired number of repetitions.

Single-Arm Swing

The single-arm swing uses the same basic movement as the two-arm swing, but only one hand is used. Remember to swing upward by thrusting the pelvis forward rather than lifting from your shoulders, and allow gravity to bring the kettlebell down in a smooth, controlled movement. Keep the free arm at the side of the body. Perform for one minute or a desired number of repetitions, then change arms and repeat.

Body Pass

Begin in the same body position as for the two-arm swing. Release one hand from the bell, and swing the bell behind your back with the other hand. Grasp it with the free hand at the back and bring it back around the other side to the front again. Make sure you grasp it firmly and breathe throughout the movement. As the weight moves from hand to hand, your arms will loosen and tighten. After the required number of repetitions, repeat in the opposite direction.

Figure Eight

The figure eight is an advanced version of the body pass and should not be done until you have mastered that move. Instead of passing the kettlebell around your body, you pass it from one hand to the other between your legs from the front of the body to the back and from side to side, so that it creates a figure-eight pattern. This gives you an excellent workout. After the required number of repetitions, repeat in the opposite direction.

june 15

Kettlebells for the Aging Population

Swinging and lifting kettlebells may sound like a form of training best left to weightlifters, hardcore athletes, and members of the younger generations. But the reality is that everyone, especially seniors, can benefit from properly training with kettlebells. In 2010 the American Council of Exercise (ACE) at the University of Wisconsin conducted a survey about kettlebell training and its effects on individuals. Researchers found evidence supporting the positive implications of kettlebell training’s potential to strengthen the core muscles by 70 percent, especially for elderly people. One of the research leaders, John Porcari, Ph.D. says, “I think that’s huge because the stronger people are through the core, the less low-back pain they are going to have.” He also pointed out the importance of how working out with the unique weights can affect and improve balance for older kettlebell users. “Older people who are doing some sort of kettlebell-like training are going to be more likely to avoid dangerous falls,” he says.

Kettlebells training can also improve bone density (preventing osteoporosis), combat against age-related muscle atrophy, and help control blood pressure, blood sugar, and cholesterol levels among the older generations.

Due to the many health benefits and quality of life improvements associated with kettlebell training, kettlebell classes and workout videos for older age groups are cropping up all over America. Of course, as with any other type of workout program for the elderly involving weights, the key to getting a safe workout is using wise judgment. It is also advised to consult with a physician before starting any kettlebell training, to begin slowly and gradually increase intensity and weight, and to pay close attention to proper form to avoid injuries. 

Here are just a few typical activities you regularly engage in that require some form of pulling, pushing, lifting, and/or balancing objects that have a displaced center of gravity (meaning they’re not centered and balanced in your hand):

picking up a child or pet

mowing the lawn

operating the vacuum cleaner

toting bags of groceries

catching your balance when you start to slip or fall

walking your dog

playing a sport

carrying a full laundry basket

lifting a suitcase or gym bag

Beginner Kettlebell Exercises for Older Adult

Kettlebells are a centuries-old exercise tool originally used by Russians to develop strength, stamina and endurance with a single piece of equipment. Seniors can use these weights to perform exercises that build muscular strength, improve heart health and increase bone density. Limit your use of a kettlebell to simple exercises using a light weight as you begin to learn how to use this increasingly popular piece of fitness equipment.

Step 1

Perform biceps curls, a simple exercise you can do standing or sitting, to work the muscle on the front of your upper arm. Start with the kettlebell hanging at your side with your palm facing forward. Bend your arm at the elbow, bringing your palm and the kettlebell toward your shoulder. Hold for one or two seconds, then lower the kettlebell. Perform this exercise one arm at a time or using two kettlebells at once. If you can stand while you perform the exercise, curl the kettlebell across your stomach instead of up to your shoulder. Balance yourself with one hand against a chair or wall if you exercise standing up.

Step 2

Perform triceps extensions using a kettlebell to work the upper backs of your arms. Without using the weight, practice putting your hand behind your head with your palm facing your back. Extend your arm at the elbow, turning your hand outward so your palm faces forward when you’re finished. Decide if you can perform this exercise with the weight of kettlebell you have chosen without losing your balance or straining your back. If you can safely perform the exercise, add the weight of the kettlebell.

Step 3

Perform rows, a simple exercise you can do while kneeling on a bench. Place one knee on the bench and one hand on the seat in front of you for support and hold the weight straight down with your palm facing your body. Raise and lower the weight to your chest, bending your arm at the elbow. Keep your elbow tucked into your side and squeeze your shoulder blades together as you raise the weight. This exercise will work your biceps and the fronts of your shoulders as well. Change positions to work your other arm.

Step 4

Add kickbacks to your workouts, which start from the same position as rows, using a slightly different movement to emphasize your triceps and rear shoulder muscles. Raise the kettlebell to your chest, bringing your elbow back behind you with your palm facing your body for your starting position. Extend your arm at the elbow, bringing the weight backward without changing the position of your elbow and upper arm. Return to the starting position by bending your elbow. Switch positions to work the other arm.

Step 5

Work your forearms, chest and the fronts of your shoulders with arm raises. Hold the kettlebell at your side with your palm facing behind you while you are in a standing or sitting position. Raise your arm straight ahead, up to shoulder level. Hold the weight still for two seconds, then slowly lower it. Switch sides.

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